Conflict Resolution in the ER

By: John Turley, MS-NCR ‘10

A seasoned and well-traveled nurse once counseled me to always remember that patients do not want to be in the hospital in the first place. They are typically uncomfortable, testy, and in pain, with an intense desire to return to the comforts of home as soon as possible.  This leitmotif often comes into play in the emergency room, as new patients come and go frequently. As a volunteer at the Emergency Department(ED) of the University of Michigan Hospital in Ann Arbor, Michigan, I assist the medical staff with conflict management, while addressing the many and varied needs of the patients throughout their hospital stay.

Within the hospital, a well-coordinated team of highly skilled generalists, specialists, nurses, technicians and administrative staff attends to the medical needs of their patients with purpose and resolve.  Their concerted efforts are like the intricate workings of a world class operatic orchestra performing Verdi’s Il Trovatore or Puccini’s La Boheme.  How harmoniously conflict is resolved depends on the patient’s individual situation as the medical staff responds to their needs.

Like an effective beat cop, in my volunteer role, I mingle with the patients in the waiting room and listen to their particular situation and circumstances.  I walk the halls of the emergency room to anticipate needs or the potential outbreak of conflict between patients and the nurses or medical technicians.   My mediation training is invaluable when I encounter disputes in the waiting room between patients, their family members, and sometimes the medical staff. 

An effective mediator actively listens to clients to understand their respective positions and why they may be in conflict with each other.  My questions are directed toward either or both disputing sides to expand upon a point, a firm position, or an expressed need.  The unmet needs which are the most compelling emerge after a deeper dive of questioning. Mediators follow a process of observation, listening, withholding judgment and remaining as neutral as possible in guiding people in conflict toward determining their own creative solution to their dispute.

Patient behavior is usually the best indicator of the potential rise of conflict.  Patients loathe waiting too long without knowing when they will be seen by a doctor or nurse.  The “lone wolf” patient agitator can cause a considerable amount of tension and disruption in the waiting area.  On one occasion, a patient returned to the ER waiting area after treatment and proceeded to unravel his bandages to the shock and discomfort of the patients and their family members.  His blood spewed about as he plucked at his stitches.  Hospital security was slow to intervene, so I eased the man toward the security station as I calmed the horrified patients while placing sheets to cover a considerable amount of discharged blood. The goal of the encounter was to remove the source of trouble and to restore order while reassuring the visitors of their safety.

On a separate occasion, a patient and a nurse were engaged in a fierce verbal battle at the ER check-in desk.  The patient resorted to foul language which prompted the nurse to eject the patient from the hospital.  Several hours later, I encountered the disgruntled patient in a different area of the main hospital.  I listened to his concerns and processed his expressed needs for medical attention.  I negotiated a course of action with him whereby we would return to the ER check-in area under the condition that I would ask the nurse to reconsider his admittance so long as there was no more foul language or expressions of anger.  The dispute was settled to the satisfaction of all parties including myself.  The patient was treated and released.

These two examples attest to my training as a mediator in a healthcare environment.  Assess the situation, and follow the ADR process to produce the desired results.  In the first instance, my goal was to restore order and allay people’s fears.  In the latter example, I wanted the patient to receive help according to the hospital’s standards and processes.  I am grateful for my practical training in settling conflicts and ability to put them to use in a volunteer healthcare setting.