GDN3986: Clinical Leadership and Management Conflict Analysis

This report, submitted by a student, analyzes a real-life conflict situation within an aged care community setting. The student, an enrolled nurse, details an event where a patient with dementia became distressed during a bathing procedure due to the absence of the reporting RN and the fear of the student's teammates. The report examines the roles of the healthcare professionals involved and describes the immediate measures taken, including patient-centered communication, empathy, and the application of transformational and situational leadership styles. It discusses the outcomes of these interventions, highlighting increased patient satisfaction and improved nurse motivation. Furthermore, the report considers the changes implemented to prevent similar situations, offering recommendations for enhancing outcomes and preventing future conflicts within the clinical setting. The report emphasizes cultural competency and the importance of effective leadership in managing complex patient care scenarios.

Running head: CLINICAL LEADERSHIP AND MANAGEMENT
CLINICAL LEADERSHIP AND MANAGEMENT
Name of the Student:
Name of the University:
Author note:

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Introduction
Healthcare organizations are home to the multifaceted treatment and therapeutic facilities
and hence, cater to the need of a wide variety of patient population of varied cultures, ethnicities,
ages, genders and disease conditions (Almost et al., 2016). Likewise, in addition to patients,
healthcare organizations are also home to a broad team of clinical staff, of various capabilities
and competencies. Such an environment of multiple skills and health states is bound to result in
circumstances of differential opinion and conflicting situations (Forbat et al., 2017). Such
situations are highly prone to occurrence in aged care community settings, considering the
diverse physiological, emotional, social and psychological upheavals such elderly patients have
to encounter. Hence, healthcare professionals must hence, seek to keep themselves enlightened
on a variety of leadership and management strategies, to ensure timely, prompt and efficient
resolution of conflict resulting in optimum staff as well as patient satisfaction (Sexton &
Orchard, 2016).
The following paragraphs of this paper will seek to shed light on a situation of conflict
occurring in a real life healthcare setting, the events which unfolded due to the lack of conflict
resolution at the moment, the key positions of the nurses or healthcare professionals directly
associated with the situation, the measures and leadership style undertaken to efficiently manage
the incidences, the outcomes which were a resultant of these actions and the long term
implications and recommendations which can be predicted as a product of the aforementioned
leadership and management interventions.

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Discussion
Position
Prior to proceeding towards the details of the event, it is necessary to highlight the
positions and delegations of the various stakeholders of the conflict situation, for improved
management and leadership comprehensiveness. I am currently employed in a community aged
care centered which provides geriatric services to elderly patients, who are inflicted with a wide
variety of age associated complications, such as neurodegenerative diseases like dementia,
Alzheimer’s Parkinson’s, immobility associated musculoskeletal disorders such as osteoarthritis
and metabolic deficits such as diabetes and cardiovascular complications. I am employed as an
enrolled nurse since the last 1 month in this comprehensive aged care community setting. As an
enrolled nurse employed in a aged care community setting I am required to adhere to certain
competencies and standards established by the Nursing Council of Zealand, of which the most
essential being competency 1.3, which requires to me to consult the Registered Nurse (RN) for
performing delegated nursing tasks as per competency (Nursing Council of New Zealand 2019).
Hence, I engage in my nursing professional practice as instructed by my reporting RN. During
my enrollment, I was also introduced to two more enrolled nurses, who were also reporting
under the same RN. Together as a nursing team, we actively assist our RN in managing the care
of the patients she cater to. These include tasks pertaining to the scope of enrolled nurse practice,
such as assessments, medication administration, provision of patient assistance - all as per the
instructions of the RN. Additional responsibilities as per the competency standards included
communicating with the RN for any doubts considering her tenured clinical and professional
expertise and health literacy along with being aware of the concepts of patient centered care and
whanau for cultural competency (Nursing Council of New Zealand 2019).

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Event
The event occurred on an day when our reporting RN was absent due to personal
commitments. When me and my nursing peers arrived at our workstation, we were informed by
another RN that we will be required to work on our own as per handover instructions of the
patients our attended till date, with assistance from other experienced nursing supervisors. The
RN to whom we were supposed to report to for the day, instructed us to assist in bathing an
elderly female patient, Mrs. X, who is 70 years old, of indigenous background and is suffering
from Stage 5 dementia. While I was quite eager and enthusiastic to proceed with the task, my
teammates demonstrated fear and doubt and were unsure of themselves in assisting me in the job.
Hence, without reporting to the RN, I proceed with the task alone and began to assist the patient,
without delving much into a conversation with her. Halfway through the process, the patient
began to scream at me followed by incessant crying and bawling. Hearing the noise, the RN and
my teammates rushed over and after looking at the situation, expressed disgust, anger and her
hatred towards working with nursing students like us. While she left the scenario abruptly, me
and my teammates, through the administration of conflict resolution and strategies of leadership
and management, successfully calmed the patient and proceed to care for her and communicate
later with the RN. Such strategies will be emphasized in the succeeding sections.
Measures
One of the first measures which had to be administered was patient centered
communication, empathy and gentle persuasion. The practice of patient centered approach
involves directly encouraging the patient to express his or her opinion and as a result participate
directly in the clinical decision making process in the regulation of the nursing care plan (Liang
et al., 2017). Empathy and gentle persuasion involves comprehending a situation through the

4CLINICAL LEADERSHIP AND MANAGEMENT
shoes of the individual, that is patient, and gently, patiently and compassionately communicate
with him or her the reasons underlying nursing intervention and hence, establish a therapeutic
relationship in the process (Hojat, DeSantis & Gonnella, 2017). Hence, taking insights from
these theoretical perspectives, I firstly turned off the shower from preventing the patient from
feeling cold and with help from my teammates, wrapped her in a towel and spoke to her gently,
by firstly apologizing, asking her how is she feeling at the moment and what may make her feel
better. I also gently communicated with her, with my name and my position, the reason why I am
helping her to take a bath and how, in absence of such assistance she may encounter accidents
which can further worsen her condition and increase her time of being away from her family.
The patient, now significantly calm, but still upset, expressed how she misses her family and that
she wanted to go home.
After this, my demonstrating leadership styles of transformational and situational
leadership, I instructed one of my team mates, to assist me in helping the patient to change into
clean clothes and help me take her to her bed, while simultaneously instructing my other team
mate to rush to the nursing work station, call the patient’s family and arrange for a visit with the
patient to make her feel better. This strategy highlighted demonstration of cultural and family
centered practices where aspects of the unique culture of the patient as well as preferences of his
or her family/whanau are incorporated in the nursing care plan (Paipa et al., 2015). This was
followed by demonstration of emotional intelligence and interpersonal communication strategies.
Emotional intelligence entails the practice of demonstrating analytical awareness of one’s own as
well as other’s emotions (Lewis, Neville & Ashkanasy, 2017). Interpersonal communication
entails a form of two way communication where both parties must engage in patiently interacting
with each other as well as actively providing the scope to listen to each other’s concerns (Regan,

5CLINICAL LEADERSHIP AND MANAGEMENT
Laschinger & Wong, 2016). For this, me and teammates proceed to apologize and communicate
with the RN on what went wrong, how we handled the situation and what we felt was required in
the future, along with actively listening to her recommendations on what may have caused her to
react aggressively with us. The result was a win-win situation of ensuring positivity across both
stakeholders, where the RN as well as the patient was satisfied with our duties.
Leadership Style
As discussed previously, the leadership style which I demonstrated were akin to the
principles of a situational and transformational styles of leadership. A situational style of
leadership comprises of a leader delegating, supervising and instructing followers as per the
urgency of nature of the situation. Hence, a situational leader must respond to circumstances on a
priority basis (Lynch et al., 2018). As evident, the current conflict situation was a clear resultant
of a breach of patient centered requirements. While I was deeply hurt with the remarks of my
RN supervisor, the evident lack of cooperation from my teammates as well as the unpredictable
aggressive response of the concerned patient, I had to act as per a situational perspective and
hence, address calming the patient and completing the bathing process as a first priority since in
absence of the same, the patient could have felt more distressed, injured herself in the process
and further escalated the conflict. Through the usage of a situational leadership style, I was able
to centre my strategies from a patient centered perspective and hence, resulted prompt patient
associated conflict management. In criticism, a situational style of leadership may not comply
during times of medical emergency due to its time consuming nature (Fontes et al., 2019). Hence
alternative conflict management frameworks may have to be established in the future which will
be addressed in the succeeding sections.

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The second leadership style which I adhered to is a transformational style of leadership.
A transformational leader is known for delegating responsibilities to his or her followers per their
levels of competencies as well as strive to motivate and inculcate values of continuous
professional improvement in the future (Weng et al., 2015). Considering the given situation, I
was aware that it was beyond my scope as an enrolled nurse to lead or delegate my supervisors.
However, my delegation allowed me to at least delegate my teammates who were at par with my
competency as well as communicate with the RN for future supervision and guidance as per
competency 1.3. Further, taking note that both my teammates exhibited fear in taking charge of
the situation, I must delegate tasks as per their competency and confidence in order to inculcate a
positive sense of self-esteem and motivation to improve in the future within my teammates. This
led to my delegation of tasks of assistance and relatively less complicated tasks like calling the
patient’s family to my teammates resulting in their prompt and confident response and conflict
resolution. Allocating responsibilities as per followers’ levels of competency characteristic of
transformational leadership results in followers feeling motivated and in control of their
functioning during critical circumstances (Cheng et al., 2016). In criticism, it has been stated that
transformational leadership styles are often time consuming and induce stagnancy especially due
to followers who are resistant to change (Brewer et al., 2016). Hence, future recommendations to
mitigate the same have been considered in the succeeding sections of this paper.
Outcomes
The implementation of the above strategies resulted in positive outcomes resulting in a
win-win situation where both the RN, me and my teammates and the patient concerned,
expressed satisfaction over the results of the situation. Hence , the outcomes were associated

7CLINICAL LEADERSHIP AND MANAGEMENT
with increased patient satisfaction, enhanced nurse motivation and improved nursing
interpersonal professional relationships.
Changes
The patient now spoke to us positively, remained calm in our presence and was delighted
with the fact that her family will visit her soon. Indeed it has been implicated that patient
centered approaches of empathetic communication and compassionate care, result in feelings of
security, safety and comfort within the patient along with him or her perceiving the
organization’s healthcare services to be of high quality (Makoul et al., 2018). After the prompt
delegation strategies undertaken by me, me and my teammates were confident in our abilities to
manager future such situations of conflict. It has been evidenced that situational and
transformational styles of leadership result in followers feeling motivated and inspired to
improve professional practices due to recognition and appreciation of their abilities by the leader
(Lin et al., 2015). Lastly, the RN who was supervising us on the day the incidence occurred, was
now appreciative of our efforts and the shortcomings in duties in ours as well as hers during the
situation and recognized that a nursing team approach is required for managing future situations
of conflict. Interpersonal, two way form of communication, administered collectively with
emotional intelligence, results in stakeholders taking part in the communication process to
acknowledge the reasons underlying their emotions and attitudes and work collectively towards
conflict resolution (Al‐Hamdan et al., 2017).
Recommendation
Despite the efficient management of the situation, the same could have been improved
and hence, certain strategies can be recommended for optimum conflict prevention and optimum
resolution in the future. Firstly it was noted that as an enrolled nurse I proceeded to work alone

8CLINICAL LEADERSHIP AND MANAGEMENT
without RN supervision. Hence, it is recommended that enrolled nurses adhere to their scope of
practice and undertake supervision from the RN, who has greater expertise and nursing
knowledge. It was also observed that I did not introduce or communicated with the patient and
proceed directly for bathing assistance (Nursing Council of New Zealand 2019). Hence, it is
recommended that enrolled nurses engage in patient centered communication and adhere to
handover tool such as ISBAR, which provides guidance through establishing communication
with the patient and administering nursing interventions as per patient handover (Chitkara et al.,
2017). It was also observed that the RN did not assist us during the conflict. RNs are hence
recommended to promptly delegate, supervise, train, guide and instruct subordinate nurses from
improved nursing team collaborative care (Nursing Council of New Zealand 2019). Lastly, to
reduce fear and confusion, it is recommended that a fixed conflict resolution framework coupled
with training provision is established for improved conflict resolution and improving staff
capabilities (Kim et al., 2017).
Conclusion
Hence, it can be concluded that timely and prompt usage of adequate leadership and
management strategies will result in efficient resolution of a conflict situation. The above
scenario was managed with the aid of leadership styles of the situational and transformational
type, followed by professional nursing competency and management based strategies of
empathetic communication, patience, compassionate care, therapeutic relationship and cultural,
family and patient centered approaches to care. It is hence recommended that established
organizational frameworks of conflict management followed by educational programmes to
teach staff on conflict resolution strategies are implemented to ensure improved mitigation of
critical situations in the future.

9CLINICAL LEADERSHIP AND MANAGEMENT
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