Providing lying on the floor. As the RN,

Providing teamwork and collaboration may
improve safety and quality improvement. Team work and collaboration is key
importance to provide efficient care to clients, as professional nurses. “Nurses
and health care team members must work together to achieve the common goal of
providing the best possible care for clients.” (Hood, 2014, p.101).

Care Hindered

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At my previous job, I was the RN
Supervisor on second shift; I was the only RN in the building in charge of 105
residents, and 20 staff members. During the seven months that I was employed at
this Long Term Care Facility, we could not keep the floors staffed on second
shift. Between call offs, employees finding other jobs, or no shows; this was
hindering patient care. Each floor has 35 residents, and we were to have 2 LPNs
and 6 CNA’s. Each LPN was responsible for 17 residents. Each CNA was set to
certain assignment with so many residents. My goal as the RN supervisor was the
safety of my staff and the residents. When there were issues I was there to
address them right away. The last 2 months that I was employed there, patient
care was being hindered because we didn’t have enough staff to care for the
residents. Most days not only was I in charge of the house, but I was also the
nurse caring for those 35 residents. So if something would happen on another
floor, I had to leave my floor of 35 residents to deal with that issue on other
floor, this was high risk safety issues on my floor.  


of being short staffed

One evening when I was the RN on the floor;
caring for 35 residents; keeping in mind that I was also in charge of the
house, had a resident fall. I was passing medications down one hallway, when I
heard a scream come from the dining room on that floor. I looked over and
quickly ran to my resident, as she was lying on the floor. As the RN, I was
responsible for assessing the patient and providing the proper care. My patient
stated that she was getting ice from the machine and some fell on floor; she
was backing up with her walker and slipped on the ice that fell on floor, stating
that she had pain in her groin area. My CNA’s which I only had 4 at the time
instead of 6, were all in rooms with residents doing care. I then called for
help, because I needed to get the resident up off the floor. At this point, we
don’t know if she broke anything or what may be going on. When the CNA’s came
over they are so used to just picking the resident up and not thinking if
anything may be wrong. I told them as the RN we need to be cautious because we
are not sure if she broke anything. They insisted they knew what they were
doing and continued to do what they normally do. As they were placing resident
in her wheelchair, the resident was screaming, because her leg hurt. Two of the
CNAs lifted the top half of resident; while the other two CNAs lifted the legs.
I wanted them to use the lift for patient safety and for their back safety, but
they told me they do not have time for the lift.

this time, I kept the resident with me at the nurses’ station and called the on
call doctor with my assessment and findings, and asked for an order to have in
house x-ray done. X-ray showed up two hours after the incident, completed the x-ray
films. The in house x-ray tech went out to the mobile x-ray to develop the
films so the radiologist could read the results. She then called me and told me
she was coming back with the CD because there was a positive fracture in resident’s
hip. I then had to call the on call doctor again to get a verbal order to send
resident out to hospital, because of the fractured hip. I then had to call the
Director of Nursing to update her on the incident. This was then considered a reportable
incident to the state, because the resident fell under my care and broke her



“This conflict occurs between people. Sometimes
this is due to differences and/or personalities; competition; or concern about
territory, control or loss” (Finkleman, 2016, pp. 324). I chose this conflict,
because I feel it relates well to this situation. Prior to me becoming the RN
supervisor, this LTC facility had trouble keeping a reliable RN on second
shift. The CNAs ruled the house and walked all over the previous RN
supervisors. I am the type of person where I do not let people walk all over
me. Everyone that I was in charge of was working under my RN license, and I was
not about to lose my license for someone else’s stupidity. In this situation
the CNAs thought they could do what they want and what they were doing
previously before I came to be the supervisor. At the time of the incident I
was more concerned for my patient, and was not about to confront the staff members
in front of the resident. This is a situation that needs to be taken in a
private room and to be discussed. This situation was not discussed until later
that evening after the resident was taken to the hospital. My priority as the
nurse was to keep the resident safe and pain free. Most of the staff was very
competitive with me because the older generation does not like younger bosses.
They knew I was a recently graduated RN and I was considered the underdog of
the facility.

Stages of Conflict: Hindering Patient Care

first stage is latent conflict; considered the anticipation of conflict. In
this situation; I knew as the RN how this should be handled, and the CNAs took
over me at this time creating a barrier for proper care and safety of the
resident. The second stage is perceived conflict; this stage requires
acknowledgement that conflict exists. I could perceive there was going to be
conflict in this situation. Although, I know the CNAs did not think they were
doing anything wrong, because this is the practice they had prior to me
starting. The third stage is felt conflict: occurs when individuals begin to
have feelings of anxiety or anger. I could feel it inside me boiling up,
because I could not tell the CNAs that we cannot lift the patient like that,
because we do not know if there is anything broken or not at this time. Being a
new graduated nurse and being the underdog, these CNAs knew how to get under my
skin, but I took everything with a grain of salt. The fourth stage is manifest conflict:
defining the conflict as constructive or destructive. At that point in time I
was not able to address the issues with the CNAs, because it was not the right
time or place to do so. That would fall under the destructive conflict, because
if I would have addressed the issues right away, I probably would have came across
as a mean supervisor, because I was angry at the time of the incident and very
stressed being short staffed.

to Resolve Conflict

In this type of situation, it is best to
have a staff meeting and address all the issues to the staff that was involved.
During the meeting, I would want to focus on behaviors and events and not point
fingers to resolve this conflict. I want to address how they were risking the residents’
safety and educate ways to prevent injuries. I want this to be an educational
session, not pointing fingers sessions. “Nurses need to achieve effective team
building skills within nursing groups in order to deliver quality and
productivity required for the organizational structure” (Heimer, 2018). In the
health care setting; nurses need to build on the conflict resolutions skills in
order to succeed in nursing. Nursing always has its conflicts, because there
are always changes in skills, policies, and procedures. Communication and collaboration
is a huge key in nursing. I do not think delegation was an issue here, it was
more so how the CNAs handled the situation and chose to not listen to their
superior. Again, like I stated before these CNAs were used to their skills
being handled the way they were before I took over. I care about my residents,
therefore I want to make sure they have proper care and that they are safe.

within the team

“Use of effective interpersonal
communication strategies by nurses in both personal and professional settings,
may reduce stress, promote wellness, and therefore, improve overall quality of
life” (Vertino, 2014).  Communication
amongst the interdisciplinary team promotes efficient care to clients and safety.
Providing the most efficient care to clients relies on teamwork within the interdisciplinary
team. Continuity of care is the best practice any facility can follow. “The
increased emphasis on interprofessional teams to meet the patient’s needs
across the continuum of care requires effective use of collaboration”
(Finkleman, 2016, pg319). Providing the same nurse and aides with clients
promotes quality improvement and patient safety. Having the same nurse, the
clients are able to build on that trusting nurse-client relationship. Also,
promoting safety and quality improvement, it is important to follow policy
protocol and practice within the nurses’ scope of practice. In this type of
situation it is best to have communication amongst the staff; to make sure
everyone is on the same page, and that the protocols are being followed to
prevent further injuries. Also, in this case with being short staffed higher
ups need to look for agency to come in to help if not able to hire staff. I
feel the facility should have competency trainings monthly to prevent any
conflict in the future with this type of situation.



In conclusion, no matter how hard it is to deal
with conflicts, it is easier to speak up before the event occurs. Being in
nursing, there are always conflicts that we come across and have to deal with.
Not many people like change, but sometimes change is a good thing. Every nurse
or aide should be competent in what they do and have respect for their team
members. After this incident had occurred, and after every CNA was talked to
about the situation, the CNAs then followed how I wanted to run the facility. I
made sure they knew I was there for everyone’s’ safety and I care about
everyone. It was then taken upon the Director of Nursing to hire agency to come
in and help so we were not short staffed and that we could prevent further
conflicts and control safety in the facility with our residents.