Step One: Problem Identification

Selma, a registered nurse and nurse manager at X Hospital, is making the rounds of the oncology ward. Elvira is a bedside nurse in the ward, and complains to Selma about the treatment Dr. Jankovic is carrying out on a patient, Mr. Smith. The nurses and the doctor, according to Elvira, are aware that the condition of Mr. Smith is dire, but Jankovic nevertheless is informing the Smith family that the patient will benefit from further chemotherapy treatments. The feeling among the nurses is that Dr. Jankovic is dishonest to the Smith family, unnecessarily ordering treatment when the patient case’s is terminal, and not informing the family of the severity of the patient’s condition. Elvira has decided that she no longer wants to treat patients for Dr. Jankovic, since she concludes that he is deceptive to patients. Other nurses want to take a similar course of action.

Step Two: Identifying Values

1. The well-being of the patients, doing what is best for them.
2. Lack of open communication between the family and the hospital staff and the nurses and the doctors.
3. A possible transgression of rank, as the nurse refuses to adhere to the doctor’s orders.
4. Hostility between nurses and doctors.

Step Three: Identifying Options

1. To communicate to the doctor the concern about this treatment, urging him to be honest with the patient.
2. To communicate to the doctor the concerns of the nurses and urge a meeting with the nurses.
3. To explain to Elvira the issues of rank, such that she must acquiesce to Dr. Jankovic’s decisions.
4. To support Elvira in not working with patients treated by Dr. Jankovic.

Step Four: Consequence Identification

1. Will let the doctor know about the concerns, however, this could be viewed as undermining Jankovic’s rank as doctor.
2. A meeting between the doctor and the nurses can let all the problems be presented in an open forum.
3. The potential distrust and animosity between nurses and doctors, as nurses’ feel they are not valued.
4. This will created a divided work environment, where certain nurses do not work with certain doctors, an obviously undesirable situation.

Step Five: Option Selection

The issue of rank is crucial, and Selma believes that everyone must understand Dr. Jankovic’s decisions for further treatment. However, the opinions of the nurses are also valuable. There seems to be a fundamental tension between the nurses and the doctor regarding treatment. Accordingly, Selma decides that it is crucial to settle these issues and create a dialogue. The nurses have to understand precisely why Dr. Jankovic is acting in such a manner, while Dr. Jankovic must be aware of the opinions of the nurses. From this beginning point, progress can be made.

Step Six: Documentation

The nurses in the oncology ward are concerned with both the honesty of the head doctor towards the patients and his treatment decisions. Ordering further chemotherapy treatment for a patient who it appears is terminally ill, and moreover, creating a false sense of hope in the family of the patient by not acknowledging the direness of the situation are decisions criticized by the nurses. A nurse in the ward has communicated to the nurse manager that she and some of co-workers will no longer care for the doctor’s patients. The nurse manager understood that such a “strike” is unfeasible, and suggests an open dialogue and meeting between the doctors and the nurses. With this meeting, the nurse manager hopes that the concerns of the nurses in the oncology ward will be made clear to the doctor, whereas the doctor can express his exact reasons for treatment and also his approach to patients, which the nurses have interpreted as deceptive. Such an approach will create dialogue between the workers in the oncology ward and foster a more unified working environment as the values of the oncology ward are lucidly defined, which will have clear benefits to the healthcare of the patients.