Forty Pages a Night: Resolving Conflict Between Night Nurses and a New Hospitalist Team Through Principled Negotiation and Structured Communication
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Master of Science in Nursing Program, Aspen University
N522: Modern Organizations and Health Care
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Forty Pages a Night: Resolving Conflict Between Night Nurses and a New Hospitalist Team Through Principled Negotiation and Structured Communication
Conflict between nurses and physicians is common, and it is rarely only personal. It usually reflects how work is organized, how information moves, and what each group needs to do its job. This paper analyzes a conflict between night-shift nurses and a newly formed hospitalist group at a composite community hospital. It uses Tuckman's stages of team development to explain why the conflict arose when it did, principled negotiation to resolve it, and structured communication to prevent it from returning.
The Conflict
Four months ago, Lakeshore Hospital replaced its community physicians' overnight coverage with a contracted hospitalist group. One night hospitalist now covers about 110 medical and surgical patients across five units. Night nurses page the hospitalist through a single pager, averaging 40 pages a night. The hospitalists complain that many pages are for routine matters such as laxative orders, sleep medications, and mild blood pressure readings, and that repeated interruptions keep them from urgent admissions. Nurses report that callbacks can take 45 minutes, that some hospitalists respond curtly, and that they are unsure what warrants a page.
The conflict escalated after a patient with rising heart rate and falling blood pressure waited 50 minutes for a callback because the page was lost among routine requests. The patient required a rapid response call and transfer to intensive care. Each group now blames the other: nurses say hospitalists do not respond, and hospitalists say nurses cannot prioritize.
Why Now: Tuckman's Stages of Team Development
Tuckman (1965) proposed that groups move through stages he called forming, storming, norming, and performing. In forming, members orient themselves and depend on leaders for structure. In storming, conflict emerges as members resist the group's demands and assert their own. In norming, the group develops shared expectations, and in performing, energy goes into the task.
The night team at Lakeshore is a new group formed by an organizational decision, and it skipped the work of forming. No one met to establish how nurses and hospitalists would communicate, which issues would be batched, or what counted as urgent. The team went directly into storming, with each group asserting its own norms: nurses carried over expectations from community physicians who knew their patients, while hospitalists brought expectations from other hospitals where nurses followed standing protocols. The conflict is not a sign that the team is failing; it is a sign that it never agreed on its norms.
Resolving the Conflict With Principled Negotiation
Fisher et al. (2011) propose four principles for negotiation: separate the people from the problem, focus on interests rather than positions, invent options for mutual gain, and insist on objective criteria. Applied here, the positions are "respond faster" and "page less." The interests underneath are shared: both groups want patients safe, both want urgent problems addressed quickly, and both want less wasted time.
Separating the people from the problem means treating the paging system, not each other, as the problem. In a facilitated meeting, the nursing director and the hospitalist lead reviewed a week of pages together. They found that about half were for routine orders that could be handled by protocols or batched, and that urgent pages were not distinguishable from routine ones. Options for mutual gain followed: standing nurse-driven protocols for common routine issues, a batching schedule for nonurgent requests, and a separate urgent line. Objective criteria, such as early warning score thresholds, would define what counts as urgent, so the decision to page would not depend on who was working.
Structured Communication: SBAR
Even with better paging, communication itself must improve. Leonard et al. (2004) describe how differences in training lead nurses to communicate in narrative, descriptive terms while physicians expect brief, problem-focused summaries, and they recommend SBAR, situation, background, assessment, and recommendation, as a shared structure. SBAR also gives nurses permission to state an assessment and a request, such as "I think he is becoming septic, and I need you to see him now," which can be difficult across a hierarchy.
At Lakeshore, urgent pages would be followed by an SBAR call, and nurses would receive brief training with practice scenarios. Hospitalists would agree to call back urgent pages within 10 minutes and to acknowledge nonurgent batches at set times.
Respectful tone is part of the agreement as well. Curt responses at 3 a.m. teach nurses to delay calls, which is the opposite of what a safe night requires. Both leaders agreed to address disrespectful exchanges directly and privately, and to treat a nurse's hesitation to call as a warning sign for the team rather than a personal failing.
The Agreement and Its Measures
The final agreement, signed by the nursing director and hospitalist lead, includes an urgent line triggered by early warning score criteria, SBAR for all urgent calls, 10-minute callback expectations, standing protocols for eight common routine issues, nonurgent batching at 10 p.m., 1 a.m., and 4 a.m., and a monthly joint review. Success would be measured by the number of pages per night, callback time for urgent pages, rapid response calls preceded by delayed callbacks, and a short survey of both groups on respect and teamwork. The monthly review is the team's norming process, deliberately built into its schedule.
Lessons for Nurse Leaders
Three lessons apply beyond this case. First, when an organization creates a new team through a contract or restructuring, leaders should plan the forming stage deliberately rather than leaving norms to emerge through conflict. Second, conflicts between professional groups are best resolved by examining shared data about the work, which shifts attention from personalities to processes. Third, communication tools work only when both groups commit to them; SBAR from nurses without timely callbacks from physicians would simply move the frustration elsewhere.
Conclusion
The conflict between night nurses and hospitalists at Lakeshore arose because a new team was formed without agreed norms. Tuckman's model explains its timing, principled negotiation reframes it around shared interests and objective criteria, and SBAR gives both groups a common language. The resulting agreement addresses the system that produced the conflict and includes the measures and regular review the team needs to move from storming toward performing.
References
Fisher, R., Ury, W., & Patton, B. (2011). Getting to yes: Negotiating agreement without giving in (3rd ed.). Penguin.
Leonard, M., Graham, S., & Bonacum, D. (2004). The human factor: The critical importance of effective teamwork and communication in providing safe care. Quality and Safety in Health Care, 13(Suppl. 1), i85-i90. https://doi.org/10.1136/qshc.2004.010033
Tuckman, B. W. (1965). Developmental sequence in small groups. Psychological Bulletin, 63(6), 384-399. https://doi.org/10.1037/h0022100
How this N 522 Module 5 example is structured
N522 Module 5 typically centers on teams, conflict and communication. Aspen does not publish module deliverables, so check your classroom for the exact prompt. This example describes a conflict fairly from both sides, uses a team development model to explain it, applies a negotiation framework step by step, adds a communication tool and closes with a measurable agreement and lessons for leaders.
N522 Module 5 questions, answered
What does N522 Module 5 usually ask for?
The module typically covers teams, conflict and communication, often asking you to analyze a conflict or team problem in an organization you know with named frameworks and propose a resolution. Aspen does not publish module deliverables, so your classroom's instructions govern.
What are Tuckman's stages of team development?
Forming, storming, norming and performing. Groups orient themselves, then experience conflict as members assert their own expectations, then develop shared norms and finally focus energy on the task.
What is principled negotiation?
Fisher and Ury's approach: separate the people from the problem, focus on interests rather than positions, invent options for mutual gain and use objective criteria to decide.
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