HLTH 3105 Week 5 Team Conflict Case Analysis Example

Not a Difficult Colleague but a Structure That Invited the Fight: The Charge Nurse, the Case Manager and Two Measures That Pulled in Opposite Directions

Student Name

Walden University

HLTH 3105: Interprofessional Teamwork in Healthcare

Instructor Name

Month Day, Year

Not a Difficult Colleague but a Structure That Invited the Fight: The Charge Nurse, the Case Manager and Two Measures That Pulled in Opposite Directions

The Conflict

For several months, the charge nurses and one of the nurse case managers on our medical unit have clashed over discharge timing. The pattern repeats. Around 1000, the charge nurse, under pressure from the bed management office to free beds for emergency admissions, asks the case manager to have patients out by 1100. The case manager pushes back, saying a particular patient's home services are not confirmed and an early discharge risks a return to the hospital. The exchange grows sharp. Staff describe the case manager as rigid and the charge nurses as pushy, and new nurses have been warned to avoid getting caught between them.

The easy story is about personalities. This paper tells a different one. It asks what the structure invited: which overlapping authority, unclear decision right or competing measure made this disagreement likely before either person said a word. The unit is described from my observation as a discharge coordinator assistant; names and details are left out.

Structural Cause 1: Competing Measures

The charge nurse and the case manager are each judged on a different number. Charge nurses report to the unit's nurse manager, whose dashboard prominently tracks the share of discharges completed before noon, a measure the hospital adopted to improve patient flow from the emergency department. Case managers report to the case management department, whose dashboard tracks 30-day readmissions and avoidable days. Each person is doing exactly what their own measure rewards. An early discharge helps the first number; a discharge delayed until services are confirmed helps the second. When one patient's discharge affects both numbers in opposite directions, conflict is close to guaranteed.

Classic work on organizational conflict describes this kind of structural source: when interdependent people are evaluated on goals that cannot all be met at once, conflict follows regardless of personality (Thomas, 1992).

Structural Cause 2: An Unclear Decision Right

Nobody on the unit can say who decides when a patient is ready to leave. The physician writes the discharge order, which states that the patient is medically ready. The case manager decides whether the plan for after discharge is safe. The charge nurse decides how the unit's beds and staff are used. When the physician has written the order but the home services are not confirmed, each of the other two believes the decision is theirs. The hospital's discharge policy says discharge planning is "a collaborative process," which is true and settles nothing.

Federal rules require the hospital to have an effective discharge planning process, but they leave the assignment of decision rights to the hospital (42 C.F.R. § 482.43). Our hospital has not made that assignment for the specific situation that produces most of the conflict.

Structural Cause 3: Overlapping Authority Without a Shared Forum

Both roles have legitimate authority over part of the discharge, and the parts overlap at the hour of departure. Yet there is no regular time when they meet to settle that hour together. The conversation happens at 1000 in a hallway, under time pressure, with a bed request already waiting. A conflict that could be resolved calmly the evening before, with both measures in view, is instead resolved in a few tense minutes with neither person able to step back.

The interprofessional competencies stress that teams need shared processes for communication and decision-making, not just mutual respect (Interprofessional Education Collaborative, 2023). Respect between these two professionals exists; a shared process does not.

What the Structure Predicts, and Why Personality Is the Wrong Target

If the conflict came from personalities, replacing either person would end it. The structure predicts otherwise: any charge nurse measured on noon discharges and any case manager measured on readmissions, meeting at 1000 with no settled decision right, would clash over the same patients. In fact, a second case manager on the unit has had milder versions of the same disagreements, and a charge nurse transferred from another unit adopted the pushy role within weeks. That pattern is evidence for the structural reading.

Treating the conflict as personal also does harm. It teaches new staff to avoid both people, which slows communication, and it leaves the case manager, who is raising real safety concerns, labeled as difficult, which makes it harder for anyone to raise similar concerns in the future.

What the Two People Said When Asked Separately

When I asked the case manager, privately, what made the 1000 conversations so hard, she said she was not trying to block discharges; she was trying to avoid the call two days later from an emergency department nurse saying a patient had come back because oxygen never arrived. When I asked one of the charge nurses the same question, she said she was not trying to rush unsafe discharges; she was trying to avoid the call from bed management asking why three emergency patients were still waiting for beds at noon. Each was describing the call she dreaded, and each call came from the measure she was judged on.

Neither described the other as difficult. Both described the situation as frustrating. That difference, between how staff spoke about each other in the hallway and how each spoke about the situation in private, is itself evidence that the conflict is structural. People in a structural conflict often blame each other in public because the structure is invisible, while privately they describe the pressures they share.

Changing the Structure

Three structural changes would make the conflict less likely. First, align the measures: add readmissions to the nurse manager's dashboard and add noon discharges for patients with confirmed services to the case management dashboard, so each role sees both sides of the trade. Second, assign the decision right in writing: once the physician's order is written, the case manager decides whether the post-discharge plan is safe, and the charge nurse decides the order in which ready patients leave. Third, move the conversation: a ten-minute discharge huddle at 1530 the afternoon before, where tomorrow's discharges are sorted into ready by noon, ready later and not ready, with reasons. Most of the 1000 arguments would then happen calmly a day earlier, or not at all.

References

Condition of participation: Discharge planning, 42 C.F.R. § 482.43 (2024).

Interprofessional Education Collaborative. (2023). IPEC core competencies for interprofessional collaboration: Version 3. https://www.ipecollaborative.org/ipec-core-competencies

Thomas, K. W. (1992). Conflict and conflict management: Reflections and update. Journal of Organizational Behavior, 13(3), 265-274. https://doi.org/10.1002/job.4030130307