Nurse Leader Conflict Scenario 1: Resolving Conflicting Provider Orders (Cardizem, Abiraterone and Edema)

Nurse Leader Conflict Scenario 1: Conflicting Provider Orders for a Cardiac-Oncology Patient (Cardizem and Abiraterone)

Dr. Marcy Maribell is a cardiologist consulting with the patient in room 67, Wendell Edwards. Mr. Edwards is a 72-year-old male who was admitted for complications from COVID-19 eleven days ago. Darrel Perkins, DNP, FNP-C, is Mr. Edwards' primary care provider. Mr. Edwards is also being seen by Dr. Sarah Parlay, oncologist, for an atypical case of aggressive prostate cancer. Dr. Maribell insists that Mr. Edwards not only stay on his Cardizem but needs an increased dose due to rising pressures. However, Dr. Parlay insists that Mr. Edwards stay on his abiraterone. Dr. Perkins has assessed that his patient is having increased edema and hypertension because of the incompatibility of Cardizem and abiraterone. Everyone is concerned about the pulmonary side effects of edema, but refuse to listen to one another, giving conflicting orders to the nursing staff. How will you, and the unit manager, address the conflict?

Directions: For each scenario, evaluate the situation and name (1) the kind(s) of issue occurring, (2) the method(s) you as the leader will use to bring a resolution, from your module reading, and (3) the communication and other actions you would take to resolve the situation fairly and equitably for the participants, the unit and the organization. Copy the scenario into a Word document and answer in 200–400 words.

Original example for study purposes (about 540 words). The scenario is copied at the top, as the directions require; the answer below it is within the 200–400 word limit. Replace the references with your module reading if required.

Scenario: Dr. Marcy Maribell is a cardiologist consulting with the patient in room 67, Wendell Edwards. Mr. Edwards is a 72-year-old male who was admitted for complications from COVID-19 eleven days ago. Darrel Perkins, DNP, FNP-C, is Mr. Edwards' primary care provider. Mr. Edwards is also being seen by Dr. Sarah Parlay, oncologist, for an atypical case of aggressive prostate cancer. Dr. Maribell insists that Mr. Edwards not only stay on his Cardizem but needs an increased dose due to rising pressures. However, Dr. Parlay insists that Mr. Edwards stay on his abiraterone. Dr. Perkins has assessed that his patient is having increased edema and hypertension because of the incompatibility of Cardizem and abiraterone. Everyone is concerned about the pulmonary side effects of edema, but refuse to listen to one another, giving conflicting orders to the nursing staff. How will you, and the unit manager, address the conflict?

Kind of Issue

This is an interprofessional (interdepartmental) conflict among three providers, rooted in competing goals: Dr. Maribell is focused on blood pressure, Dr. Parlay on cancer control and Dr. Perkins on a possible drug-related cause. It has become a patient safety and communication issue, because conflicting orders leave nurses unsure what to give, and Mr. Edwards is at risk of fluid overload in his lungs after COVID-19.

Method of Resolution

I would use collaboration, the conflict resolution strategy that seeks a win-win solution focused on a shared goal rather than on who is right (Marquis & Huston, 2021). Competing or avoiding would leave the patient at risk. Collaboration is supported by structured team communication tools such as SBAR and a care conference (Agency for Healthcare Research and Quality [AHRQ], n.d.).

Communication and Actions

1. Protect the patient first. The unit manager would tell the nurses to hold any disputed dose change until the orders are clarified, keep monitoring vital signs, weight, intake and output, oxygen saturation and lung sounds, and report changes right away. Conflicting orders must be clarified, not guessed.
2. Call a same-day care conference. The manager would bring together Dr. Maribell, Dr. Parlay, Dr. Perkins, a clinical pharmacist and the charge nurse. Using SBAR, the nurse would present the patient’s current condition and trends.
3. Refocus on the shared goal. I would open by naming what everyone agrees on: keeping Mr. Edwards safe and treating both his heart and his cancer. The pharmacist would review the drug interaction concern. Abiraterone can raise blood pressure and cause fluid retention, and diltiazem can also cause edema, so the team can weigh options such as dose changes, alternative blood pressure medicines, steroids given with abiraterone and diuretics.
4. Agree on one plan and one voice. The team would name an attending provider responsible for writing reconciled orders and document the plan in the EMR. Mr. Edwards and his family would be included in the decision.
5. Escalate if needed. If the providers cannot agree, the manager would use the chain of command to the medical director or chief medical officer.
6. Follow up. Afterward, the manager would debrief with the nursing staff and suggest a unit protocol for handling conflicting orders from multiple consultants.

This approach treats each specialist’s concern as valid, keeps nurses out of the middle and puts the patient’s safety at the center.

References

Agency for Healthcare Research and Quality. (n.d.). TeamSTEPPS: Team strategies and tools to enhance performance and patient safety. https://www.ahrq.gov/teamstepps-program/index.html

Marquis, B. L., & Huston, C. J. (2021). Leadership roles and management functions in nursing: Theory and application (10th ed.). Wolters Kluwer.

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