This paper examines conflict reduction strategies applicable to a hospital emergency care scenario involving an on-call orthopedic physician's delayed response, inadequate treatment, and a physician assistant's failure to address patient concerns. Drawing on EMTALA regulations and established conflict management frameworks, the paper recommends that the nurse manager employ both forcing and accommodation strategies. Forcing entails consulting risk management and compelling physicians and physician assistants to comply with policies, while accommodation focuses on addressing the patient's grievances and explaining her rights. The paper also emphasizes the importance of educating staff on reporting procedures, referral policies, and disruptive behavior protocols to prevent future conflicts.
The paper demonstrates applied policy analysis: it identifies a real regulatory standard (EMTALA), maps a specific patient care conflict against that standard, and then prescribes management interventions drawn from conflict resolution literature. This technique — anchoring recommendations in authoritative policy before applying theoretical frameworks — is a hallmark of healthcare administration writing at the undergraduate level.
The paper opens by establishing the regulatory context and summarizing the conflict in Betty's case. It then moves through a series of prescriptive recommendations, each addressing a different party or strategy: consulting risk management (forcing), consulting nursing leadership and addressing patient accommodation, educating the physician assistant, and finally synthesizing both strategies in the conclusion. The argument flows from problem identification to multi-party resolution recommendations.
According to EMTALA (Emergency Medical Treatment and Active Labor Act), hospitals are responsible for ensuring that on-call physicians respond within a reasonable time frame, and medical staff bylaws, policies, and procedures must define the responsibilities of on-call physicians to respond, examine, and treat patients with emergency medical conditions (On-Call Responsibilities for Hospitals and Physicians, 2013). Furthermore, "when feasible, requests for consultative services should be made in accordance with patient's preferences and/or health plan" (EMTALA and On-Call Responsibility for Emergency Department Patients, 2013).
The conflict in Betty's case involved the orthopedic resident's response time of two hours, an indication of surgery by Thursday when the physician was not in the office before Wednesday, the physician's failure to treat the patient's hands — which necessitated another referral a week later — and, after Betty returned to the emergency room, the physician's assistant's failure to respond to questions concerning the availability of the physician.
The first recommended action for Linda, the nurse manager, is to meet with all parties to define the conflict and gather information (Complying with the New Leadership Standard LD 2.40, November 2007). Conflict can be a symptom of a larger problem. The root cause may be a lack of communication between the physician and the orthopedic resident, a lack of training with the orthopedic resident, or both. The physician assistant may also be unaware of the reporting policies required to address and confront such issues.
Forcing is defined as using formal authority or other power to satisfy concerns without regard to the other party's concerns (William, n.d.). After gathering the facts of the situation, Linda should first consult with the hospital's risk manager for advice on how to handle the matter. By doing so, she will be better prepared to confront the situation with the physician. This step will also help clarify the legal and liability issues that can stem from the conflict, and provide support if the physician does not comply with established policies.
Accommodating is defined as allowing the other party to satisfy their concerns while setting aside one's own (William, n.d.). Betty deserves accommodation for the poor quality of care she received. Linda should consult with the director of nursing to gain insight on how to address that quality of care and how rectification can be provided to Betty — even if it consists only of an explanation that the situation is being handled, clarification of her rights, and guidance on other measures she can use to resolve her treatment concerns.
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