On a professional level it is also significant because they used to have mutual respect for one another and now they are finding that they do not seem to work together well. Findings

Managed care and the way that is has changed medical care in this country is one of the biggest culprits when looking for a scapegoat regarding why there are so many problems between these two people at this point in time. The doctor clearly no longer takes the nurse seriously, but that is something that is between them as people, not as doctor and nurse. The managed care issue and how their work has changed because of it is also between them now, and that is something that they could and should address on a professional level. It could help to diffuse an otherwise increasingly volatile situation that other staffers are beginning to witness, as well.

One area that is very significant to the nurse, however, is the way that the doctor does not stop the interns from being disrespectful. It is hard enough for doctors and nurses to really get along with one another without encouraging or ignoring the kind of behavior that actually drives them further apart. In other words, most doctors do appear to think that they are better than nurses because they have more skills and experience and can do more things, but it is really the nurses who care for the patients the most and provide them with much of what they need. That being the case, they deserve the respect of the doctors. If they were not there, the situation would be dire.

Because their relationship, both personal and professional, has changed so much, the doctor and the nurse both must be aware of the challenges that each other are facing. Their hands may be tied in some areas but that does not mean that they cannot keep communication lines open. If they are able to talk openly and honestly to one another there is a higher possibility for conflict resolution.

Recommended Action

For the doctor and the nurse to get along like they did in the past may not be possible, but they clearly need to get back to at least a good working relationship, and there are ways that they can do that. They both have to be willing, however, and it is difficult to tell at this point of either one or both of them are willing to do what it takes to re-strengthen their relationship. In the interest of a good working environment it would be best if they would both agree to sit down and talk, perhaps with a mediator like someone from human resources or another neutral party. It is very important that person not be another doctor or another nurse, because it could appear too much as though that person is taking sides.

When people take sides they just end up hurting both parties to the discussion. The person who is 'on their side' does not seem as serious and will not be listened to because there is too much distrust. The other person feels as though he or she is being ganged up on, and that makes honestly listening to what is said very difficult. Someone from human resources is neutral and can mediate between the two sides without taking one over the others. It is very important to have a good working environment, especially in an area where patients can become very agitated and problematic, so working this problem out would be in the best interest of all of the people involved and affected by it in some way.

One or both parties will not always be so agreeable to try to talk things out, however, and if that is the case there might be little that can actually be done to diffuse the situation and makes things alright between the two again. At that point all that could really be done would be to try to schedule them where they did not work directly with one another to avoid conflict in front of other staffers and in front of patients.

Questions

1. When issues like managed care show up they change the dynamics of both professional and personal relationships, and human resources has a duty to make the transition as easy as possible. Managed care at this hospital made things more difficult because there was a lot more paperwork and patients could only be stabilized, not actually treated....

Patients should always be able to be treated, so this created an ethical dilemma, as well. Since nurses are so focused on helping patients, this caused a big problem between nurses and doctors at the hospital. Human resources departments need to be more focused on how the people actually feel about these changes so that problems can be lessened.
2. The changes in the relationship between doctor and nurse also came about because the nurse no longer needed a mentor. Because they were so close in the past, it was much more difficult for them to be more distant, and that made them conflicted internally. This spilled out into fights and other problems.

3. The nurse should be been more respectful and not demanded help. The doctor should have been willing to come to her aid and realized that she was not over-exaggerating the situation. In the future, written policy for chain of command and emergency patient aggression diffusal situations should be created.

4. Professional relationship are just that -- professional. Fraternization and joking and those things should be left for outside the hospital or avoided all together. This should be written policy, and respect for ALL people on the staff should be mandatory. How the situations will be handled should also be in writing, read and signed by every employee. The hospital should be a team, with no one being treated as 'less than' to anyone else.

5. In general, human resources should leave people to work out their own problems. Most places do this. When those problems start to spill over into patient care, however, administration must step in and do something about the issue before it becomes more of a problem for patients and for other members of the staff.

Case Study #3 -- Sexual Harassment: Innocent Initiation or Hostile Work Environment

Analysis

In this particular case, what is happening to Keenan is very important, but she has not been documenting it, and that could be a problem. If she cannot prove that she has been a victim she will find that she has a hard time establishing any case. While the harassment is very unwelcome, it is not all that surprising given the nature of her job and the way that she obtained it. In other words, she is the first female in an all-male department and she is breaking through barriers and stereotypes. People who do those things are quite often the subject of harassment and/or persecution because they are not staying within the roles that society thinks that they should have.

With a part of the country that is mostly not interested in changing, there is a 'place' for women, and it is subservient to men. This may not be right or fair, but it is the way it is. With that being the case, Keenan will have trouble trying to keep her job or advance in that department because there will be men who will try to hold her back. They may know about the policies that say this is illegal, but they assume that they can get away with it and that no one is really taking any of it too seriously.

Findings

For this case, the main finding is that sexual harassment does appear to be taking place under the guise of a hostile work environment. Not everyone sees this kind of thing as hostile, but for a woman working in a man's world it is not surprising that she would be offended by it. If she is uncomfortable she should speak up, but it is very difficult to do that when you are the new person and in a serious minority. It puts extra pressure on that person to just go along with whatever is taking place. Unfortunately, this kind of behavior will escalate if a person does nothing about it and the harassment will only get worse.

Women do not want this, and there have been cases of men being harassed, too, although it is not as common and can be harder to prove. The assumption (incorrectly in many cases) is that men like this kind of attention and women do not, so it must be harassment when it happens to women and not to men. With Keenan, however, this harassment has been going on for some time and she has been putting up with it. This could make it more difficult to prove that she was actually offended by…