NR 582NP Week 3 Conflict Case Analysis Example

Conflict Case Analysis: Day and Night Nurses on a Telemetry Unit Disagree About 05:00 Baths, and What Each Shift Is Actually Protecting

Student Name

College of Nursing, Chamberlain University

NR 582NP: Leadership and Role Development for Advanced Nursing Practice

Instructor Name

Month Day, Year

Conflict Case Analysis: Day and Night Nurses on a Telemetry Unit Disagree About 05:00 Baths, and What Each Shift Is Actually Protecting

The Presenting Complaint

On my telemetry unit, day nurses complain that night nurses leave baths and linen changes for the day shift. Night nurses complain that day nurses expect patients bathed at 05:00, waking them after a broken night. The complaint surfaced at a staff meeting as a request for a policy: "baths are night shift's job."

What the Disagreement Is Really About

Set aside the baths, and the disagreement is about workload at shift change and about who decides what patients need. Day nurses are protecting the first two hours of their shift, when admissions, discharges, rounds and morning medications collide. Night nurses are protecting patients' sleep and their own sense of practicing good care, since waking a patient with heart failure at 05:00 to bathe is hard to defend clinically. Each shift stands to lose something real: the day shift, time; the night shift, a standard of care they believe in.

Each Party's Interests

Day shift interests: a manageable 07:00 to 09:00, patients ready for rounds, no surprises at handover.

Night shift interests: uninterrupted sleep for patients between midnight and 06:00, credit for care given overnight, not being blamed for a workload problem they did not create.

Shared interests: patients who are clean, rested and ready for the day; less resentment between shifts.

My Default Conflict Mode

On the conflict mode instrument developed by Kilmann and Thomas (1977), my default under pressure is accommodating: I give way to keep the peace. As a day nurse who also works some nights, I am tempted to agree with whichever shift I am working. That would not resolve anything; it would just move the complaint to the other meeting.

What I Can Actually Do

I am a staff nurse, not the manager. I cannot write a policy or reassign workload. What I can do is propose a conversation and a small trial, and offer to do some of the work of setting it up.

What I Would Say

To the day nurse who raised the complaint, privately before the next meeting: "I hear that mornings are swamped. Can I ask what would make the first two hours workable, if baths weren't part of the argument?"

To the night nurse most frustrated by it: "I know waking people at five for a bath feels wrong. Would you be willing to try something for two weeks if day shift tried something too?"

At the meeting: "I don't think this is really about baths. Mornings are overloaded, and nights are protecting sleep. What if we tried this for two weeks: patients who want an evening bath get one before 22:00, patients who need a morning bath get it after 07:30 from day shift, and night shift takes over the 06:00 vital signs and weights so day shift starts with those done?"

What I Learned From Talking to Each Shift First

Before the meeting, I asked two day nurses and two night nurses the same question: what would make the change of shift easier for you? Day nurses named three things: vital signs done, weights done, and no surprise baths at 07:00. Night nurses named two: not waking stable patients before 05:30, and not being blamed when a patient refuses a bath overnight. Nobody on either shift said baths themselves were the real problem. That told me the proposal should trade tasks rather than move baths from one shift to the other.

Why This Proposal and Not Another

It trades work rather than assigning it. Night shift gives up morning vital signs and weights, which they are already awake for; day shift gives up the expectation of early baths. Evening baths respect sleep. The trial is short and reversible, which lowers the cost of agreeing.

What the Leadership Literature Adds

Relationship-centered leadership is linked with better nurse satisfaction and work environments (Cummings et al., 2018), and Kouzes and Posner (2017) describe enabling others to act as building trust and shared ownership. Both point the same way here: a trade agreed by both shifts is more likely to hold than a rule handed down.

Why My Default Mode Matters Here

Because I accommodate under pressure, the risk at the meeting is that I agree with whoever speaks loudest. To guard against that, I wrote the proposal before the meeting, shared it with one nurse from each shift in advance and asked each to tell me what would make them say no. That gives me the likely objections in writing before the meeting, when I can think about them, rather than during it, when I am most likely to give way.

The Manager's Role

The manager does not need to decide anything for the trial to start, because no policy changes; both shifts are agreeing to swap tasks for two weeks. I would still tell the manager before the meeting, so the manager is not surprised and can say if there is a reason the trial cannot run, such as an audit of vital-sign timing already planned.

What a Good Outcome Looks Like Even Without Agreement

The meeting may not end in agreement. A good outcome would still be both shifts naming what they are protecting, out loud, in the same room. That alone would change the complaint from a fight about baths into a discussion of morning workload and overnight sleep, which is the discussion the unit actually needs to have.

What Would Count as Success

At two weeks, three measures: fewer complaints at handover, recorded by the charge nurse; no rise in patients missing a bath for more than 24 hours; and both shifts willing to continue. If only one shift wants to continue, the trial is not a success, because the trade depends on both sides.

What Happens if One Shift Refuses

If night shift will not take the 06:00 vital signs, the trial cannot run, and I would ask the night charge nurse what part of it is unworkable. If day shift insists on early baths for every patient, I would ask for a list of patients who truly need them before 07:30, which is usually very short. In either case, the next step is a smaller trial, perhaps on one hallway, rather than a policy imposed by the manager.

What I Cannot Fix

Staffing. If mornings are overloaded because the unit is short, a bath schedule will not solve that, and I would say so at the meeting rather than let the trial take the blame. That conversation belongs to the manager, and I would ask the manager to attend the two-week review so it can happen there.

References

Cummings, G. G., Tate, K., Lee, S., Wong, C. A., Paananen, T., Micaroni, S. P. M., & Chatterjee, G. E. (2018). Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review. International Journal of Nursing Studies, 85, 19-60. https://doi.org/10.1016/j.ijnurstu.2018.04.016

Kilmann, R. H., & Thomas, K. W. (1977). Developing a forced-choice measure of conflict-handling behavior: The "MODE" instrument. Educational and Psychological Measurement, 37(2), 309-325. https://doi.org/10.1177/001316447703700204

Kouzes, J. M., & Posner, B. Z. (2017). The leadership challenge (6th ed.). Wiley.