INTRODUCTION
The clinical leadership emphasised on the team and patient’s outcomes, driven through clinical proficiency than the official authority. . Conflict within the overall health and social care setting, in the environments of high pressure, such as the Emergency department (ED), is inevitable because of the urgent nature of care delivery, diverse professional roles, and patient needs complexity.
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The conflict might be defined as the situation in which two or more parties perceive their responsibilities, values and interests as incompatible, resulting in tension and disagreement. The conflict cannot be negatively inherent; this mismanagement might diminish the morale of staff, impair teamwork and patient safety, and hinder the efficient resolution of conflict. This is a significant conflict resolution within the overall clinical practice. The ED offers a unique context in which healthcare professionals are regularly needed to make quick decisions related to resource allocation and prioritisation. In the context of the environment, the leadership approaches and clinical judgement might escalate easily within the conflict. The report will shed light on the incident of the two ill patients and their treatment. Moreover, it will delve into the detailed explanation of the search strategy provided, required data/elements/discussions/issues and ideas.
Body of paper
Event leading to conflict: The conflict in the healthcare settings is effectively triggered through the situations of high pressure, differences in professional judgment and competing priorities. Within the case, conflict occurs within the ED when the two ill patients has arrived. The first one showcased acute chest pain, which can be a myocardial infarction (MI). The second one is sustained different traumatic injuries with the bleeding uncontrolled. Both conditions have been life-threatening and require quick intervention.
The charge nurses focused on the patient trauma, focusing on the haemorrhagic shock immediacy, which might lead to death within a few minutes. In the context of the physical attending, the suspected MI patient needs to be initially attended to, as the particular myocardial tissue is affected at this time, which is sensitive and irreversible, along with the golden hours being significant for survival outcomes. The deviation within the clinical judgement showcased not only the differences in professional judgment but also the agreement on the single protocol's lack in the situation.
The disagreement effectively escalated into an open conflict among the front staff, causing confusion among the junior nurses, who were uncertain about what to follow. As per the Nursing and Midwifery Council, the unresolved conflict within the overall teams of healthcare might contribute to delays in care and disrupt workflow, making the practice unsafe (Nursing and Midwifery Council, 2024). In this case, both patients were stabilised eventually; however, the initial delay compromised the outcomes and decision-making.
Through the theoretical lens, the overall incident might be assessed through the overall structural conflict theory, which offers the suggestion that the overall conflicts occur through the authority gradients, role ambiguity and organisational structures (Nieuwboer et al, 2019). The physician and the charge nurse overlapping the responsibilities and a lack of clear communication led to the clash. Moreover, the theory of interpersonal conflict is implemented as the key disagreement which was not related to the clinical urgency. This is related to the leadership authority and professional hierarchy within the ED.
Thus, overall incident effectively underscores how environments based on the high stakes with the hierarchical tensions and unclear protocols make the ground fertile for the conflict, putting an impact on the team cohesion and patient safety.
Position within workplace: At the incident, the role was related to the (RN) Registered nurse within the ED. Effectively was responsible for the offering regular monitoring, initiating the interventions lifesaving and assisting patient assessment. Expected to focus on the different directions through the attending physician and the charge nurse, this placed them in a challenging position at the time of conflict (Conflict management in nursing, 2024).
Within the situation, the key disengagement among the physician and nurse made the role of confusion for the different junior nurses and myself. We effectively were caught between the conflicting instructions of the two authorities. This is leading to the delayed interventions and hesitation. This focuses on the frontline nurses can experience stress at the time of inter-professional conflicts, this is accountable to the medical hierarchies and nursing leaves these criticism vulnerable related to the made decision.
The position limited the overall capability to intervene within directly conflict, I understood the impact negative which was on the team morale and patient care (Guibert‐Lacasa & Vázquez‐Calatayud, 2022). I emphasised on the stabilising in this the patient needed the quick nursing interventions. The overall incident showcases the significance of RNs empowerment with the protocols and communication skills to navigate the directives of conflicts.
Measure implemented to the immediate resolution: At the time of conflict, the rapid focus was the deterioration prevention within the two patients. The charge physician and nurse eventually reached the compromise temporary, the patient trauma was focused for the haemorrhage control and airway management, another physician called to check the patient with MI. The labor division permitted the care and decreased immediate tension to simultaneously proceed.
On the other hand, it was improvised solution apart from the structured strategy of the conflict resolution. No de-escalation formal techniques were utilised; overall, the dispute was unresolved and left after both patients had stabilised. As per the (TKI) Thomas Kilman conflict mode instrument, overall approach effectively employed might be categorised as the compromise in which the these parties satisfied partially the concern through responsibility splitting (Thomas Kilmann conflict mode instrument (TKI), 2024ss). The compromise permitted both patient to effectively and equally receive care, this cannot be resolved the issues underlying of the leadership and communication ambiguity.
The overall incident showcased the structured communication frameworks lack like as (Situation, background, assessment and recommendation) SBAR, these are developed to facilitate the concise and clear communication within the setting of high pressure (Jack et al, 2022). SBAR utilised, the physician and nurse can have showcased the reasoning clinical within the structured manner, decreasing the emotional escalation.
Furthermore, No immediate conflict resolution and debriefing discussion happened after the crisis, this is related to the persisted tension and developed to the reduced morale between the staff. The overall literature suggest that the conflict which are unresolved contributes to the decreased satisfaction of patient, staff turnover and burnout. Hence, the resolution based on the short term assured the stabilisation of patient, effects of long term on the dynamics of team were negative.
Leadership styles within the conflict resolution: The overall conflict showcased leadership styles contrasting among the joining physician and charge nurse. The different charge nurses focused on the factors related to the situational leadership. This is creating a quick decision-making process, which is autocratic; the key input from the physician cannot be considered initially. On the contrary hand, physician showcased the directive leadership style, this is asserting the clinical expertise authority based within the cardiology.
The clash showcases how the approaches of differing leadership might exacerbate the conflict whenever this cannot be aligned. As per the transformational leadership theory, the leaders guide teams, develop mutual respect and inspire collaboration by shared goals. The leader within the overall case showcased the qualities transformational at the time of incident, the conflict has been face issues apart from the decision making collaborative process.
The incident effectively resonates with the theory of shared leadership, this is developed focused within the teams of inter professional healthcare. In this the responsibilities might not concentrated within one individual, these are effectively provided within the professionals which are based on the key expertise (Nieuwboer et al, 2019). Within case, the shared leadership can facilitated decision making simultaneous. The nurse who is leading the management of trauma and cardiac care led by physician, effectively avoiding the conflict which are unnecessary.
Moreover, the (EI) Emotional intelligence lack within the contribution of leadership to the escalation. The leaders with the EI effectively capable to conflict de-escalation, empathise with the different individuals and regulate the emotions. The developed voices and visible frustration from the both of the leaders focused on the limited EI limitation. This cannot confused only overall team but this decreased the junior staff for the psychological safety.
The incident effective underscores the requirement for leaders within the overall ED settings which to effectively adopt the emotionally and collaborative intelligent leadership styles (Fiorini et al, 2022). This is offering support through the interprofessional respect and clear communication frameworks.
Outcomes for staff and patients: Within the outcomes of patient, the individuals eventually were stabilised. The patient with the trauma effective received the haemorrhage control and airway management, the MI patient which immediately underwent the interventional treatment and pharmacological attended. Neither suffered adverse long term effects which attributable to kind of delays.
On the other hand, the staff outcomes were positive less. The junior nurses were reported diminished confidence, hesitation and confusion within the roles. The overall morale of team declined, the incident also left tension among the medical staff and nurses. The research highlights the unresolved conflicts have been consequences based on long term like as decreased culture of patient safety, absenteeism and staff dissatisfaction.
Moreover, incident focuses on the trust within the leadership, the staff of junior level perceived the conflict particularly as the disruptive and unprofessional as well. This can demotivate them from effectively offering their ideas and speaking up within upcoming critical conditions. It lines up with the psychological safety, this focuses on the whenever the staff can feel unsafe related to the errors and voice concerns are effectively to go as the unreported.
Thus, the patients clinical outcomes were effectively acceptable, psychological and organisational results for the staff has been concerning. This showcasing the requirement for the effective systemic changes within the conflict management, leadership and communication.
The incident within the ED showcases the conflict among the physician and Charge Nurse, this highlights the challenges broader systemic within the healthcare. The overall research offered suggestion that the conflicts among the nurse-physician were not be one of the isolated events, this the issues recurring influenced through the cultural norms, role ambiguity and organisational hierarchies (Husebø & Olsen, 2019). Within the different settings, the physicians are effectively seen as the key decision maker, the different nurses are focused to follow on the various kinds of directives. On the other hand, within the contexts of emergencies, the nurses assume the roles of leadership within the stabilisation and triage. This making the overlap which might generate the struggles of power.
From the perspective of theoretical, the theory of organisational culture offers the effectively valuable insights. The ED’s culture can focuses on the professional autonomy and quick decision making but lack the shared decision making’s culture. Without the effective norms established related to the conflicts and collaboration such as this has been developing. Furthermore, the (HRO) High reliability organisation theory focuses on the high risk and complex environments like as organisations and health care. These needs to prioritise the learning, teamwork and communication from the errors effectively to decrease. The overall incident focuses on the how lapses within the communication and reliability undermine the overall safety.
The dimension which is related to the distress morale between the staff. The junior nurses showcased the issue related to the hesitation and stress, this might contribute to the moral injury and emotional exhaustion when the clinical feel the not capable to work within the best interests of patients because of the organisational dysfunction (Mc Carthy et al, 2019). The regular exposure to the different situations can develop the attribution and burnout. Thus, the applications extends the beyond one conflict, impacting the culture of patient safety and workforce sustainability.
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The overall case showcases the urgent need for healthcare organisations to focus on conflict management structured within the design systems, encourage interprofessional respect, which reduces the dependency on the judgment of individuals within crises. Through resolving these structural issues, the organisations of the healthcare might change conflict by the disruptive force within the growth and collective learning opportunity.
Changes implemented after incident
The following incident, administration of ED recognised the requirement for developments within the conflict management and team communication developments. The different changes were effectively implemented:
Introduced tools of structured communication: Formally SBAR was integrated within critical processes of decision making and ED handovers to decrease ambiguity and clarity.
Interprofessional training simulation: The staff start the participation within the training based on the simulation which focused on the decision making collaborative under the pressure, like as conflict role playing scenarios (Jordal et al, 2022).
Debriefing protocols: After this kinds of critical incidents, the overall sessions based on the structured defining were introduce effectively to identify the learned lessons, resolve tensions and staff to effective reflect.
Guidelines of revised triage: The effective and clearer protocols were enhanced to smoothly guide priorotisation within the different scenarios. In this the different critically ill individuals arrive, decreasing the dependency on the alone individual’s judgment.
The different kinds of changes were intended to boost the effectiveness clinical but boost the culture of respect and collaboration within the roles of professionals.
Recommendation for development
As per the analysis and literature, the different recommendations might be created to reduce the same incidents:
(IPE) Boost interprofessional education: The ongoing training sessions which collaboratively bring allied professionals of healthcare, physicians and nurses might develop mutual understanding related to the responsibilities and roles, decreasing the conflicts.
Encourage shared and transformational leadership: The leaders need to be effectively trained within the transformational leadership. This inspires the shared leadership and collaboration to decision making distribution based on the effective expertise.
Boost conflict resolution skills: The staff needs to have the training which is based on the frameworks of the conflict resolution (Heinen et al, 2019). This includes the model of Thomas Kilman, permitting them to maintain the constructive disagreements.
Develop psychological safety: The leadership needs to promote the open communication, this is without retribution fear and encouraging the junior staff to boost the concerns at the time of conflicts.
Implement the Debriefings routine: The ongoing debriefing needs to be effectively normalised to offer the different opportunities for ongoing development, feedback and reflection (Ferreira et al, 2022).
Emotional intelligence integration in leadership: Developing the EI within the leaders might offers help in reduce the escalation emotional at the time of situations based on the high pressure.
Through applying the different recommendations, ED might develop the staff, patient outcomes, decrease conflicts and develop teamwork.
Search strategy: In order to offer support within the analysis, the literature structured review was effectively conducted while utilising the databases. This includes Medline, CINAHL, PubMed and Nursing and midwifery council. The keywords involved are interprofessional communication, conflict resolution leadership, nurse and physician, emergency department teamwork and conflict within healthcare. The Boolean operators like as OR/AND were utilised to filters the results limitation, refine searches to articles peer reviewed published among 2000 to 2024 to assure about the appropriate relevance.
The criteria of the inclusion based on the different studies which resolves the conflicts within the emergency settings and acute care. The leadership within the interpersonal collaboration and healthcare. The exclusion criteria effectively eliminated different types of articles which unrelated to the environments based on the clinical and those who emphasised alone on the outcomes of patients without resolving the team dynamics. The strategy assures the analysed literature was evidence based and relevant. This is permitting for the synthesis critically which applied directly to the case within the review. The approach focuses on the separating the individual from the issues, emphasising on the development of respect and shared goals among the different team members. If this is implemented, overall physician and Charge nurse can have the reframed different kinds of conflicts within the common goals apart from hierarchical dominance asserting.
Furthermore, the (IPEC) interprofessional educational collaborative framework showcases the different competencies, such as ethics/values, teamwork and communication, for the practice-based on interprofessional. It effectively aligns with the evidence which collaboration interprofessional decrease the adverse events and also boost the outcomes of patient (Ellis, 2021).
Within the policy level and also broader organisational, the overall incident focuses on the requirement to the conflict management institutionalise strategies. The different policies needs to mandate the frameworks of structured communication at the time of emergencies to assure the reasoning clinical is offered transparently and shared rapidly. Moreover, the training of interprofessional simulation needs to be created requirement of routine, effectively preparing the staff in maintaining the interpersonal conflicts and medical emergencies under pressure.
From the perspective of workforce, smoothly embedding the emotional intelligence training and conflict resolution within the medical and nursing curricula might equip more future professional in the different skills to develop the hierarchical tensions. The hospitals need to establish the roles of conflict mediation and trained senior staff within mediation. Developing the psychological safety culture is significant. The policies promotes the interprofessional respect, error non punitive reporting and open dialogue can change the ED within the organisation's learning in which the conflict has been a key opportunity related to the development.
CONCLUSION
Conclusively, it states that the conflict within the healthcare is the inevitable within the environments of high pressure. This is including the competing priorities and quick decision making frequently intersect. The incident including the physician and Charge Nurse focused on the how the differences within the clinical judgment. This combined with the frameworks of the inadequate communication and hierarchical tensions. This might escalate within the open conflict within the repercussions of the negative for the risks and staff for the patients. Although the patients has been stabilised, the episode assessed the key weaknesses within the approaches of leadership, team coordination and role clarity. At this stage healthcare professional should treat all patients equally and treat them accordingly. This can reduce the chances of conflicts and improve the patient's outcomes. Both the patient had severe issues and health care professional needs to provide care to patients as per their expertise.
REFERENCES
Books and journals
Ellis, P. (2021). Leadership, management and team working in nursing.
Ferreira, T. D. M., de Mesquita, G. R., de Melo, G. C., de Oliveira, M. S., Bucci, A. F., Porcari, T. A., ... & Gasparino, R. C. (2022). The influence of nursing leadership styles on the outcomes of patients, professionals and institutions: an integrative review. Journal of Nursing Management, 30(4), 936-953
Guibert‐Lacasa, C., & Vázquez‐Calatayud, M. (2022). Nurses' clinical leadership in the hospital setting: A systematic review. Journal of Nursing Management, 30(4), 913-925.
Heinen, M., van Oostveen, C., Peters, J., Vermeulen, H., & Huis, A. (2019). An integrative review of leadership competencies and attributes in advanced nursing practice. Journal of advanced nursing, 75(11), 2378-2392.
Husebø, S. E., & Olsen, Ø. E. (2019). Actual clinical leadership: a shadowing study of charge nurses and doctors on-call in the emergency department. Scandinavian journal of trauma, resuscitation and emergency medicine, 27(1), 2.
Jack, K., Bianchi, M., Costa, R. D. P., Grinberg, K., Harnett, G., Luiking, M. L., ... & Scammell, J. M. E. (2022). Clinical leadership in nursing students: A concept analysis. Nurse Education Today, 108, 105173.
Jordal, K., Saltveit, V., & Tønnessen, S. (2022). Nursing leadership and management in home care: A qualitative scoping review. Journal of Nursing Management, 30(8), 4212-4220.
Mc Carthy, V. J., Murphy, A., Savage, E., Hegarty, J., Coffey, A., Leahy‐Warren, P., ... & Drennan, J. (2019). Development and psychometric testing of the clinical leadership needs analysis (CLeeNA) instrument for nurses and midwives. Journal of nursing management, 27(2), 245-255.
Nieuwboer, M. S., van der Sande, R., van der Marck, M. A., Olde Rikkert, M. G., & Perry, M. (2019). Clinical leadership and integrated primary care: a systematic literature review. European Journal of General Practice, 25(1), 7-18.
Nieuwboer, M. S., van der Sande, R., van der Marck, M. A., Olde Rikkert, M. G., & Perry, M. (2019). Clinical leadership and integrated primary care: a systematic literature review. European Journal of General Practice, 25(1), 7-18.
Online
Conflict management in nursing, 2024. Online. Available through https://pmc.ncbi.nlm.nih.gov/articles/PMC11676306/
Nursing and midwifery council, 2024. Online. Available through https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf
Thomas Kilmann conflict mode instrument (TKI), 2024. Online. Available through <https://kilmanndiagnostics.com/overview-thomas-kilmann-conflict-mode-instrument-tki/>
