Interdepartmental War

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    How do you prevent interdepartmental war in the hospital? I’ve worked in nearly every department in the various hospitals I have worked in, ICU, Tele, OR, ER, floated to medical/surgical/peds, etc, and I’ve noticed that nearly universally, departments don’t get along well with each other. Why is this, and what has your hospital done to fix it?

    As an ER nurse, I get frustrated with ICU and MSP for stalling on accepting a patient. The room is not ready, the nurse is on break, it is too close to report time, etc. I also get frustrated with OB when we send a pregnant woman who is over 20 weeks pregnant and has abdomen pain down to OB to get seen, per hospital policy, and after ruling out the baby is ok, but discovering the patient has a UTI, they send the patient back to the ER for antibiotics instead of having the OB doc write a script. Sure, this is more of an OB doctor problem as opposed to the OB department, but it does add to the us vs them mentality when we in the ER feel like we are just the dumping ground for any patient any other department doesn’t want to deal with.

    As an ICU nurse, I HATED floated to MSP because, without fail, I would get the WORST assignment they could come up with. Instead of dividing the patients into 6 groups and assigning them based on skill and acuity, they would divide the patients into 5 groups, assign these groups to the core staff, telling them all to pick the one patient from their group that they didn’t want, and give it to me. I would end up with every patient on the floor that needed blood, had just pulled out all of his tubes, was crazy, or who had constant diarrhea, and these would all be on opposite ends of the three hallways.

    As an OR nurse, my expectations of the other departments were pretty low, so I would just assume that I would have to go to the floor, interview the patient, start the IV, get them into a gown, etc, but now that I don’t work in the OR, the policy has changed, and the circulating nurse doesn’t even come to the ER to get report and to help out the getting the patient ready for surgery. They just call, say bring the patient, and then get mad if it takes more than a minute because you are in another room taking care of another critical patient, or God forbid the entire pre-op checklist isn’t completed before you bring them down … which was something I would do as a circulating nurse myself.

    I know every department has busy times and busy days and they feel like the other departments are dumping on them, but how can we get some teamwork going?

    My hospital has paid thousands of dollars on people coming in to analyze our working environment and working relationships, but I don’t really see much change.

    Does anyone have any good ideas on how they have managed to control interdepartmental wars?

    Profile photo of HowieRN

    There should be no war between any departments/units. All should work together as a team. All are professionals. But sadly this may exist because of communication problem and/or because other department have mentality/feeling that they are superior over others.
    All must be reminded that each staff are equal and each play important roles in patient care. Any staff/department should not compare or expect the same environment on other department since they are on different field of expertise.

    Managers in each Department should meet with their staff to discuss what are their concerns regarding other departments. For each concern that a staff nurse give, the staff nurse should also propose a solution. Managers should also discuss how can their department build good relationship with other departments to improve communication and promote team work in achieving common goal of providing best care to patients.

    After meeting with their staff, all department managers should have a meeting to lay out the concerns and proposed solutions. Department managers then should come up with a system / solutions of the problems and then commit themselves in working together to improve communication and relationships between departments.

    If they see a need for a team-building fun activities, managers should make a proposal to higher management or administration to provide fun activities. (Example: Make 4 teams to play a team-building game. Each team should have a representative from every department. No team should be composed of members from a single department. Friendly competition in a team-building would hopefully help build good relationship.)

    Any positive actions / behaviors should always be recognized specially if it came from other department. (Example: MedSurg is short in staff. ICU floated a nurse down to MedSurg. MedSurg should equally devide the unit. MedSurg Manager should recognize the assistance of ICU department and send a simple Thank You card to the Unit and to the nurse that floated.)

    Happy Staff = Increase Quality of Care = Happy Patients = Increase Patient’s Satisfaction Surveys

    Profile photo of Brock-MN

    It’s really a shame that things like this happen!

    Profile photo of Anne

    I was on a unit that had a war with the pharmacy. It was awful because we communicated by phone and fax. The pharmacy tried a de-centralized pharmacy approach, where each unit was assigned a pharmacist who spent most of his or her day on our units.
    The change was remarkable. Now the pharmacist was a friend with a face, who was a part of the team, not just a person on the phone who you yelled at when your meds were not there on time. It was great having a pharmacist to answer questions, help with patient teaching, get you the STAT meds when you needed them, etc. He ate with us, came to our parties, shared life with us. I still count him as a friend 25 years later.
    Sadly the next administration changed back to the centralized pharmacy, and the wars resumed.

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