Nurse Leader Conflict Scenario 2: Handling Disruptive Physician Behavior at a Bedside Bone Marrow Procedure

Nurse Leader Conflict Scenario 2: Disruptive Physician Behavior at a Bedside Bone Marrow Procedure (Oncology/Hospice Unit)

Caroline Xen is a nurse on your oncology/hospice unit. She is an experienced nurse who receives accolades from patients and families alike. Caroline is young, bubbly, and full of energy. Statistically, she has excellent results with her patients. Dr. Mitchell Schmidt is an oncologist who has been practicing for over 50 years and demands that everything be done the way he has always done them. More than once, he has been heard telling nurses that he can't believe the lack of respect they show and that he would fire them all if the nurse-manager would just listen to him. He refuses to use the EMR and does not return texts from the electronic message system when nurses follow the facility protocols for alerts to providers and requests for orders or clarifications. Until now, most of the staff just walked on eggshells around Dr. Schmidt. However, today, Caroline Xen was assigned as his nurse at a bedside bone marrow extraction. The session ended with Dr. Schmidt yelling at the top of his lungs, the patient in intense pain, and Caroline was in tears. No one did anything technically wrong. However, it was a mess. How will you handle the event on your floor?

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 580 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: Caroline Xen is a nurse on your oncology/hospice unit. She is an experienced nurse who receives accolades from patients and families alike. Caroline is young, bubbly, and full of energy. Statistically, she has excellent results with her patients. Dr. Mitchell Schmidt is an oncologist who has been practicing for over 50 years and demands that everything be done the way he has always done them. More than once, he has been heard telling nurses that he can't believe the lack of respect they show and that he would fire them all if the nurse-manager would just listen to him. He refuses to use the EMR and does not return texts from the electronic message system when nurses follow the facility protocols for alerts to providers and requests for orders or clarifications. Until now, most of the staff just walked on eggshells around Dr. Schmidt. However, today, Caroline Xen was assigned as his nurse at a bedside bone marrow extraction. The session ended with Dr. Schmidt yelling at the top of his lungs, the patient in intense pain, and Caroline was in tears. No one did anything technically wrong. However, it was a mess. How will you handle the event on your floor?

Kind of Issue

This is an interpersonal conflict between a physician and a nurse, caused by disruptive (uncivil) provider behavior and a clash of values: Dr. Schmidt holds on to old routines, while Caroline follows current facility protocols. It is also a patient safety and quality issue. The Joint Commission (2008) warns that intimidating and disruptive behaviors undermine a culture of safety, and Dr. Schmidt’s refusal to use the EMR and electronic messaging creates delays and communication gaps. The patient’s intense pain shows that the conflict affected care, even if no one made a technical error.

Method of Resolution

I would use confrontation through collaboration: addressing the behavior directly and privately with clear expectations, rather than avoiding or smoothing it over (Marquis & Huston, 2021). I would combine this with just culture principles, which focus on behavior and systems rather than blame, and with the facility’s code of conduct and chain of command.

Communication and Actions

1. Care for the patient first. I would make sure the patient’s pain is reassessed and treated, check the procedure site and apologize to the patient and family for the distress they experienced.
2. Support Caroline. I would meet with her privately and let her describe what happened. I would affirm her professionalism, offer the employee assistance program and ask her to file an incident report describing behaviors, not opinions.
3. Gather facts. I would speak with witnesses and document objectively.
4. Meet with Dr. Schmidt privately. I would invite the medical director or department chief to join. Using the DESC script (describe, express, specify, consequences) from TeamSTEPPS (AHRQ, n.d.), I would acknowledge his experience, describe the specific behaviors, explain their effect on patient care and staff, and state expectations. These include respectful communication, use of the EMR and response to electronic alerts.
5. Use the chain of command. Repeated behavior would be referred to the medical staff’s professional conduct process, as facility policy requires.
6. Strengthen the unit. I would hold a team debrief, provide TeamSTEPPS training on tools such as CUS (“I am concerned, uncomfortable; this is a safety issue”) and make clear that staff should report disrespectful behavior without fear of retaliation.

These steps protect the patient, support staff and hold every team member to the same standard of respect.

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

The Joint Commission. (2008). Behaviors that undermine a culture of safety. Sentinel Event Alert, (40).

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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