Activity 4:

CONFLICT RESOLUTION, DECISION-MAKING, RECORD AND PATIENT MANAGEMENT

SCENARIO:
You are the Head Nurse of the Male Medical Ward in the primary Hospital. You have only ten staff nurses
because it was during the height of COVID-19 Pandemic. Two weeks ago, three of the staff nurses were tested positive
for COVID-19 and were recommended for home quarantine. Because of limited staff, you decide to have two nurses
only during night shifts to maximize availability of nurses in your ward. One night, one of the staff nurses committed
medication error. He did not divulge the incident he committed because he was afraid. During his shift, there was no
immediate untoward effect of the medication because the meds were given on the latter half of the shift. On the
succeeding shift, the patient experienced cardiac arrest. He was then intubated because the effect of the error
medication was becoming intense. Luckily, the patient survived for three days, but died on the fourth day. The attending
physician suspected medication error because the patient was supposed to be discharged on the following day as
evidence of a well-improved medical condition. The attending physician reported the case to you as head nurse and
he cannot pinpoint the culprit. Further laboratory and medico legal exams reveal error medication as the root cause of
the death of the patient and the family will file a case against the hospital. This incident also causes misunderstanding
among the staff nurses because of pinpointing among each other. It insinuates doubts, insults and even a plan of
resignation among the staff.

TASKS:
1. Propose a solution for the current understaffing situation in your ward………………………….20 points
2. Resolve the escalating conflicts of the staff nurses in your ward…………..……….……………20 points
3. Draft a Record Management System that can prevent medication error………………………. 20 points
4. Construct a Patient Management Checklist that can prevent malpractices. …….……………. 20 points
5. Write a report about the incident reflecting your decision about the case………….……………20 points

NOTE:
1. Work with the same group
2. Submit the output a week after

RUBRIC:

Members:
● Abarquez, Micah Andrea
● Amil, Adrian Miguel
● Eligio, Jannelle
● Lerias, Reggiene Kate
● Son, Juanne Claire
TASK 1: PROPOSED SOLUTION FOR THE CURRENT UNDERSTAFFING SITUATION

When the facility is understaffed, it may need more than recruiting solutions. Coming up with a strategy that eliminates
problems and stops them from coming back is needed. That can be tough in the current healthcare landscape, where
nursing shortages, state mandated nurse-to-patient ratios, and last-minute scheduling conflicts which may leave the
hospital in chaos.

Below are proposed solutions that can help the ward with its current understaffing problems:

ASSESS THE STAFFING REQUIREMENTS

Evaluate the current personnel and the work tasks at hand. Then, make a plan to ensure the hospital can combat its
current understaffing issue. As the staffing needs are mapped out, consider the budget needed. First, assess the
requirements to ensure there is sufficient staff to handle tasks. As the plan is put into action, don’t forget to monitor
progress. This minimizes the risk of understaffing going forward.

MAKE SURE THAT UPPER MANAGEMENT IS AWARE OF THE PROBLEM

Ask for, or consider alternate resources to handle the workload, such as allowing to hire temporary employees. Inform
that patient satisfaction is not achieved and that errors have been committed; this supports the request for adequate
staffing.

ESTABLISH A CLEAR CALL-OUT POLICY

Almost every nurse will need to call out from a shift on occasion. They might be ill or need to take a mental health day.
While you can't avoid call-outs, you can minimize their impact on your staffing numbers. Implement a policy defining
acceptable call-out reasons and establishes a time limit for calling out, such as no later than two hours before a shift,
except in emergencies.

STRIVE FOR BALANCE AND EFFECTIVE COMMUNICATION WITH THE STAFF

Openly discuss what the goals and priorities are for the healthcare facility, and see how this measures up with the rest
of the team. Set a time limit for accomplishing each goal. Ask staff what they think could be done differently, to get
better results with more efficiency.

DON’T ASK STAFF TO TAKE ON MORE LOAD

The entire staff is already working at maximum capacity, and it’s hard to keep your retention rate high if the talent burns
out. Work as a team to find the solution. Schedule an emergency meeting. The staff needs to come forward with their
workload issues and offer individual solutions until these come together and work for everyone. This approach is likely
to illuminate common goals and help create a unified road map in how to move forward as a team.

UTILIZE THE OTHER STAFF TO THE FULL EXTENTENT OF THEY ARE ALLOWED TO DO
Not all nurses and physicians utilize the medical assistants or unlicensed staff in their department; as long as they are
used within their job description, assistants can help ease the workload.

PRIORITIZE AND ORGANIZE TASKS

Examine tasks and categorize activities as high, medium, or low priority. Start with the high-priority activities. These
include critical assessments and interventions, such as tracheal suctioning. Next, tackle medium-priority duties, such
as teaching patients. Many low-priority activities can be delegated to unlicensed assistive personnel (UAPs) and
volunteers.

HIRE MORE NURSES/STAFF

If possible, hire more nurses to provide adequate cover for each shift. Another option is to work with a staffing agency
to bring on nurses as needed.
SELF-SCHEDULING
Some systems enable nurses to access units' overall schedules so that they can request shifts and swap shifts with
their colleagues. This helps them better balance the demands of work and home life, and improves job satisfaction and
decreases turnover.
Self-scheduling also encourages nurses to share responsibility with unit managers and their colleagues for ensuring
that all shifts are covered and adequately staffed. Unit managers end up making fewer requests for nurses to stay a
few more hours after completing their scheduled shifts. Such requests are a source of friction on nursing floors and
increase costly overtime. Hospitals that use self-scheduling find they can reduce overtime and the need to bring in
agency nurses.

CREATE AND USE ALTERNATE STAFFING PLANS TO MITIGATE SHORT-STAFFING

When faced with understaffing challenges, health systems can benefit from having the flexibility to deploy different
staffing strategies based on the severity of the understaffing and which clinical and non-clinical support staff are
available to help stretch the capacity of the acute care nurses. By developing multiple staffing plans that address
different scenarios, health systems can quickly adapt to current and projected situations when understaffing is an acute
issue.

TASK 2: SOLUTION FOR THE ESCALATING CONFLICTS OF THE STAFF NURSES IN THE WARD

In the case scenario, due to the medication error which led to the death of the patient, this has led to misunderstanding
within the staff nurses in the ward. This creates a problem as this leads to the insinuation of doubts, insults as well as
the plan of resignation among the staff nurses.

According to Marchica, 2004 from the book ‘The Accountable Organization: Reclaiming Integrity, Restoring Trust’,
conflict resolution follows the following steps:
1. State the problem
2. Considering the impact
3. Acknowledge your Role
4. Describe the ideal result
5. Identify the obstacles
6. Create your strategies
7. Predict likely outcomes

This is further visualized in the chart below. This involves putting your view into perspective in relation to the perspective
of the opposition. In the case of being a head nurse, this can also be visualized with the perspectives of the two parties
or various parties. When following these steps, an action plan can be established which will then direct the parties
involved towards a solution.
 Figure 1: Conflict Resolution Diagram - Marchicha, 2004

Steps of the conflict resolution diagram:

1. State the Problem: Clarify the problem, who is involved, and why, in the most straightforward words possible,
making sure it isn't merely a symptom of a broader issue. Consider the events that have led to this critical
juncture in history. What events contributed to this conflict? In the case of the scenario the problem is the
medication error committed by an individual staff nurse who has not owned up to the mistakes. This led to
misunderstanding, blaming and threats of resignation among the staff members.
2. Consider the impact: After that, examine how the dispute is hurting the business, the institution, personal
connections, and other aspects of the lives involved. What are the financial (and social) implications of the
hospital/company? What will happen if the conflict will not be resolved. In this case, if the conflict is not
resolved, staff nurses may threaten resignation. This will also stain the integrity of the institution as the family
will file a case against the hospital. The trust of the patients towards the hospital and staff may decrease.
Patient care may decrease in quality and may become inefficient in the long run. These are some of the
impacts that may arise when the conflict is not resolved.
3. Acknowledge your role: So, what part of the conflict have the parties done so far? The most difficult
component of the exercise is identifying each parties’ own accountability in a circumstance where they believe
they are "right". In this case, the parties, where it be the staff nurses, must identify how they are involved in
the conflict, and how their actions may result in a negative or positive outcome of the conflict. Therefore, it is
important to address the problem systematically and approach each staff nurse in discussion. Allow for
openness and as the head nurse, create an environment where the staff nurse can freely express their
thoughts and concerns.
4. Describe your ideal result: The parties involved must be specific in what they want as a result. What would
the best result be if all parties were able to successfully work through the problem? As the head nurse, this
would mean listening to all staff nurses in what their ideal results would be, as well as explaining what you,
as the head nurse, would want as the ideal result in relation to the institution's values. An example would be,
the most ideal result would involve the staff nurse who committed the error to take accountability and own up
to their fault in private, and discuss moving forward the appropriate measures to ensure appropriate
punishments would be implemented.
5. Identify obstacles: What is preventing this conflict from being resolved? Which party is the largest
impediment to resolving the disagreement. Also consider other parties' perspectives and potential roadblocks.
In this case as the head nurse, it is important to acknowledge that the main obstacle for the staff nurse who
 committed the error to not own up to their error is the repercussions to their fault. Which may include being
fired or even arrested because of the error.
6. Create your strategies: Identify strategies for confronting and overcoming the barriers that stand in the way
of resolving the conflict. The application of a conflict management chart can be utilized here to identify the
best outcome. In the case of the scenario, an accommodating approach is the best conflict resolution wherein
the nurse involved in the medication error must yield and take accountability to benefit the other staff members
as well as the hospital institution.

Figure 2. Five primary styles of conflict management (Conflict Management Styles | Organizational
Behavior and Human Relations, 2022)

7. Predict likely outcomes: It is important that in advance, identification of likely outcomes of each party
confronting the conflict, including the worst and best-case scenarios, as well as some in between, is done. In
the best-case scenario, if the nurse involved will confess, at least due to their accountability, the reputation of
the hospital can be salvaged and other staff members will not resign, which in turn can maintain the quality of
patient care with the patients. In the worst-case scenario, due to the nurse not taking accountability, the staff
nurses may resign, the hospital will be sued, and patients will distrust the quality of care or service that they
are receiving. Quality and efficiency of patient care will be decreased.

Once an action plan has been made, it is important that as the head nurse, to initiate and execute the action plan in
order to progress towards a proper and satisfying conflict resolution outcome among all parties.

Sources:
- Marchica, J. (2004). The accountable organization: reclaiming integrity, restoring trust. D/B (Davies-Black)
- Conflict Management Styles | Organizational Behavior and Human Relations. (2022). Lumenlearning.com.
https://courses.lumenlearning.com/wm-organizationalbehavior/chapter/conflict-management-styles/
TASK 3: RECORD MANAGEMENT SYSTEM

To prevent further cases of medication error, the record management system must have a general protocol
of incorporating a rapid assessment concerning the various systems needed for assessment before
administering drugs to the patient.

Before finally administering the medication, to avoid medication error, the record management system should include
in the patient’s MAR chart the following:

1) Name and birth date - the system should never permit the nurse to mention the name of the patient, but
instead let the patient tell his/her name. To further verify, in instances wherein there are 2 patients with the
same name, the date of birth shall be used to confirm verification.
2) Allergies - both food and drug allergies should be noted because some drugs and foods may relate or
increase the risk of acquiring severe side effects to the patient leading to further complications.
3) Medical Diagnosis - the medical impression should be noted to confirm the indication of the drug.
4) Laboratory Results - in situations where the medical diagnosis is not enough to confirm drug indication,
laboratory results may be included to verify a patient's indication of the drug.
5) Date of Administration - the date of administration should be provided so the next nurse is aware of when
to administer the next dosage.
6) Time of Administration - the exact time of administration should be included to avoid repetition of medication
administration.
7) Drugs to be administered - the name of the drugs are highlighted in red for easy scanning in cases wherein
a drug-to-drug interaction may possibly occur. Drugs indicated should include the generic name and brand
name. In addition, the record should also include the dose, frequency, and route of administration.
8) Patient’s Indication - to ensure the need for medication administration, the indication should also be noted.
Moreover, to reduce errors, the patient should be able to verbalize why certain drug/s is/are being
administered and for him/her to be familiar with the pharmacologic treatment.
9) Nurse in-charge of Administration - for proper documentation, nurses who administered the medication
should write their name and signature in the column provided. This will also encourage the nurse to properly
 check the administered medication since his/her name is being documented and errors will be accused to
him/her directly due to easy tracking of legal documents.
10) Witness - to further reduce medication errors, the witness’ name should also be included under Rechecked
by. Although this will not directly cause harm to a nurse’s license, the fact that he/she is involved in rechecking
the drug will add more weight in taking his/her responsibility seriously.
11) Remarks - the column under the Remarks section should include whether the drug has been administered or
not, discontinued, shifted, and other significant findings that are not mentioned in the previous columns. Drugs
that contain a black box warning labels and drug cautionary such as “Do not chew” or “Give with meals” should
also be included in the remarks section.
TASK 4: PATIENT MANAGEMENT CHECKLIST: MEDICATION ADMINISTRATION
TASK 5: INCIDENT REPORT

PATIENT INCIDENT REPORT FORM

Last Name: First Name: Middle Name:

Tanke Edith Tiu

Address: Brgy. Pahina Central City: Cebu Province: Cebu Telephone #: (032) 238-
City 0123

Gender: __ M _/_ F Date of Birth: 01/25/1968

Hospital ID: 2022-04-12345 Ward: Female Medical Ward Bed Number: 5

Patient Diagnosis:

Dilated Cardiomyopathy

Date and Time Incident Occurred: Date and Time Discovered: Date and Time Reported:

March 25, 2022; 10:00 AM March 25, 2022; 4:00 PM March 25, 2022; 7:00 PM

Location of Incident: Cebu Normal University-Medical Center // Female Medical Ward

Incident Description (Please state facts only)

The client is a 54-year old female presented to the emergency department with chief complaints of nausea,
shortness of breath, and abdominal cramping and a 5-day history of awareness of irregularities of her heart rhythm.
This was not accompanied by any chest pain but she revealed a one-month history of shortness of breath, tiredness,
and leg swelling. Initial V/S are as follows: T- 37.5 C, PR- 92 bpm, RR- 20 cpm, BP- 120/70 mmHg, PS- 3/10.

The attending physician noted that while the patient was not in acute distress, blood chemistry levels showed
abnormality with the potassium level of 2.9 (normal range is 3.5 to 5.0). Therefore, the physician ordered 30mEq of
potassium to be added to each bag of the patient’s intravenous fluid, infused at 80 milliliters per hour. The order was
to be maintained through the remainder of her course of treatment.

Two days later, despite the potassium added to his intravenous fluids, the patient’s potassium level was noted to be
3.0, so the attending physician ordered 80 mEq of potassium to be administered by mouth. The patient vomited the
medication (amount retained undetermined). The attending physician then ordered two doses of 40 mEq of
intravenous potassium to infuse over a four-hour time period with the plan of increasing the potassium level between
4 and 4.5.

The staff nurse on duty mistakenly administered two doses of 100 mEq of intravenous potassium. The staff nurse
did not document the said medication administered as no clinical manifestations were noted upon administration
and the entire duration of the shift. However, unfortunately, it did surface during the next shift, resulting in the client
being intubated. The client survived for the next three days but died on the fourth day, having a cardiac arrest.

Nature of Harm/Health Damage

On March 25, 2022 at 4:00 PM, the client was noted to have difficulty in breathing, angina, and vomiting. V/S are as
follows: T- 36.5 C, PR- 140 bpm, RR- 30 cpm, BP- 70/40 mmHg. ECG readings noted ventricular tachycardia.

Immediate Action Taken: (Provide details of action taken)

The physician ordered the administration of calcium gluconate (IV route) stat. With the client’s status improving, the
physician also prescribed insulin with glucose to the client to further improve severe hyperkalemic state. The client’s
condition improved but resulted in an altered LOC (client in comatose state). The client was then transferred to the
Intensive Care Unit, for further monitoring. After four days, the client went into cardiac arrest; the on-call emergency
physician attempted to resuscitate, but was unable to obtain a heartbeat and the patient was pronounced dead.

The attending physician suspected a medication error done by a staff nurse, but is unable to pinpoint the culprit.
Further laboratory and medico legal exams reveal error in medication administration as the root cause of the death.

Name of Individual Submitting Report: Dr. Keisha Kaye Alberio

Signature of Individual Report: Date Report Completed: March 25 2022

FOR INTERNAL USE ONLY

Department Review:
Head Nurse
Mrs. Edith Tiu Tanke was a 54-year-old female diagnosed with dilated cardiomyopathy. There was
an order given by her physician that 2 doses of 40 mEq of potassium be infused to his IV bag to
run for 4 hours. Nurse Brody accidentally administered two doses of 100 mEq of potassium via IV
on March 25, 2022. Nurse Brody had come in for the morning (6 AM - 2 PM) duty and clocked out
after his shift. It was further confirmed by the documentation of the patient’s medication record
which contains Nurse Brody’s signature. Nurse Brody has confirmed that he did administer a total
of 200 mEq potassium during his shift. He also acknowledged failure to report said error.

Action:
 1. All staff nurses in the female medical ward are to be
reoriented regarding appropriate medication
administration. ___Recommended: Dismissal
2. Submission of this case to the hospital administration of Mr. Brody Yankee.
and to suggest conducting research regarding ___Required: Re-evaluation
incidence of medication error in the institution and of all staff nurses in the
exploration of new medication administration systems female medical ward.
to reduce incidence of errors.
3. All staff nurses, in the male medical ward, are subject
to evaluation. Assessment of their knowledge and skills
in rendering care towards clients, to note possible
errors in the future.

a. Should the staff nurse fail in some areas of

assessment, the staff nurse will be required to attend seminars
related to it.

4. The staff nurse, guilty of the incident, will be subject to

the sanctions befitting of the err made and as deemed
appropriate by the hospital administration.
Signature: Date:

Ms. M.A.J.J.E.
March 31 2022
CNU-MC Female Medical Ward Head Nurse