Managing Lateral Nurse Conflict

Cindy Smith, RN, and Kim Jones, RN, were finishing work on the day shift of a postoperative surgical floor when a new patient arrived from the emergency room. Cindy stopped what she was doing and proceeded to admit the new patient. When Cindy got to her room, the transporter allowed the new patient to get up off the cart and walk to her bed, which she did easily. Cindy helped her get settled, noting no acute distress, and told her she would return in 10 minutes. The patient said, "Fine, I don't need anything." Cindy went back to finish end-of-shift duties.

Just as Cindy was about to finish her last room, Kim walked in and asked her, "Where's the admission sheet you started on the new admit?" Cindy stated she hadn't started one yet, as she wanted to finish these tasks before report, and planned on admitting the patient next. Kim abruptly walked away from Cindy and began the process of admitting the new patient. Cindy walked into the room and tried to help, but Kim said, "You should always take vital signs immediately when a new patient is admitted."

Outside the patient's room, Cindy tried to explain herself, when Kim, screamed at her. "You don't do anything right! I hate to work with you! You are lazy, and you put a patient at risk!" Cindy didn't know what to say. She completed the admission, gave her report, and left the division.

What is your analysis of what happened in this situation?

Are new patient admissions a priority?

What could Cindy have done differently? What could Kim have done differently?

Managing Lateral Nurse Conflict

Analysis

This case study is a very good example of nurse-to-nurse or lateral nurse violence. Lateral violence in nursing can be anything from careless or snide comments that can leave emotional scars to outright cruelty that is intended to damage or humiliate a co-worker (Rowell, ANA). Cindy has been overtly sabotaged by Kim as evidenced by Kim shouting, criticizing, blaming and putting Cindy down in an act of humiliation. Unfortunately, Cindy displays a common non-dominant reaction for nurses experiencing conflict- avoidance. (Trossman, 2011).

Kim and Cindy's priorities are very different from one another. Cindy seemingly used her critical thinking skills after she initially saw the new admission was "fine" and continued to perform other tasks before coming back to finish admission paperwork. Kim, to me, seems to be more task oriented because she was focused on the admission paperwork rather than the patient condition or Cindy's workload.

Admissions

Kim was partially correct that Cindy should have performed an initial assessment upon the patient's arrival to the floor, including vital signs. The American Association of Critical Care Nurses advises nurses to perform an "Admission Quick Check Assessment" when the patient first arrives to the floor (Chulay & Burns, 2010). This initial rapid assessment would also include the vital signs that Kim focused much of her verbal battering on. New patient admissions are a priority, but paperwork can wait. As long as the patient is stable and their needs are currently being met, there is no