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Difficulty: HardInterprofessional Teamwork and Conflict Resolution

A 75-year-old woman is recovering on the medical ward from a severe chronic obstructive pulmonary disease exacerbation. The attending physician writes orders for her to be transferred to a lower-acuity rehabilitation facility this afternoon. The bedside nurse reviews the chart and notes that during a morning mobility assessment, the patient's oxygen saturation dropped to 84% on room air, requiring a prolonged recovery period before returning to baseline. The nurse approaches the physician and states, "I am concerned that this patient may not be stable enough for transfer today given her significant desaturation during physical therapy." The physician replies, "Her resting vital signs are back to baseline and her wheezing has completely resolved. The facility transport team is already en route, so please prepare her for departure."

According to standardized interprofessional conflict resolution and patient safety protocols, which of the following is the most appropriate next step for the nurse?

  1. Express a second, unambiguous statement emphasizing the immediate safety risks associated with transferring the patient.Answer
  2. B
    Immediately invoke the emergency chain of command by contacting the hospital's chief nursing officer.
  3. C
    Proceed with the transfer preparation and subsequently file a retrospective patient safety incident report.
  4. D
    Yield to the physician's clinical judgment as they bear the primary legal responsibility for the disposition.
  5. E
    Unilaterally cancel the transport team and enter an electronic order for a pulmonary medicine consultation.

Answer

Express a second, unambiguous statement emphasizing the immediate safety risks associated with transferring the patient.
The correct action follows the Two-Challenge Rule, a cornerstone of interprofessional communication and patient safety (e.g., TeamSTEPPS). When a team member identifies a potential safety risk, they must voice their concern. If the initial statement is ignored or dismissed—as occurred when the physician cited resting vitals and ordered the nurse to proceed—it is the team member's responsibility to assertively voice the concern a second time. This ensures the decision-maker has fully comprehended the risk. If the second challenge is also dismissed, the team member must then escalate the issue through the formal chain of command or 'stop the line.'

Step-by-Step Solution

1
Identify the communication framework required when a team member perceives a patient safety risk during interprofessional collaboration.
Standardized tools such as the Two-Challenge Rule or the CUS (Concerned, Uncomfortable, Safety) framework should be utilized to stop the line.
These frameworks provide a structured method to halt unsafe processes while maintaining professional respect and reducing hierarchical barriers.
2
Analyze the current state of the conflict described in the scenario.
The nurse has issued the first challenge by explicitly stating, 'I am concerned...' The physician has acknowledged the statement but dismissed the concern, directing the nurse to proceed with the potentially unsafe plan.
Tracking the progression of the conflict determines which tier of the escalation protocol is legally and professionally required next.
3
Determine the required next action according to the Two-Challenge Rule.
The protocol requires the team member to issue a second explicit challenge. Only if this second challenge is ignored or dismissed should the team member take control or escalate to the chain of command.
The second challenge ensures the primary decision-maker has fully heard, processed, and recognized the specific severity of the safety risk.

Key Concept

The Two-Challenge Rule requires a healthcare team member to assertively voice a patient safety concern at least two times if their initial assertion is ignored or dismissed, before escalating to the formal chain of command.
Estimated Time:1m 15s
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Topics

Interprofessional Teamwork and Conflict Resolution

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