Peer Reviewed Nursing and Health Care Journal

Nurse-Physician Conflict and Power Dynamic

Faisal Ameen*

Assistant Manager Cath Lab, Tabba Heart Institute, Pakistan

Submission: September 22, 2017; Published: November 21, 2017

*Corresponding author: Faisal Ameen, Senior Cath Lab Nurse, Tabba Heart Institute, Pakistan, Tel: +92300-9218739; Email: ursfaisal_83@hotmail.com

How to cite this article: Faisal A. Nurse-Physician Conflict and Power Dynamic. JOJ Nurse Health Care. 2017; 5(3): 555665. DOI: 10.19080 / JOJNHC.2017.05.555665

Background

The image of physician-nurse relationship is not simple because it has many conflicts. The doctor nurse relationship like other professional relationships is not restricted to a single factor but it is resulting from several factors. Those assigned factors will specify whether the outcome of a relationship would be positive or negative. As any set of relations between a pair in the place of work, the relationship between nurse and doctor are threatened somehow by inter-professional conflicts. These conflicts can be caused by gaps such as education, competency issues, gender and socio-economic situation, misunderstanding, miscommunication and incompatibility. In addition the recent decision of nurses to undertake greater responsibilities as one of the conflict factors. Therefore it is very important to test the significance that constitutes both the medical profession and the nursing profession to obtain facts on the professional standards and realities. The history of medicine is characterized by multiple concepts of science. However, the union of the applied science and the moral commitment is an attribute of this tradition. The relationship between the brilliant and influential physician and the unprotected nurses is still under the average of the desired goals of any health organization. Intern of patient needs and team work insight.

Scenario

Operating nurse (OR) was assisting a surgeon in removal of parts from abdominal organs affected by cancer in a privet hospital. The surgeon was the owner of the hospital. Before the surgery start the surgeon inters the operation room in a hurry without wearing sterilized gown, he saw the patient going under Anesthesia or nurse was surprised about this unprofessional attitude and she asked the surgeon to step out of the operation room for scrubbing. The surgeon got very angry and he ordered to change the nurse. He also threatens her that she will lose her job very soon. Then he asked anesthesia technician and his assistant some questions then he wear the gown and started the surgery.

During the surgery surgeon find difficulty to join the two parts of colon after removing the affected parts. Thus, to ease his work he removed the unaffected kidney so; he could join the two separated parts of colon. The other scrub nurse assisted in procedure, and she was unsatisfied about this wrong procedure. She was aware that surgeon is doing wrong act with patient, and should find a better way to resolve this matter, but she did not dare to discuss it with the surgeon. After the surgery, physician put the parts which he removed on a try and asked the nurse to put them in a special bag and to send them to laboratory for histopathology. Mistakenly the surgeon put the kidney among the removed parts and sent it to lab with other parts. Patient belonged to a low education family from the rural areas. Few days later lab results came and the family of patient came to know from the laboratory that the unaffected kidney of his mother has been removed. Hospital manager blame the OR nurse and she went to the surgeon office and started arguing with him and finally she lost her job. Nurse and patient family sued in court against the surgeon but there was no evidence against him and the case was closed.

General Characteristics of Conflict

A. Two parties or more are involved in the conflict.

B. Strong emotions and behavior, directed toward defeating or suppressing the opposite party.

C. Opposing parties trying to win the power against each other. Marquis and Huston (2006) state that "when a conflict arises, dissatisfaction is present as a result of differences in ideas, values or feelings between two or more people".

Causes of the conflict

There are many factors beyond the conflict between the employees in health organization especially between nurses and physicians .those reasons contains, power dynamic and power imbalance and physician dominance; bulling and violence, competency issues and lack of trust and respect among health care team members; in addition, low job satisfaction and nursing shortage, work overload related stress are also significant reasons beyond many conflicts.

Doctor's dominance

Dominance is defined by the Merriam Webster dictionary (2010) as dominant position especially in social hierarchy and dominant as commanding, controlling or prevailing over others. In health organizations and in especially in clinical areas doctors dominancy is very clearly present in term of decision making this single approach of decision making is sometimes threatened to be very weak and it sometimes exposed to be fail decision, comparatively the group decision making looks very stable and strong for the seeking of patient benefits in another words, dominance is closely related to power and authority especially in the process of decision making [1]. Physicians Dominance has led to power imbalance in health care organizations and the failure of physicians to adopt and respect the role of other health team members and the ethical role of other specialties especially nursing. "Patient requires a base of moral commitment and general promise to use the power of medicine for a patient's well-being" Storch & Kenny.

Competency issue

Though nursing has passed a huge distance in educational and clinical and administrative settings in the last century, but still there is very acute weakness in their performance. Majority of the nurses still under the border line of the higher education in hospitals we rarely see nurses with university degree as a clinical nurse. Novice nurses usually facing many challenges to adjust with new environment. Lack of clinical experience and hesitation while they communicate with team members and performing their tasks and utilizing their skills, farther more competency is not only limited to the previous aspects but also personal issues is involved in this term the way some one handle and thinking. Nurses should be adequately eligible health care member for a duty, to achieve effective, suitable, sufficient, official way. "Competence can be defined as a potential capability for undertaking a job and competency as the actual performance in complying with standards of care". Nurse competence is directly linked with the nurse's capability to utilize his or her knowledge while competencies are results resulted from utilized skills in practice. The competence notion is very vast. It involves a varied set of qualities such as skills, knowledge, attitudes, motives, personal attentiveness, perception, reception, maturity and some characteristics of individual uniqueness.

Stress and work overload

Shortage of employees in health care organization is one of the most common factors beyond stress and low job satisfaction and always participating in generating or exaggerating conflicts. For instance, nurses are unable to communicate effectively with patient and health care team when they have amount of deities more than their capability or tolerance. And this will obviously lead in to medical errors and will result in conflicts. In accordance to Rahim & Bonoma "conflict-resolution model (1979). Integrating and dominance approaches in resolving conflict were associated with low stress levels".

Many other reasons was clearly presented and emphasized as conflict exaggeration factors

The Conflict among coworkers can worsen in many cases: In case of violence or bulling existence in the cases after escalation of argument, in case of lack of cooperation which is increase the barriers among the team and creates new obstacles of positive communication and probably may lead into more ignorance of other party opinions. for example, (formation of groups character based on religion or culture); farther more some groups may formed based on age, experience and length of and this will definitely negatively reflect on the novice employees, work groups [2] members do not support each other in Achieving work goals or approaching Organization needs; in charging employee in the wrong place less than their capability may generate intentional or unintentional conflict ; novice s and recently graduated employee are not oriented to the new position of work or may not supported by their senior colleagues; hesitation and delaying of conflict reporting or may be lack of awareness of reporting importance may exaggerate the conflict and increase.

Analysis of the problem on the light of formwork and defining the suitable Leadership style and strategies to resolve the problem

Conceptual model in Figurel shows the relationships among the concepts in case of conflict management. Respondents framed expectations the cooperation in several professional zones. There are two ways to handle the conflict ignorance and conflict engagement. Ignoring the conflict may help to avoid conflict exaggeration, but still it may would not be the proper way to deal with. Ignoring the conflict can be used effectively in some cases but it is not always work. Such a strategy need to evaluate the type of the conflict for example, ignoring the conflict causes may help in case of daily and routinely problems that results from work overload or shortage of staff which could not be avoided. On the other hand ignorance of the cases of bulling, violence and harassment in work place will lead into problem complexity if it ignored. According to Marquis and Huston (2006) state that when a conflict arises, dissatisfaction is present as a result of differences in ideas, values or feelings between two or more people.

Engagement in conflict means to face the conflict and deal with it. And also there is tow ways to handle; one is direct and the other is indirect way in the direct way of dealing with the problem the person may use effective discussion it Professional communication to resolve the conflict and to use one’s own power and authority to resolve it. In contrast the indirect way is to raise the conflict in to higher level by reporting or complain. person(s) with whom collaboration is not going smoothly Engaging in the conflict respondents mean to confront the (Forte', 1997; Vazirani et al. 2005).

There are many styles in term of conflict management each style has a specific setting to use effectively according to the literature there are five styles of for this purpose whether the respondent select the avoidance or engaging strategy those styles are influence of oneself, influence of the other, the nature of the conflict, the context of conflict, and the personal motives. Rahim & Bonoma"s conflict-resolution model (1979). They are: integrating, obliging, dominance, avoidance and compromise approaches. Integrating and dominance approaches in resolving conflict".

Democratic leadership style is the best choice for conflict prevention and conflict management

Democratic management style or participative management style is a kind of leadership which allows the employees to participate in the process of decision making to attain organization goals. Many researches stressed on this type of leadership because it was one of the moist successful and most productive style and it when the employees allowed participating in organization policy setting.

In healthcare sittings the democratic leadership larders has the final say of the decision, but when they receive feedback and suggestions from their stuff, this will help them to reach the highest levels of patient or clients satisfaction rather than their staff satisfaction. Thus, stuff also will fell their autonomy when they contributing in decision making and this also will give chance to the managers to identify the uniqueness of their stuff members and the uniqueness of their way of thinking. All of that will help the management to invest such characteristics in future and to decrease to difficulties of decision making burden. This type of leadership prioritize the people first and stress wellbeing said by said with job satisfaction of health care team, democratic manager do not use anger against his/her subordinates, this type will bring together the separate team but on the other hand it is inhabit the leaders authority which will be compensated by saving manager time and achieving the accurate goal with minimum recourses and less energy.

Transformational managers support the professional and personal development of their employees they manage by enhancing teamwork, increasing self-esteem and motivate employees to participate in the formation of health organization policies. This leadership style depends on a positive, charismatic method in managing employees. It concentrates on strong communication abilities, confidence and honesty. Instead of giving orders and expecting spontaneous compliance, transformational managers explain in details the «how» and «why» of organization procedures furthermore they help to understand their vision. They use empathy to recognize their subordinate's needs, by using this vision to convey their leadership communication style to every employee.

Such style of leadership will not be applied with weak personality characteristic. He/she has to share authority with subordinates in very strict and monitored way Democratic leadership style needs strong manager to lead the group otherwise he/she will lose the power gradually because without this personality tem also will suffer.

There are many strategies to resolve the conflict among the employees trust, respect

Achievement of organization goal almost looks difficult or sometimes imposable in low trust environment or less collaboration and when respect is absent in workplace especially in health care settings the outcomes of quality care are also decrease. The concept of trust, respect and collaboration in healthcare stings is vastly concerned as it includes of the behavior characteristics of one person towards another. It is based on an attitude which values other people's uniqueness and individuality and also recognizes dignity. Trust and mutual respect are important basics for physician-nurse teamwork; they increase frankness, communication and improved client outcome. The development of inter professional respect and trust begins with presence of professional roles which is based on professional capability (Figure 2). Leever AM et al. shows the link between physician and nurse in the development of inter-professional collaboration matching with organizational expectation from the employees which effectively enhances the conflict management.

Collaboration and client needs

Boyle & Kochinda (2004) "nurses and physicians supposed to work together co-operatively to reach their mutual goal of patient care and to shared problem resolution, decision making, conflict resolving, coordination of work and positive communication". Collaboration can also be papers as a process which allows the interaction of fellows within a smooth hierarchy when person being able to make decisions both independently and as part of a team (O Brien Pallas, Hiroz, Cook, Mildon 2005). Collaboration and cooperation between physician and nurse are responsible for improvement of Clint outcomes, satisfaction, discharge or transfer decisions, care or outcomes. Also it decreased risk of long stay of patients and lead into less medication errors. It has also been found that collaboration is a vital factor in positive patient outcomes irrespective of the acuity of the patient’s condition (O Brien Pallas et al. 2005).

Positive Communication

To function successfully as part of a team, health care providers have to create positive collegial relationships. Positive mutual relationships is natural result from effective communication, mutual acceptance and understanding, use of convincing others in sated of Coercion and controlling anger during job performance. The active management of conflict is an essential part of building positive relationships. Colleagues who work together to manage conflict effectively will help to create a work climate which produces positive results for both nurses and clients [3].

Recommendation

An efficient reporting system enhances communication among health care team members by helping nurses to identify hidden reasons of conflict after arranging free communication environment and understanding and trustable way. To resolve the conflicts, management can approach many strategies as: provide a system that enhance the reporting of conflict occurrences in workplace, protects nurses from retaliation and deals objectively with reports. One more applicable way is to assess the conflict incidence and apply corrective procedure, in addition to establish strong policies and for those who breach policies aimed to prevent conflict.

For future planning many strategies are recommended

a) Nursing committee and nursing council should support the nurses in such cases.

b) Nursing council should have program for training the nurses how to define themselves against unfair behavior during their professional life.

c) Some courses related to medical low have to be included with nursing courses in nursing colleges and nursing schools.

d) Head nurse should not be assign by doctors but he/she has to be assign according to medical low.

e) Employee Lawyer position has to be found in Hospital for defining for employees rights.

f) Job description has to be done in a clear way to identify accurately what are the exact responsibilities of deferent parties and individual in hospital and other health organizations.

g) Enhance team work behavior and teem collaboration to achieve organization goal.

h) Sessions for healthy and professional communication among health team and health care providers.

i) Set future plans to prepare leader nurses who are able to take leading role effectively in health care organizations in more affective way.

j) Empower head nurse position and make it independent and free of physician influence.

k) Management can enhance quality performance settings in which nurses are supported to understand conflict and set strategies to decrease it.

l) Management can establish reporting systems to help nurses convey the real massage to the authorized supervisory when conflict has occurred.

In conclusion since conflict is affection achievement of organization goals management supposed to take it for granted as soon as any organization initiate to be establish whether it is health organization or any another establishment. Furthermore conflicts in work place possible to be avoid if staff receive good preparation for professional performance, management members may receive similar preparation and enjoy adequate awareness to know when, how, suitable strategies and policies could be applied to avoid and to resolve the conflict to achieve optimal level of both client and employee satisfaction.