COMMENTARY

Nurses Questions Answered: When Politics Divides the Healthcare Team

Diane M. Goodman, BSN, MSN-C, APRN

Disclosures

October 21, 2022

Conflict Resolution

Nurse: Nurses are working on a busy medical/surgical unit as word of President Biden's student loan forgiveness program has been released. Two nurses on the unit get into an intense argument about details of the plan.

One nurse, close to retirement age, is furious she struggled years to pay off her loans, working nights and weekends for extra funds. A younger nurse with two small children in daycare, is delighted that money will be shaved off her payments. A third nurse attempts to tone down the anger in the room but fails as voices rise, each person anxious to be heard.

The conversation takes a nasty turn, with the group discussing additional topics involving the Inflation Reduction Act and options regarding asylum/migrants at the border.

How would you approach this conflict?

Goodman: There are very few conversations, aside from political topics, that result in participants becoming agitated and/or angry, especially in recent years. Whether it is an antiabortion debate or anxiety related to secure borders, nurses have strong feelings and want their views to be heard.

Conflict may occur in the workplace for several reasons, including nurses feeling unduly rushed, stressed, and fatigued owing to an ever-increasing workload. However, strategies exist to decrease conflict among colleagues.

If employees feel well-respected and understood by management, conflict is less likely to develop between peers.

But when conflict does occur on the job, removing peers to a neutral location is best for honest dialogue and expectations to be met. Setting a meeting at a later date or time for individuals to discuss their points of view in an area where they cannot be blamed or belittled is of primary importance.

However, when the incident occurs, a team leader (senior nurse) should attempt to defuse the situation by reminding nurses they are in a work environment where patients and visitors could hear what is happening.

Group expectations should be established before the meeting, as well as behavioral ground rules: no shouting, name calling, angry outbursts, or personal statements. Each group member should be allowed time to articulate their point of view, including why they feel strongly about their respective opinion(s).

Respect for differing viewpoints is an innate foundation for nursing values. Understanding we come from varying cultures, ethnicities, and religious beliefs is pivotal for understanding the politics of colleagues as well as patients. Respect begins with listening and an open mind, no matter how foreign the beliefs of a coworker may be.

Conflict can be positive for employees who work together. It encourages creativity and cooperation in future assignments, including the ability for nurses to establish a core set of values to respect those with differing life experiences. In that aspect, recognizing conflict as an opportunity to view challenging perspectives and opinions is part of providing care.

Privacy Infringement

Nurse: A patient is being checked in for outpatient surgery. A novice nurse, friendly to the point of being gregarious, discusses events of the unit, including why a cake and decorations have been brought in.

During the chat, the nurse discloses personal information regarding a coworker's health, information that should not be shared with a patient or with visitors in the room. While feeling empathetic, the young nurse unintentionally disclosed a coworker's recent pregnancy loss to the people being checked in.

If you were within earshot of this conversation, what would your actions include?

Goodman: The above scenario is definitely a problem and could even be a

violation of HIPAA (the Health Insurance Portability and Accountability Act of 1996), if the coworker is a patient of the practice. But I would not assume that a newer nurse knows that she has committed a violation until I had a conversation with them.

They may believe that they are being open and direct in communicating with a patient. Has a recent staff meeting stressed communication with patients, and the importance of positive feedback? She may be focused on being cordial as a result.

Nurses are the same. It is quite easy to talk shop and forget that ears may be listening.

If this is a first infraction, taking the nurse aside and reinforcing the damage that may be done by disclosing personal issues is best. Watch for a pattern of behavior as well as intent. Education and reinforcement should be the priority.

Medical Device Policy

Nurse: A younger nurse with an external bone stimulator and wrist splint is wondering about the feasibility of working with her medical device in view of patients and staff. She has clearance from her physician and human resources for light duty but is concerned that questions might occur to distract colleagues (as well as patients/visitors) from care.

What are your thoughts?

Goodman: The presence of a medical device on a healthcare provider often prompts questions from peers and patients. It is natural to be curious, whether a colleague has a device placed for chemotherapy or a visible bandage after an injury.

The nurse may or may not be comfortable sharing that she recently fractured her wrist, and the splint and bone stimulator are to complete healing to the joint to avoid additional interventions) for the injury.

Peers may want to hear information about what the nurse can do for light duty, such as a weight restriction for lifting. Patients and visitors may be curious or empathetic, as the presence of a medical device reinforces the idea that nurses can also be sick or injured.

As a nurse who has worked with orthopedic boots after a foot fracture and a jugular line for pheresis, I discovered that it was easier to offer an explanation as to why the device was needed. A simple explanation worked best.

I also explained concerns to peers regarding working with patients who could be confused or delirious because that might be dangerous for an employee dealing with a medical issue or a visible medical device However, emphasizing to colleagues where I would be a resource proved helpful, such as patient intake or discharge.

Although nurses working with medical devices may tire of answering questions about themselves, keep in mind this is becoming more common. A model recently walked the runway at a Versace show with her insulin pump in full view of attendees. Medical devices are becoming trendy!

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