Teamwork is one of the most important concepts in nursing. The purpose of teamwork is to ensure that clients receive the best possible care. For the new graduate or re-entry nurse there is many aspects to teamwork, these can be both positive and negative. You are required to critically analyse the literature to:
Discuss your responsibility and accountability as a new member of this team
Demonstrate an understanding of the interpersonal relationship skills that new graduates need to be part of this team
Define conflict resolution with specific reference to the new graduate or re-entry nurse
Discuss how new graduates manage conflict resolution situation in the workplace
Discuss conflict resolution principles with regard to bullying and harassment in the workplace
Introduction
Transition from being a student of nursing studying in a university to a new graduate nurse working in a hospital setting will never be an easy toll that every novice RNs (Registered Nurses) must face individually. New RNs will face challenges far more different and complex than those they have tackled inside the classroom and it is important that they are well equipped with the right knowledge once they enter their professional careers in the workplace. Building teamwork amongst each member of the team as well as developing an effective communication and conflict resolution skill will be an essential factor that new nurses should generally work on to ensure that clients get the best care possible.
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Discussion
Discuss your responsibility and accountability as a new member of this team
As the newest member, it is my responsibility to fit in and establish a productive and positive working relationship with my colleagues (ANMC 2005, 10.1, p.7). Following the five-phase model based on organizational development and group process theory known as the Team Spirit Model, it is one way of opening up and starting team interaction (Griffiths & Crookes 2005). Introduction of one’s self to the rest of the team as an initial step is important, as well as sharing each others’ point of view and outlook on how they could work harmoniously amongst each other is an essential element of building trust within the team. The second phase is to have a shared vision and mission by being open about the assumptions they have of their own work and of the other members work leading the team to the third phase of the model which is doing the work assigned to each member of the team. The team at this stage usually becomes successful only if they were able to achieve the second phase of the model. The fourth stage is usually overlooked by the team, but celebration of recognition achieved by members and sharing of success stories is important in strengthening closeness among them. The last phase of the model is to ensure that an effective communication is always present between each member, ‘seek first to understand, then to be understood’ is a guiding principle that applies to effective communication (Griffiths & Crookes 2005). As a new graduate nurse, it is my responsibility to work collaboratively with the health care team by becoming an active participant in providing complete and proper nursing care by establishing a positive and productive working relationship with colleagues, and recognizing and understanding the separate interdependent roles and functions of each health care team members (ANMC 2005, 10.1, p.7; Griffiths & Crookes 2005, p.185). RNs should remember that they are accountable for every action and decision they make even if they are already part of the team and it is the RNs utmost responsibility to clarify unclear questions, decisions and directions which they do not understand. RNs should collaboratively work on the nursing care plan in consultation with the interdisciplinary health care team and explain to them the role that nurses play within the team (ANMC 2005, 10-10.1, p.7). According to QNC (2006, p.1), building a collaborative relationship needs a solid foundation and these include clarifying the roles of people with whom we wish to participate in collaboration, developing supportive environments and open communication. A successful patient management within the team will be based on individual accountability and responsibility while working collaboratively with the rest of the members in delivering quality care. It is important that the nurse first establish if they share any responsibility for the care being carried out by others so that they could be properly supervised and ensure that the care provided is within the scope of nursing practice (QNC 2005, p.5).
Demonstrate an understanding of the interpersonal relationship skills that new graduates need to be part of this team
Becoming the newest member of the health care team is not easy. Newly or re-entering RNs may encounter difficulties when it comes to establishing and or understanding interpersonal relationship skills. Interpersonal skills are basically the skills we need to get along with others in which effective communication becomes the foundation of interpersonal relationships (Hauck & Hussey 1997). In order to have a successful interpersonal relationship with other members of the team, the RN needs to improve different sets of skills like developing trust, empathy and respect for the individual/group, effective listening and communication, and by effectively initiating, maintaining and concluding interpersonal interactions (ANMC 2005, 9, p.7). One good example is when a high-risk patient arrives under our management, while working with the team, one should be able to practice and implement an effective therapeutic approach to successfully provide care. Collaborating and effectively communicating on how to organize the nursing care plan is important to facilitate continuity in the provision of a comprehensive nursing care to arrive at the agreed health outcome (ANMC 2005, 10.3, p.8). As the newest member, it is important to gain their confidence and trust by efficiently and competently doing what is assigned to me. If ever guidance is needed on my part, it is my responsibility to request for supervision in order to uphold that everything is for the best interest of the patient and to ensure that standards of practice are always met. New graduate nurses need to understand the importance of building good interpersonal relationship skills for them to jive effectively with their team. One example of good interpersonal skill is when a member of the team like an EN (Enrolled Nurse) came to ask a RN on how elevating the client’s leg, which is full of varicosities, with pillows helps in the minimizing leg congestion. The RN then focuses his attention to the EN to actively listen, and having good interpersonal skills, instead of telling the EN to just read on anatomy and physiology of the human body, the RN would explain that elevating the leg at a level above the heart would facilitate venous return by gravity because patient’s with varicosities have abnormalities in venous valves which causes the blood to backflow resulting in venous congestion and leaking-out of fluids to the surrounding tissues with the affected part appearing edematous, usually noticeable on the most dependent part of the body like of the lower extremities. With good applied interpersonal skills, the RN would definitely gain the trust and confidence of other members which would help build a harmonious relationship and a therapeutic-collaborative approach benefiting the team and most importantly, their patients.
Define conflict resolution with specific reference to the new graduate or re-entry nurse and discuss how new graduates manage conflict resolution situation in the workplace
RNs deal with different types of people, be it another professional health care worker or a client needing care. In reality, RNs are exposed to possible conflict scenarios more than any other health professionals. Conflict is a communication problem between two or more people which tends to ‘arise when there is a perceived difference in opinion or when one party believes that another is preventing them from reaching their goal’ (ADF Mental Health Strategy, nd.). According to Sivamalai (2008, p.9), ‘the failure to manage conflict effectively is one of the most common causes that prevent nurses from developing to their fullest potential. When conflict remains unresolved, trust and commitment do not exist’.
New RNs should follow the basic principles of conflict resolution when dealing with conflicts in the workplace. Having a nurse manager as a mediator would be the best, most direct way of negotiation between conflicting parties (Managing Conflict in the Workplace n.d.). The RN, if acting as the mediator, should initially bring both parties together and then lay down ground rules, e.g. they should not interrupt each other because each party will get a chance to state their opinion. The mediator should identify the problems with each party having the chance to outline the incident/issues from their point of view, prioritizing according to urgency. The RN must then find a way so that both parties would be able to understand each others’ feelings and point of view or to agree or disagree on cases of irresolvable issues. A resolution for each issue should be sought looking for ways to prevent recurrence in the future. The involved parties will be given a written transcript of the meeting and have each one sign a commitment to future awareness of the problem/issues. Review of the situation should take place to determine if the issues were resolved or if there is further need for another mediation procedure (State of Queensland (Integrated Resource Manual) 2007a).
Discuss conflict resolution principles with regard to bullying and harassment in the workplace
Bullying, harassment and discrimination includes a wide range of unwelcomed and unsolicited behaviors that are largely defined by the offended person and can be defined as ‘the repeated less favorable treatment of a person in the workplace which may be considered unreasonable and inappropriate workplace practice’ (ANF 2007; NSW 2005). Workplace harassment does not include any actions coming from the management if it is reasonably done and in scope of the employment practice such as corrective actions done by the management in response to the nurse’s poor working performance, and an isolated incident of an unreasonable behavior can’t be considered as bullying because of being a one-off incident, but typically should not be ignored or tolerated to prevent the situation from escalating (State of Queensland 2008, pp. 2 & 5; State of Queensland (Integrated Resource Manual) 2007b, p.2). Bullying tends to be a continuous behavior pattern aimed at causing someone else harm (CARM n.d.). According to Perry (2004), the prevalence of workplace harassment usually occurs downwards, employees being bullied by more senior staff which is often behind closed doors and tolerated by a culture of silence; laterally, between a nurse and a co-nurse and upwards, a nurse harassing his or her nurse manager. RNs have a role to play in eliminating harassment and bullying in the workplace by refusing to join in with these types of actions and are encouraged to report any incidents of such behavior so that a process of resolution can be made (State of Western Australia 2008, p.2).
According to ANMC (2008a, p.5), dismissiveness, indifference, manipulativeness and bullying are intrinsically disrespectful and ethically unacceptable so that nurses who harass or bully someone would violate provisions of this Code. Employers have the obligation to ensure the health and safety of their employees, therefore, employers obligation extend to minimizing or eliminating exposure to the risk of workplace harassment (Queensland Workplace Health and Safety Act 1995, s.28). As for employed RNs, they should ensure and be responsible enough to comply with the instructions given for workplace health and safety by their employer (Queensland Workplace Health and Safety Act 1995, s.36).
Every RN has the duty and responsibility to report any suspicious act of harassment or bullying, inability to report these health and safety issues would put the RN in violation of the Code of Professional Conduct for Nurses conduct statement 4 which states that ‘nurses respect the dignity, culture, ethnicity, values and beliefs of people receiving care and treatment and of their colleagues’ (ANMC 2008b, p. 4). The problem is that the victim often lacks the self-confidence to report and file a complaint to appropriate authorities for fear that they may have contributed to the act and fear of being dismissed from work if they lodged a complaint (Kieseker & Marchant 1999). Examples of bullying that could make a RN feel powerless and anxious about coming to work include: verbally abusing and humiliating a nurse by the employer/supervisor/medical officer when others are present, constant ridicule and being put down, spreading malicious gossips/rumors with an intent to cause the person harm and deliberately sabotaging a person’s work like withholding or supplying incorrect information, not passing on messages and getting a person into trouble (State of Queensland 2008). The RN should act early if harassment or bullying is suspected so as not to allow the behavior to escalate. RNs and other health care professionals should not discriminate, harass, bully or mistreat patients, clients, other employees or members of the public by treating all with courtesy, honesty and by respecting the dignity, rights and views of others, including different values, belief, cultures and religions (State of Queensland 2006).
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The basic principles of conflict resolution aims to achieve resolution by commitment to an agreed action through a combined effort of problem solving, carefully analyzing the facts, looking at the situation in their perspective, dealing with aggression, emotion and stress appropriately separating them from facts, keeping hold of one’s agenda and focusing on the desired outcomes, learning to disagree as to minimize the risk of escalating the dispute is important, being aware of your actions and what you try to convey to the parties involved, and having someone to mediate between parties is important specially if one of the involved is a superior (ADF Mental Health Strategy, n.d.).
The RN must deal with the incident locally at first using the direct approach, not yet necessary at this stage to put everything in writing, by talking to a supervisor or any relevant authority regarding the issues of harassment that needs to be addressed. If the RNs immediate supervisor has failed to resolve the issue, it could be referred to the more senior manager which could offer the RN mediation, facilitation or other informal process. If all informal ways of handling harassment complaints have failed, the RN could then lodge a written complaint which would then be presented to the people you have complained against to give them a fair chance to respond, and a decision can be made about appropriate ways to resolve the grievance. After all has been done, but still cannot be resolved locally, it would be referred to the Workplace Investigating Unit (WIU) which would initially make an assessment of the complaint and may decide to still try and continue with informal methods or start an investigation. During the workplace visit, review of documentation and survey or interview staff members will be conducted by the inspector who will then identify if there is a risk of injury from workplace harassment through review of controls implemented at the workplace (State of Queensland (Department of Employment and Industrial Relations) 2007). The WIU would be the one to manage the investigative process by appointing an investigator and outlining the terms of reference of the investigation, and following the principles of natural justice, furnishing those involved of the copy of the decision made after due process has been followed (State of Queensland, n.d.).
Conclusion
In summary, it’s not easy for novice RNs to immediately accustom one’s self to a new environment and jive with a new set of heath care professionals. RNs need to develop very good interpersonal skills to be able to work efficiently and it is a must that a healthy professional relationship amongst each member be always present before, during and after each provision of care so that the patient’s best interest would always be upheld. It is the RNs responsibility to see to it that he or she would fit well with the team so that everyone could do their job efficiently. Support mechanisms need to be tailored accordingly to each new graduate nurse in an effort to meet their needs and that hospitals need to develop and implement realistic and practical ways to eradicate bullying in the workplace (Evans, Boxer and Sanber n.d.).
RNs must remember that they have an important role to play in eliminating harassment and bullying in the workplace, this is achieved by not joining and tolerating these kinds of behaviours and supporting the person to say ‘no’ to these behaviours (The University of New Castle Australia 2008). RNs need to be aware of the different guidelines and hospital policies when it comes to bullying and harassment so that incidents such as these would be tackled even before it escalates into a crisis situation. Resolution of conflict requires clear procedures for communication and decision making, commitment to team building, and consideration of factors such as number of team members and their personalities (Griffiths & Crookes 2005).
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