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Difficulty: MediumInterprofessional Teamwork and Conflict Resolution

A 68-year-old woman is evaluated in the emergency department for urosepsis. She has received 33 liters of intravenous crystalloid fluid, but her blood pressure remains 82/5082/50 mm Hg, and her heart rate is 118118/min. The emergency department attending physician contacts the medical-surgical ward charge nurse to provide a handoff report. The physician states that the on-call hospitalist has accepted the patient and that she will be transferred to the ward in 1515 minutes. The charge nurse notes the patient's persistent hypotension and believes the patient requires intensive care unit monitoring and vasopressor support. When the nurse expresses hesitation, the physician replies, "The hospitalist already accepted her, and the intensive care unit is completely full right now. We need to free up this emergency department bed." Which of the following is the most appropriate initial statement or action by the charge nurse to resolve this conflict and ensure patient safety?

  1. I am concerned about the patient's hypotension, I am uncomfortable with this transfer to the ward, and I believe this is a safety issue.Answer
  2. B
    I will accept the transfer to help free up the bed, but I will immediately activate the rapid response team upon her arrival to the ward.
  3. C
    Before transferring the patient, you must order an abdominal computed tomography scan so the ward team knows the definitive source of the sepsis.
  4. D
    Since her blood pressure remains low, I will accept the handoff only on the condition that you rapidly infuse another two liters of normal saline.
  5. E
    I will accept the handoff report now, but I will document in the medical record that you refused to upgrade her level of care.

Answer

State concern, discomfort, and the safety threat explicitly using the CUS framework.
The correct answer utilizes the CUS framework, a widely recognized TeamSTEPPS communication tool. By explicitly stating 'I am Concerned, I am Uncomfortable, this is a Safety issue,' the nurse uses standardized language to alert the physician to the severity of the disagreement and effectively 'stops the line' regarding the unsafe transfer. This approach directly addresses the conflict while keeping the focus entirely on patient safety rather than hierarchical dynamics or resource pressures.

Step-by-Step Solution

1
Evaluate the clinical appropriateness of the proposed disposition.
The patient remains hypotensive despite adequate fluid resuscitation, indicating a need for vasopressor support and intensive care, making the medical-surgical ward inappropriate.
Recognizing clinical instability is prerequisite to identifying the safety threat in the transition of care.
2
Assess the communication and conflict dynamic.
The physician is attempting to bypass clinical safety concerns due to system pressures (bed availability) and hierarchical authority.
Understanding the barriers to safe handoffs dictates the need for a standardized conflict resolution tool.
3
Select the appropriate communication framework to stop the line.
Use the CUS terminology (Concerned, Uncomfortable, Safety) to definitively halt the unsafe transfer.
Standardized language removes ambiguity, bypasses hierarchy, and forces the team to address the explicit safety concern.

Key Concept

The CUS framework is a standardized TeamSTEPPS communication tool used to explicitly escalate critical patient safety concerns and resolve interprofessional conflicts.
Estimated Time:1m 30s
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Topics

Interprofessional Teamwork and Conflict Resolution

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