Introduction

Smithtown Cancer Center: Charlene Morgan and Nancy Steele are nurses on the same unit who typically work the same schedule. Nancy can't believe they both attended the same school and the same chemotherapy certification course. She thinks Charlene's patient care is lacking, and it is tough to make sense of her documentation, even though their unit uses a well-designed flow sheet. Patients seem to like her, commenting on her warmth and caring. But Nancy is uncomfortable with her standards, and has complained to the Nurse Manager twice. Nancy has hinted to Charlene at least three times about this and nothing has changed. She is frustrated!

Hospital A, Surgical unit, 4-C: Michael Johnson has just left a monthly unit meeting with his new nurse manager, Marlys Stone, and is quite upset to discover that she has agreed to the implementation of Dr. Jones' post op protocol without consulting the nurses. In two weeks the staff are supposed to begin accepting Dr. Jones' patients, because, according to him, "4-C provides better care" than 3 North, where they would normally be admitted. This protocol requires more intense monitoring and documentation during the first 4 hours post-recovery than the "routine" patient on 4-C. Marlys has copied the new protocol for every member on the unit, and attached a note at the top stating that she expects this to begin in two weeks, on the day shift. When Michael talks to Dr. Jones, he says that changing the protocol was the hospital's idea, but that he is "fine with whatever Administration wants to do". Where do you begin?

The Practice Partners: Joanne Wilson, RN and Linda Brown, LPN, have been paired as Practice Partners on their unit for the past three months. (Their state's Nurse practice Act includes a delegatory clause which allows RNs to delegate nursing care to individuals under their supervision, as long as certain requirements for training and ongoing evaluation of the person being supervised are met.) As Practice Partners, they work the same schedule, and together, care for a larger group of patients than either one of them could handle alone. Linda has complained to Kate Jones, the Nurse Manager, at least twice about the partnership, in particular, that she felt stifled. When Kate checked with Joanne, her reply was that "everything's just fine. Our patients aren't complaining, are they?" Kate has encouraged Linda to go along with it a little longer because partnering is still somewhat new to everyone and she knows that Joanne is really committed to making the concept work. The structure and size of the nursing unit do not allow for a change in partners, and Kate is very anxious for Joanne to have a good experience with this. Joanne is one of her most positive and motivating staff. Linda seeks Kate out one more time to tell her that she really needs help with the partnership. She tried telling Joanne about her feelings, but Joanne simply replied "I'm sorry you feel that way, but I have my responsibilities and license to look out for. "

Each of the above scenarios is an example of a conflict that can be resolved using the techniques of alternative dispute resolution. Alternative dispute resolution (ADR) refers to any procedure, other than litigation, which can be used to resolve disputes. Two of these case situations will be further developed in this independent study module to demonstrate the application of ADR concepts.

The state of today's health care delivery in the United States is characterized by turmoil, confusion and frustration. It seems that everyone is affected; patients/clients, direct care providers, administrators, insurers and even regulators. ADR is important to nurses and others providing health care for two important reasons. First, conflicts will always be with us and they are only likely to increase in health care for the immediate future. Second, using conflict resolution methods that are quick and less adversarial than litigation can help us respond rapidly to change, and maintain the relationships that are so necessary for our future survival, not to mention quality of work life. The increasing number of health care mergers has shown us that today's enemy may well be tomorrow's partner.