It is not far-fetched to imagine that the next time a transgendered individual comes to the ward in which a challenging story was told, their care might be compromised by underlying unresolved issues among staff members. Other unresolved value conflicts could result in negative feelings toward the organization, a supervisor, or team members, leading to feelings of dissatisfaction, staff turn-over, diminished quality of care, and lower performance level.23 Unresolved incidents and poor communication concerning them diminishes the ability to learn, change, and develop in the hospital environment. We began with the observation Inhibitors,research,lifescience,medical that current methods for understanding

workplace satisfaction might miss some of the lived experience and contextual meaning experienced by employees in their daily work. We deliberately focused on high-performing employees to understand what they report when they are at their best and when they are challenged. We Inhibitors,research,lifescience,medical found that even the best employees have difficulty Luminespib solubility dmso resolving challenging situations in the workplace. This leads us to suggest that education

in polarity management and ways of holding difficult conversations might be used to challenge and change the prevailing culture of silence in the face of challenge. Two subcategories of values that were salient were Inhibitors,research,lifescience,medical creativity and flexibility in day-to-day work. Value-affirming stories focused Inhibitors,research,lifescience,medical on being able to create a better environment of care by bending the rules. Also, value-challenging stories were often handled by bending the rules. The ability to bend the rules made employees feel more comfortable and more autonomous in their jobs. Kelly26 Inhibitors,research,lifescience,medical warns against the trend of hospitals to give nurses less and less room for a personalized approach to clinical practice. The solution suggested for this problem was the acknowledgment of nursing values that can be implemented in health care.

Our findings support this suggestion and demonstrate, paradoxically, that when employees “follow” their values and act according to them, they are actually implementing the organization’s values, while at the same time violating formal organizational rules and regulations. As has been demonstrated in other studies, “stories reveal the gap between the formal codified space of an organization Metalloexopeptidase (roles, job descriptions, and lines of accountability) and informal un-codified space (relationships, feelings, ‘unwritten rules’, and subcultures)”.27(p. 444) The informal code among those interviewed was to place the patients’ best interests above total compliance with the organization’s rules and regulations. Our findings suggest the importance of encouraging flexibility and creativity in providing the best quality of care possible.