Conflict Management

Peer Response Length: A minimum of 150 words per post, not including references Citations: At least one high-level scholarly reference in APA per post from within the last 5 years Peer Post: Working in the operating room of a level two trauma center, you encounter conflicts of all kinds. Emphasizing the importance of being a patient advocate during surgery is imperative. Surgery patients cannot hear, nor are they aware of what happens under anesthesia. The Operating Room (OR) team is the only voice in that room for the patient. Many times, this voice lands on the circulating nurse in the operating room. The medical team consists of surgeons, anesthesiologists, nurses, and surgical technologist at minimum. It is not unusual to have conflict in the OR suite, and with that conflict, the nurse has the responsibility to advocate for their patient. OR nurses need the skills and ability to resolve an issue in a positive way that does not cause patient harm. Thomas-Kilmann Index (TKI) describes five specific responses around conflict, avoiding, accommodating, compromising, collaborating, and competing (Price and Murphy, 2018). Of these types of conflict, nurses tend to use avoiding and compromising the most (2018). Avoidance is one I often see in the OR environment, which can be detrimental to patients. As a charge nurse of the OR, I am often called upon to help resolve conflict.              Recently a trauma patient was rushed to our OR bleeding from a wound to his abdomen. He was emergently opened and packed with sponges to help absorb the blood so the surgeon could locate the source and stop the bleeding. Standard policy and procedure are to perform an instrument and sponge count at the beginning and end of every surgery where there is the possibility of a retained item. The final surgical sponge count was incorrect; the surgeon was told, he ignored the nurse and continued his closure of the abdominal cavity. The nurse is ultimately responsible for making sure all instruments, sponges, and small items are visually accounted for. She voiced the incorrect count to the surgeon, who refused to acknowledge her concern and continued to close. No one else in the OR suite spoke up, told the surgeon to stop, and that an x-ray was needed. Collectively they were avoiding a hard conversation with a very prestigious surgeon. Eventually, the nurse called out to the charge desk and asked for support; she needed help advocating for her patient’s safety. The nurse explained the situation, what they had done to find the missing sponge already, and the implications for the patient if not found. This patient safety issue needed immediate attention before the patient was awakened from surgery and taken to recovery. I very quickly went to the room; I asked the surgeon to pause for a patient care concern. I advocated for not only the patient but the nurse simultaneously. I had to do this in a way that showed the facts, followed policy, and had the patient’s best interests in mind.  I stated to the surgeon all actions taken up to this point to find the missing sponge; the room was searched, sponges in counter recounted twice, and the room garbage searched. I stated that not only am I concerned about the sponge being in the abdomen, but my nurse and surgical technologist are as well. I supported the facts with hospital policy stating that any incorrect count warrants an x-ray to make sure nothing is left behind at minimum. I validated back the surgeon’s feelings while still supporting the need for the x-ray.  He stated that he did not think the sponge could be in the patient, for he checked the abdomen thoroughly before closing.  I reminded him we have a responsibility to the patient when they are under our care to take every safety measure possible to make sure there is nothing left behind. After our discusosion, the surgeon agreed to the intraoperative x-ray. The nurse called radiology a machine was brought to the OR, and an x-ray taken. The patient remained on the table until the findings were confirmed and reported to the OR. Indeed, there was a sponge seen on the imaging left in the patient’s abdomen tucked way up under his rib cage. The surgeon had to reopen the patient and retrieve the missing sponge.  Avoidance on the nurse’s part or myself would have caused significant harm to the patient, a lawsuit for the surgeon and the hospital. Providing the surgeon with facts around the conflict, taking the blame out of the discussion, using hospital policy, and ultimately making it know to the team that we have an obligation and responsibility to do what’s right for the patient lead to the surgeon calming down and ordering the x-ray. According to McKibben, if conflict is not addressed adequately, it can have direct repercussions on patients (2017). With poor patient care delivery, personal integrity, professional, and the hospital itself is at risk (2017). This will not be the last, nor was it the first conflict to arise in our department. Having skills and knowledge around conflict resolution will continue to be a crucial skill for all nurses. As a profession, we need to uphold our integrity and be prepared to handle conflicts of all kinds; patients’ lives are at risk. References McKibben, L. (2017). Conflict management: Importance and implications. British Journal of Nursing, 26(2), 100-103. doi:10.12968/bjon.2017.26.2.100 Price, D. M, & Murphy, P.A. (2018). Conflict Resolution in Advanced Practice Nursing. In L.A. Joel Editor (Ed.), Advanced practice nursing: Essentials for role development (pp. 336-348). Philadelphia, PA, PA: F.A. Davis Company.

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