ICU: Natalie Kazakova’s Nursing Case Study

Subject: Nursing
Pages: 2
Words: 651
Reading time:
3 min


The interactive case study tells the story of Natalie Kazakova, a Russian immigrant who currently works in the ICU of a local community hospital. Before graduating with a master’s degree in nursing, she obtained a bachelor’s in engineering in Russia. Natalie is new to the ICU team and, thus, faces typical communication issues. Two experienced nurses, Susan and Pam, who have associate degrees in nursing, are skeptical of Natalie’s knowledge and expertise. As a result, following the orientation, Natalie feels uncomfortable and starts to second-guess her decision to become a nurse. In general, Natalie’s experience highlights the social exchange theory, conflict theory, and role theory in action.

The Social Exchange Theory

The Social Exchange theory relies on political and economic assumptions that it is in human nature to seek maximum profits and avoid costs while interacting with others. According to McEwen and Wills (2018), humans “are purposive and motivated to maximize material benefits from exchanges with others in a free and competitive marketplace” (p. 273). In other words, individuals tend to continue relationships with others only if they bring more benefits than drawbacks. In the case of AND nurses and Natalie, their relationships are not successful as they lack reciprocity, and the nature of exchange is not beneficial. Consequently, Natalie wants to withdraw from the other exchange (resign) considering Susan and Pam’s statements.

The Conflict Theory

The Conflict theory, initially developed by Karl Marx, sees the society in the constant conflict caused by excessive competition for limited resources. Its application to nursing lies in the assumption that inequalities in the health care setting may lead to conflict between team members (McEwen & Wills, 2018). In this case study, coworkers struggle to develop relationships based on power and determine who would enjoy domination. Nurses’ fear of losing tenured power due to Natalie’s advanced degree can explain their behavior. Although she has a master’s degree in nursing, she is still a novice practitioner who needs her colleagues’ advice and help.

The Role Theory

The Role theory assumes that every person plays a socially defined role having specific duties, responsibilities, rights, and expectations. According to McEwen and Wills (2018), feelings regarding roles determined by positions significantly affect self-perceptions and behavior at the workplace (p. 272). Natalie naturally feels unconfident with her new role as she is a new graduate nurse. She experiences a role strain caused by role incongruity, which occurs “when role expectations run counter to the individual’s values and self-perception” (McEwen & Wills, 2018, p. 272). To avoid conflict and become more confident, Natalie needs to negotiate her role with other nursing staff and patients. She should also follow her professor’s advice to take time for adaptation that would see her more comfortable with new duties and interactions.

Personal Experience

I witnessed similar situations when graduated nurses have faced a hostile environment at their new workplace. Such an atmosphere is usually created by seasoned nurses who fear to lose their acquired power and status to young and less experienced practitioners. Once, newly graduated nurse Elizabeth asked for a transfer to another department as she also faced the role incongruity. My own experience showed that the best way to establish a great working relationship with experienced nursing staff is to show your respect and willingness to receive their advice. The roles should be negotiated, and then both sides will benefit from cooperation, as newcomers can also contribute fresh knowledge.


To conclude, Natalie should follow the suggestions of her professor. Susan and Pam try to maintain their power positions within the ICU, whereas Natalie uses the inappropriate communication strategy. A time and new approach are needed to establish good collaboration. Natalie has to remind the seasoned nurses that she is not experienced and ready to learn from them despite her advanced degree. It is essential to embrace the novice role at the beginning to gain support and look less threatening to coworkers.


McEwen, M., & Wills, E. M. (2018). Theoretical basis for nursing (5th ed.). Lippincott Williams & Wilkins