Benny, the newly promoted manager of the hospital's imaging department, answered his phone, "Good morning, imaging, this is Benny, how can I help you?" The phone's caller ID indicated the person on the other end was Lucy, one of the veteran radiology technologists. "We have a situation here and an infant patient's parents want to see you immediately. Can you come down to radiology's procedure room #1?"

Benny hung up the phone and quickly made it down to the radiology department's procedure area. Upon arriving, Benny introduced himself to the parents of an infant patient who quickly related that they were not satisfied with the information provided by Lucy in reference to the sequence of events that had taken place with their child's care. Benny had little background information on the situation prior to arriving, and this put him at a slight disadvantage. He only knew that the issue began in the pediatric nursing unit when an invasive radiology procedure, called a crystogram, was ordered for the infant. (This particular procedure involves the insertion of a urinary catheter that is removed at a certain point during the exam and is typically ordered to diagnose a multitude of bladder diseases.)

Upon arriving to the radiology department, quick introductions were exchanged and the infant's father began to explain why he was dissatisfied with the hospital's services, alluding to the fact he wanted something done immediately, stating, "I am a lawyer and I am very upset! I want someone to explain what has occurred here." His comments referred to the information he just received from Lucy, which conflicted with what he had observed in the pediatric nursing unit while he son was under the care of nurse, Marcia. The infant's mother, while present, added her thoughts only periodically such as, "I felt something was not right. I don't remember seeing the nurse use any lubricant." The father's demands were specific, which included a request for an immediate reassignment of his infant's nurse due to a series of events that occurred outside of the radiology department. The vents on the pediatric nursing unit lead the father to believe the RN in this particular case was incompetent. Although the issues involved specifically related to the urinary catheter implemented by the RN, there appeared to be an overall competence concern on behalf of the parents, which was the catalyst for their present hostility.

The decision with the father focused on three specific issues. The first concern was that initially the incorrect size catheter was selected by Marcia. The second concern was that the incorrect tape was utilized, causing the skin to be irritated and swollen upon removal. The final concern was a result of both the incorrect catheter size and tape - the catheter "fell out." This series of events lead to the reinsertion of the catheter, which only served to further upset the parents.

Once Benny allowed the parents to explain the issues at hand, the father requested that the issues be addressed with Marcia immediately. To Benny, the request seemed reasonable as Marcia seemed to be the source of the parent's anger and dissatisfaction. Therefore, Benny thought that his direct communication with Marcia would quickly solve the problem at hand and prevent any further negative interactions between the nursing department (specifically Marcia) and the parents.

Benny notified Marcia that the patient's parents were requesting a nursing change. Benny spoke to Marcia in a semiprivate area and in the presence of another RN. Benny thought this was best versus a more formal environment because he wanted to communicate the parent's request before the infant patient arrived back on the pediatric nursing unit. Benny proceeded to explain to Marcia the multiple errors she committed in reference to the infant' invasive radiology procedure preparation. Because of Benny's desire to be efficient due to the impending arrival of the parents and in an attempt to avoid any confrontation, he disclosed the parents' concerns and medical errors on her behalf prior to taking her version of the events into account. Also Benny, did not consider how sensitive this issue was, as Marcia was already distressed by the initial interaction with the patient's overbearing patients while attempting to insert the urinary catheter the first time, in addition to agreeing to cover a shift in the pediatric nursing unit, with which she was not familiar.

Benny's "information" was not well received by Marcia who took the comments offensively and considered them an insult to her nursing abilities. Marcia initially responded to Benny's claims with an increased rate of speech, only to follow with silence and disconnect. Marcia folder her arms across her chest, took a step back from Benny, and did not provide him with any further verbal response. More specifically, Marcia began a foot-tapping motion and lowered her eyes to avoid face-to-face with Benny. Benny ordered the nursing change to be made immediately without involving Marcia's clinical manager. Benny informed the parents that the nursing change was underway and offered his assistant to the parents "for anything they might need" during the infant's inpatient stay. The parents appeared to be satisfied that action had been taken, so Benny returned to his department.

Later that day, Benny visited the parents again. He wanted to follow up with the infant's care, verify that the parents were content with the way the situation had been handled, and to be sure that no other concerns had arisen. Upon seeing Benny, the parents expressed their gratitude with the actions he had taken, noting they were extremely pleased that management stepped in to intervene on what they assumed had no solution.

The following day, the chief nursing officer (CNO) and senior vice president of the hospital contacted Benny for a meeting. Benny thought the purpose of the meeting was to provide him high accolades for the successful handling of the nursing issue from the previous day. In fact, Benny was quite pleased with himself. From his perspective, he was able to achieve a turnaround of the parent's negative experience without the assistance of any other manager as well as an unexpected extra bonus; a statement from the family indicating that they would return to the hospital for care, if necessary.

Regrettably, instead of praising Benny for his efforts, the meeting was to inform him of the inappropriateness of the exchanges between Marcia and himself. Benny was aware of "how things are done" and given clear instructions on how to approach similar situations in the future. The CNO indicated that all issues about nursing care must be addressed directly with the RN's clinical manager and never directly with the staff involved unless they were Benny's direct report employees. According to the CNO and senior vice president, it was not Marcia's actions, but Benny's decisions regarding the proper course of action that needed improving. Benny agreed that after reviewing his interactions with Marcia, he could have been more sensitive and less aggressive with his tone and approach. Although Benny still had much to learn as a new manager, it seemed odd to him that the nurse who was the source of the issue was not part of this discussion. Benny wondered how Marcia's actions were being addressed by senior management. Was Marcia being reprimanded, disciplined, or at the very least (and probably most importantly), in-serviced in reference for her nursing errors?

respond to the following:

1. What forms of feedback were present in this case study? What feedback strategies were missing?
2. How was lack of empathy present on behalf of both Benny and Marcia?
3. What conflict handing style would you recommend the CNO and senior vice present use in this case?
4. Think about Benny and Marcia individually and identify the various factors that may cause stress.