Nursing leadership and organizational change implementation

Nursing- Creating Change in an Organization

Several weeks ago, there was an extremely difficult patient in our clinic, and there was a great deal of debate among employees how to handle this situation. While the clinic provides excellent care to patients, there are often intrapersonnel conflicts, ranging from bickering to intense arguments. The clinic has a history of having a high turnover rate for employees, so it can be difficult to create a setting that is comfortable and encouraging for all staff members. Funding is always low as well, so there is additional stress because of the suboptimal working conditions that make our jobs as nurses even more difficult than they would be if properly stocked with supplies and with unlimited resources.

Often times, nurses have to deal with patients that are not willing to accept treatment, or have some kind of negative reaction emotionally to routine procedures, such as taking blood pressure or drawing blood samples. I have, on several occasions, witnessed patients coming close to losing consciousness or having panic attacks at the sight of blood or needles, simply because of the mental stress it causes. In this instance, a patient had a severe panic attack when his ear was being examined. Apparently, there was information on file regarding this patient's medical history that was not properly taken into account before treatment began, which is part of why tempers would eventually fly as staff members wanted to place blame. Some sort of ear injury at an early age has left this patient very sensitive about his ears, and one must be very careful when examining in or around the ear area because of the emotional scars the incident left. When calm, the patient would willingly and articulately discuss his phobia and the negative reaction that he has experienced during ear examinations on prior occasions. The patient himself had actually insisted that information regarding this be placed in his file to help avoid any unpleasant incidents.

I was finishing up paperwork not far from the examination room when the incident occurred.

There was a loud thud and the patient began to scream; every staff member in the clinic ran to find out what was happening. The patient, suffering from a severe panic attack, had turned over the instruments table, knocked almost everything off of the counters, pushed past the nurse, and was now curled up in the corner wielding a tongue-depressor like a switchblade and crying, rocking back and forth in an attempt to provide self-comfort. Someone assisted the nurse out of the examination room and closed the door.

The conflict that was the most intense was not, however, one between any staff member and the irate patient. The conflict was among two other staff members and myself. One large and strong staff member wanted to enter the room, take the tongue depressor away from the patient, and physically remove him from the examination room. Another staff member wanted to call the police. My opinion was that we should call the patient's therapist, who was listed in the patient's file, and inquire regarding the best actions to take for the safety of the staff members and patient alike. The patient had not harmed anyone, nor had he done anything particularly wrong, so I felt that bringing the police to the scene would be an unnecessary strain on him. The patient was confined in the examination room and could not cause harm to any other patients or staff members, and he was now quiet so he was hardly even causing a disturbance. Everyone wanted to resolve the incident quickly and successfully; there was simply no unanimous decision about what steps would be the best to take.

I was frustrated because I felt that my fellow staff members were not listening to my opinion, so I decided to try another way of communicating. I handed the patient's file to the other staff members and asked them to please review it because I felt that their problem solving skills were excellent and I knew that together we could come up with a solution. After personally reviewing the notes on file, they agreed that the therapist should be called for advice, but it was insisted that we also contact security so that they will be on call if their services became needed.