NUR 431 Module 3 Short Paper Example

One A.M., One Float Request, One Refusal: Communication and Conflict Resolution on a Rural Night Shift

[Student Name]

Southern New Hampshire University

NUR 431: Leadership Practices for the Professional Nurse

Module Three Short Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

One A.M., One Float Request, One Refusal: Communication and Conflict Resolution on a Rural Night Shift

Conflict is part of every shift, and nurse leaders spend much of their time in it. What distinguishes effective leaders is not the absence of conflict but the ability to understand its sources and choose a response that fits. This paper examines a composite conflict on the night shift at Ridgeline, a small rural critical access hospital, between the night house supervisor and a travel nurse asked to float to the emergency department. It argues that the supervisor's first response, insisting on the assignment, was a competing approach that treated a legitimate safety concern as defiance, and that a collaborating approach supported by structured communication produced a safer plan and a better working relationship.

The Conflict

At 1 a.m., the emergency department had four patients, including a man with chest pain and a child with severe asthma, and only two nurses. The inpatient side was calm. The supervisor asked Morgan, a traveler three weeks into a contract, to float to the emergency department for the rest of the night. Morgan refused, saying the contract listed medical-surgical experience only, that Morgan had never worked in an emergency department and that taking a pediatric asthma patient would be unsafe. The supervisor, under pressure, replied that everyone floats at a small hospital and that refusing an assignment could be reported to the agency. Morgan said again that it was unsafe and asked to speak with the administrator on call.

Sources of the Conflict

Almost et al. (2016) reviewed 44 studies of interpersonal conflict in health care teams and found that its most frequently identified sources included poor communication, role ambiguity, lack of support, poor work environments and lack of emotional intelligence. Several were present here. The traveler's role was ambiguous: the contract described medical-surgical work, while the hospital expected cross-coverage. Communication was poor: no one had discussed floating during the traveler's orientation. Support was thin: the emergency department had no plan for a surge at night other than the supervisor's judgment. And under pressure, the supervisor answered a safety concern with a threat, which escalated the disagreement. The conflict was not really between two people; it was produced by gaps in the system that both people were standing in.

Conflict-Handling Modes

In the instrument Thomas and Kilmann (1974) built, each response to conflict is scored for two things at once, insistence on one's own aim and effort to meet the other party's aim, and the combinations give five modes. Competing pushes hard and cooperates little; collaborating does both; compromising meets in the middle; avoiding does neither; and accommodating gives way. The supervisor's first response was competing, high on assertiveness and low on cooperation. Competing has a place when an emergency requires immediate action and there is no time to negotiate, but it failed here because it dismissed a concern about patient safety that was reasonable and because it damaged trust with a nurse the hospital needs for another ten weeks.

The better response was collaborating. After a pause, the supervisor asked Morgan what Morgan could safely do in the emergency department. Morgan could monitor and reassess the adult chest pain patient, run a twelve-lead electrocardiogram, start intravenous lines and document, but not manage pediatric respiratory distress. The two agreed that Morgan would take the adult patients under the emergency nurse's direction while the experienced emergency nurse took the child, and the supervisor would cover the inpatient side with the licensed practical nurse. The concern for safety and the need for coverage were both met.

Structured Communication

Morgan's refusal was, in effect, a safety concern that the supervisor at first did not hear as one. TeamSTEPPS, the federal teamwork curriculum, gives staff agreed words for escalating a worry so that others treat it as urgent: a scripted escalation of three rungs, each sharper than the last, with the top rung declaring that the matter is now about patient safety, and a rule that a concern ignored the first time must be stated again (Agency for Healthcare Research and Quality, n.d.). Morgan used the substance of both, stating the safety problem and repeating it, though without the shared language. Had the hospital trained its night staff, including the supervisor, to recognize those words as a formal signal, the first exchange would likely have been a negotiation rather than a standoff.

Preventing the Next Conflict

The lasting fix belongs to the system. The supervisor proposed three changes to the director of nursing: a floating agreement discussed with every traveler during orientation, listing the tasks each nurse is and is not competent to perform in the emergency department; a written night surge plan that names who is called in and in what order; and TeamSTEPPS communication training for night staff, including the supervisors. The director adopted the first two within a month. Almost et al. (2016) found few published interventions for conflict in health care teams, which makes it more important to address the local sources directly.

What the Supervisor Learned

The supervisor's own reflection matters as much as the policy. The threat to report Morgan to the agency came from pressure, not from a considered judgment, and it was the moment the conflict became personal. The next night, the supervisor apologized to Morgan for that remark and thanked Morgan for raising the concern clearly. That conversation did more to rebuild trust than the floating agreement did. The supervisor also began using a simple habit at the start of any disagreement about assignments: asking what the nurse can safely do before asking why the nurse will not do the whole task. The question moves the conversation from refusal to problem solving and treats the other nurse as a partner in keeping patients safe.

Conclusion

The float refusal at 1 a.m. looked like a staff member defying an assignment. Analyzed with evidence on the sources of conflict and the five conflict-handling modes, it was a reasonable safety concern produced by role ambiguity and a missing surge plan, made worse by a competing response. Collaboration found a safe arrangement that night, and a floating agreement and surge plan should keep the same conflict from recurring.

References

Agency for Healthcare Research and Quality. (n.d.). TeamSTEPPS 3.0. https://www.ahrq.gov/teamstepps-program/index.html

Almost, J., Wolff, A. C., Stewart-Pyne, A., McCormick, L. G., Strachan, D., & D'Souza, C. (2016). Managing and mitigating conflict in healthcare teams: An integrative review. Journal of Advanced Nursing, 72(7), 1490-1505. https://doi.org/10.1111/jan.12903

Thomas, K. W., & Kilmann, R. H. (1974). Thomas-Kilmann conflict mode instrument. Xicom.