Sue and Sam are both nurses working the same shift. Sue is responsible for patients in Rooms 1–6, and Sam is responsible for patients in Rooms 7–12. Over the course of their shift, both nurses routinely visit their patients’ rooms to take vitals and deliver medication.
On one of his rounds, Sam attends to his patient in Room 8. He reads the chart and notices Sue’s initials signaling that she had already checked on this patient. A bit confused, he continues on to his next patient. After another hour goes by, Sam returns to Room 8 and again notices Sue’s initials on the chart. Sam is concerned that Sue thinks he is incompetent, since she keeps checking up on his work. He decides to approach Sue and see what is going on.
A nursing team is having a routine meeting. Tanya is a senior nurse in the unit with over ten years’ experience on this specific unit. Stephen is new to the unit with fewer than three years’ experience in nursing. Tanya has been asked to present information to the team about effective time management on the unit. During Tanya’s presentation, Stephen rolls his eyes and talks to other members of the team. Tanya pauses to ask if Stephen has anything to add. Stephen replies, “No, I just don’t know why we need to talk about this again.” Tanya chooses to avoid engaging with Stephen further and finishes her presentation. Stephen continues to be disruptive throughout the presentation.
After the meeting concludes, Tanya approaches Stephen and asks why he was being disruptive. Stephen replies, “I just think we all know what the procedure is because we just learned it all during orientation training. Maybe if you don’t remember the training, you should take it again.” Tanya is shocked by his reply and quickly composes herself. She states, “Stephen, I have worked on this unit for over ten years. I was asked to present that information because there are current issues going on among the staff. Next time please respect my authority and listen to those who come before you.”
Connie, the charge nurse for her unit in a medical-surgical hospital, is a respected member of the team. She has been working on this unit for a number of years and is seen by the other nurses as the “go to” person for questions and guidance. Connie is always thorough with patients and demonstrates excellence and quality in her work. Dr. Smith is a well-respected member of the medical profession and an expert in his field of medicine. He has a reputation for excellent bedside manner and is thorough in his approach with patients.
Connie is four hours into her 12-hour shift when she is approached by Dr. Smith. He asks, “Connie, why has the patient in Room 2 not received his blood pressure medication over the past few days? I was not notified about this!”
Connie, trying to find a quick solution, replies, “I didn’t know that patient had been missing medication. I’ll go check on it and get back to you.”
Dr. Smith is persistent, saying, “I know this patient and should have been informed about the withholding of medication and the reasons why.”
Connie, again attempting to find a resolution, states, “Well, there must be some communication about this change-”
“There isn’t!” Dr. Smith interrupts.
Connie becomes upset and decides to leave the conversation after declaring, “Fine, if you know everything, then you figure it out; you’re the one with the medical degree, aren’t you?” She storms off.
Connie makes her way to the nurses’ station and vents about the frustrating encounter to the other nurses there. Meanwhile, Dr. Smith has made his way to the doctor’s lounge and tells his side of the story to his fellow doctors. A few hours later, Connie and Dr. Smith have each spoken to several people about the interaction, and as their shift continues they find more and more reasons to attack the other’s character. By the end of the day, Connie has filed a complaint against Dr. Smith, and Dr. Smith has filed his own against Connie.
Visit the TeamSTEPPS® Instructor Manual: Specialty Scenarios for multiple AHRQ scenarios requiring application of TeamSTEPPS® to patient scenarios.