NUR4103 Module 5 conflict resolution paper example

Four Admissions in Four Nights: Resolving a Disagreement With a Charge Nurse Over a Traveler's Share of the Work, Using the DESC Script

Student Name

American College of Education

NUR4103: Professional Skills to Thrive as a Travel Nurse

Module 5 Assignment

Instructor Name

February 5, 2029

The Conflict

By the sixth week of my thirteen-week contract on the telemetry unit, I had settled in, and the permanent staff had started to rely on me. On four consecutive night shifts, the same charge nurse assigned me every new admission to the unit, a total of seven admissions, while I carried five patients. On the fourth night, two admissions arrived within forty minutes, one with new atrial fibrillation and one with chest pain awaiting a second troponin, and I fell behind on hourly checks for a patient on a heparin infusion. When I asked for help, the charge nurse said the admissions had to go somewhere and that travelers were paid to take them. Another nurse laughed. I finished the shift frustrated and embarrassed, and I noticed I had started avoiding the charge nurse at the station.

Where the Conflict Came From

Conflict on nursing teams has several recognized sources. An integrative review of conflict in health care teams identified individual factors, such as communication skills, interpersonal conditions and contextual factors, including heavy workloads, poor work environments and role ambiguity (Almost et al., 2016). All three were present. The contextual driver was workload: nights on this unit were short-staffed, and admissions were rising. The role question was real: my contract said nothing about admissions, and the unit had no written rule for distributing them. And the interpersonal condition was the pay gap. Research on communication between travel and permanent nurses describes how social comparison and perceived envy can shape how permanent staff treat travelers (Gan, 2020), and the comment about being paid to take admissions suggested that comparison was part of the charge nurse's reasoning.

I also had to consider my own part. I had accepted the first three nights of admissions without comment, which may have signaled that I did not mind. Because I avoided raising it until I was overwhelmed, the first time the charge nurse heard my concern was in the middle of a crisis, in front of others. By staying quiet for three nights, I had helped create the pattern I was now resenting.

The Model: DESC

I chose the DESC script, a structured approach to raising a conflict taught in the TeamSTEPPS program for health care teams. DESC stands for describe the specific situation or behavior, express your concerns, suggest other alternatives and state the consequences in terms of shared goals, with the aim of reaching agreement (Agency for Healthcare Research and Quality [AHRQ], 2023). I chose it for three reasons. It keeps the conversation on specific, observable facts rather than on character, which matters when the other person has more power on the unit. It asks the speaker to offer an alternative rather than only a complaint. And it frames consequences in terms of patient safety, the goal both of us share. TeamSTEPPS also advises holding such conversations privately and at a suitable time, which is the opposite of what happened on the fourth night.

Other Options Considered

Before choosing a direct conversation, I considered three other responses. The first was to say nothing and accept the admissions until the contract ended. Travelers often do this, reasoning that the assignment is temporary and that complaining risks a bad reference. But the fourth night showed that the pattern was already affecting patient safety, and seven more weeks of it would have been neither safe nor sustainable for me. The second option was to go straight to the nurse manager. Managers have authority over assignments, and the manager had invited me to raise concerns at our week-one meeting. However, going over the charge nurse's head as a first step would likely have been seen as disloyal by the permanent staff, whose goodwill a traveler depends on, and it would have denied the charge nurse the chance to fix a problem she might not have noticed. The third option was to call my agency's clinical liaison. The liaison is the right contact when a traveler is asked to work outside their competence or when a unit is unsafe, but this was a disagreement about workload distribution between colleagues, not a question of competence, and bringing in the agency would have escalated it unnecessarily. I decided that a private conversation with the charge nurse was the appropriate first step, and that I would move to the manager, and then the liaison, only if the conversation failed or if an unsafe assignment recurred. Deciding the order of escalation in advance made the conversation itself less anxious, because I knew what I would do if it did not work.

The Conversation

I asked the charge nurse if we could talk for five minutes before the start of our next shift together, in the break room. I used the four steps.

Describe: Over the last four nights, I received all seven admissions to the unit while carrying five patients. On Thursday, two arrived within forty minutes and I fell behind on hourly checks for a patient on heparin.

Express: I am concerned that I could miss something important when that happens, and I felt singled out when I asked for help and was told travelers are paid to take admissions.

Suggest: I am glad to take my fair share of admissions, and I know travelers are often expected to take more. Could we rotate them through the nurses with the lightest assignments, and could I give you a heads-up at the start of the shift if my patients make another admission unsafe?

Consequences: I think that would keep the admissions safe and help me stay reliable for you for the rest of the contract, including taking extra when the unit is really stuck.

The charge nurse was quiet for a moment, then said she had not realized I had taken every admission, because the other night charge nurses had also been giving them to me, and that the comment about pay had been a bad joke. She agreed to rotate admissions by assignment load and said she would mention it to the other charge nurses.

Outcome and Reflection

Over the next three weeks, I received two or three of the roughly nine admissions each week on nights, a heavier share than some permanent nurses but no longer all of them, and the charge nurse began checking my assignment before sending an admission. The relationship improved; she asked me in week nine whether I would consider extending the contract. Research on travel nurses' satisfaction with assignments found that travelers stayed or extended when they felt supported and had some flexibility (Owens et al., 2024), and this conversation was a turning point in whether I felt supported.

Three lessons carry to future contracts. Raise a pattern early, after the second occurrence rather than the fourth, and never first in front of others during a crisis. Use a structure such as DESC, which kept me specific and calm when I was frustrated. And own my part: my silence had made the pattern easier to continue. I will carry the four steps on a card to my next assignment.

References

Agency for Healthcare Research and Quality. (2023). TeamSTEPPS 3.0 pocket guide.

Almost, J., Wolff, A. C., Stewart-Pyne, A., McCormick, L. G., Strachan, D., & D'Souza, C. (2016). Managing and mitigating conflict in healthcare teams: An integrative review. Journal of Advanced Nursing, 72(7), 1490-1505. https://doi.org/10.1111/jan.12903

Gan, I. (2020). Social comparison and perceived envy-motivated communication involving travel nurses: A qualitative study. Journal of Nursing Management, 28(2), 377-384. https://doi.org/10.1111/jonm.12939

Owens, S., West, B., & Watson, H. (2024). Exploring reasons for satisfaction with job assignments among travel nurses. Journal of Nursing Administration, 54(11), 625-630. https://doi.org/10.1097/NNA.0000000000001501