Conflict Resolution in the Operating Room

Conflict has graced the presence of every professional at one point or another throughout their career. Because conflict knows no bounds it is important for every professional to be able to handle conflict in a way that is both constructive and has the least amount of impact on patient outcomes. Conflict occurs when there is a difference in opinions on a matter and a resolution cannot be easily reached (Finkelman, p. 323, 2016). Conflict can be broken down into three categories: individual conflict, interpersonal conflict, and intergroup or organizational conflict. Individual conflict exists where there is role conflict, interpersonal conflict exists when conflict occurs between people, and intergroup or organizational conflict exists when there is conflict between teams of individuals (Finkelman, p. 323, 2016). Conflict also goes through four different stages. The stages of conflict include latent, perceived, felt, and manifest.

The Operating Room has not fallen short when it comes to seeing and handling conflict. Conflict within the OR can severely impact patient outcomes if it is not dealt with both appropriately and in a timely manner. A reoccurring conflict present within the operating room is that of multiple PSI’s, or a patient safety initiative, being performed at one time. The PSI is to be performed on every surgical patient prior to bringing the patient up to the OR, should be done independently, and should be done immediately before transferring the patient. No PSI’s should ever be grouped to save time. A recent conflict in the OR included a nurse gathering her team (RN, Anesthesia, and Surgeon) and performing individual PSI’s on multiple patients at the beginning of the day instead of coming down to perform the PSI directly before transferring the patient for surgery. This goes against policy and puts multiple patients at risk for encountering the three W’s: wrong-site, wrong-procedure, and wrong-patient. The guidelines for the PSI have been previously elaborated on and the determination of individual PSI’s directly before patient transfer had been stressed in prior morning huddles. My coworker and I who witnessed the conflict brought it up to the clinical coordinators attention as it was happening. The clinical coordinator addressed the staff directly about the unsafe practice that should not be happening and was told by the RN that for this doctor the practice was ok. This is untrue but allowed the RN to save time throughout her busy day by cutting corners. The clinical coordinator told the RN and other staff for that room that the incident would be brought higher up to management to resolve but in the meantime the PSI’s should be performed again and performed correctly. I do not think that this conflict was resolved because ultimately the RN did not comply with the instruction from the clinical coordinator and went about her day. As this incident occurred just this week, I do not believe that the issue has been resolved and will continue to be a safety concern until all staff are mandated to attend an in-service and sign documentation that they understand the policy and procedures are in place for patient safety.

The four stages of conflict: latent, perceived, felt, and manifest apply to the situation discussed in one way or another. Latent conflict is all about anticipation of the conflict occurring in the first place (Finkelman, 2016). Latent conflict was evident when the PSI topic was brought up in huddle as it was anticipated that some may not be following the policy. The nurse leader wanted to address the matter at that time before it led to an adverse event. Perceived conflict is all about recognizing that the conflict does in fact exist (Finkelman, 2016). Perceived conflict began to take place when my coworker and I started to recognize how a nurse just came and went with her patients without additional team members, which is unusual. Felt conflict is all about feeling the effects of conflict which may present itself as feelings of anxiety, anger, or stress about the situation (Finkelman, 2016). Felt conflict began to take shape when anxiety started to set in that these patients were being taken up to surgery without a PSI being performed directly prior to their transfer. Luckily the situation was not avoided, and the issue was able to reach the fourth stage of conflict, manifest conflict. Manifest conflict is all about the conflict coming to a head; it can be an opportunity for constructive or destructive responses to the matter (Finkelman, 2016). Manifest conflict was evident and turned destructive once the RN, who was addressed for the reckless behavior, decided to continue to ignore policy and continue to place patient safety at risk.

“The fast pace and rapid turnover that are characteristic of an operating room (OR) combined with passive responses or silence from staff members contribute to preventable medical errors and wrong-site surgery” (Mennella & Heering, 2017). It is our responsibility as nurses and healthcare professionals to stand up for our patients and address conflict as it arises no matter how busy we may be. There are many ways that a nurse leader can work with his/her team to address conflicts in a clear, concise, constructive, and collaborative way. Negotiation is a great way to deal with conflict in a way that provides an opportunity for education and growth. Using negotiation, I could work with the nurse leader to come up with a way to address the PSI implementation problem in a way that allows staff, in a group setting, to identify important outcomes and question reasons for certain practices to understand them better (Finkelman, p. 332, 2016). It is also important for our collaboration to involve and highlight written materials that go over clear expectations of staff, patient safety outcomes, and policies (Finkelman, p. 332, 2016).

The nurse leader and I can address conflict in the future by using the “development and maintenance of shared expectations” (Hall & Tobias, p. 4, 2016). By developing, enforcing, and maintaining what is expected with shared expectations the staff can work together to improve their understanding of educational and interventional expectations as an operating room nurse (Hall et al., 2016). “Meaningful shared expectations, in turn, arise most commonly from the clear establishment of cultural norms, shared goals, and carefully aligned incentives” (Hall et al., p. 4, 2016). Another important aspect to conflict resolution includes reinforcement. Reinforcement is important for leaders, staff, and even students. With reinforcement leaders, staff, and students learn of behavioral standards and reoccurring issues that need to be addressed; as “conflicts are inevitable” (Hall et al., p. 4, 2016).

An additional conflict resolution method that may be useful in the OR includes using simulation, role playing, and even thoughtful exercises in a way that allows staff to learn different conflict management styles, to recognize conflict as it arises, and become more comfortable addressing conflict (Labrague & Petitte, 2017). I think that the best method of conflict resolution that could be implemented by the nurse leader and I would be that of development and maintenance of shared expectations. It would be best to do this in a group, provide a sign off sheet, and make sure it is an open forum that allows for discussion. Providing this type of environment would allow every staff member the chance to question, understand, and eventually implement the changes necessary to meet expectations, follow policies, and improve patient safety outcomes.

Learning about conflict, conflict resolution, and valuable methods to deal with conflict will help me to improve on my practices in the future. In the future I will be able to not only identify conflict before it arises but I will be able to understand my own view point on the matter, have multiple understandings of conflict resolution, and I’ll be able to address the conflict a lot more confidently then I would have been able to in the past. “The formulation of good practices is based on the analysis of the actions developed by the health services through a process of critical reflection on what works well in a given situation. This requires thinking about the action, its why, and how it might be most effective” (Gutierres, Santos, Peiter, Menegon, Sebold, & Erdmann, p. 2776, 2018).

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