NR 447 Conflict Resolution Paper
NR447 Conflict Resolution Paper
Conflict Resolution Paper
Conflict Resolution in Nursing
Chamberlain
... [Show More] College of Nursing
NR 447: RN Collaborative Healthcare
May 2018
Conflict Resolution in Nursing
Conflict occurs every day. We read about it in the paper, we see it on the nightly news, observe it on school yard playgrounds and experience it in our workplaces. Conflict occurs when two or more people disagree, the disagreement is expressed in an emotional response and actions/behaviors occur to express the emotion or interfere with another’s needs. In the healthcare setting, conflict can occur due to a shortage of resources, perceived inequity, change in process, and change in leadership, job responsibilities or interpersonal relationships. If the conflict remains unresolved, staff can become resentful and patient care can suffer.
Conflict Observation
In a small Family Medicine clinic, every provider (MD, PA and FNP) has their own nurse. The nurse’s primary job is to room their provider’s patients when they arrive, give vaccines or medications when ordered and assist the provider as necessary. There is also an electronic “inbasket” where patients can send messages looking for advice, ask follow up questions, review test results with comments and recommendations, schedule appointments, and request medications. Also in this clinic is a triage nurse whose primary responsibility is to answer patient phone calls when they call in, triage anyone who happens to walk in to the clinic, and handle 75-90% of what is in the inbasket.
Perceived Injustice
One of the nurses, (Kacey), who is assigned to a mid-level provider (FNP) who is in the clinic four and a half days per week, was openly discussing how the clinic nursing responsibilities were divided. She was unhappy that another nurse, (Erin), who was assigned to the busiest provider in the office who was only there two and a half days per week, didn’t have time to help handle the overwhelming amount of messages in the inbasket. Erin attempted to explain that on the days the doctor was not in the clinic, she was actually keeping messages from coming in to the inbasket by reading through the result notes and overdue lab messages that were in the provider’s basket and deciding what needed a provider review and what she could handle. Kacey refused to listen to Erin and kept saying, “It isn’t fair that she doesn’t have to help in the inbasket. If she’s not helping, why should I?”
Emotional Response, Behavior
One day Kacey flatly refused to work in the inbasket since she felt it was unfair Erin wasn’t helping the way Kacey thought she should be helping. This created a backlog of messages for the triage nurse to handle and she became upset that the provider’s nurses weren’t taking care of their particular provider’s result notes (lab results) which was part of their job responsibility. Kacey told another nurse in the clinic (Robin) about her plan to “boycott” the inbasket and during their downtime they sat at the nurses’ station discussing how unfair it was that Erin was working on things for her provider. As the conversation continued, Erin became more and more uncomfortable as did the other staff in the clinic. Kacey and Robin’s providers weren’t very busy that morning and Erin’s provider was out of the office for the morning so she was trying to work in his inbasket. The phones were ringing and the front staff was sending messages through Skype to let the nurses know who was on which line and the basis for their call. While the triage nurse did the best she could to keep up with the volume, Kacey and Robin were watching the Skype messages come up and you could hear them talking about the call and deciding who was going to take it if the patient was “difficult” or “a handful” or they thought it was going to be an involved conversation. Meanwhile, Erin, who is not confrontational, tried her best to ignore their hostility. This continued for several days and while hands on patient care wasn’t directly affected, the overall vibe in the clinic had changed, so much so almost anyone who came into the clinic could feel it.
Types of Conflict
The observed conflict in the clinical setting was an example of one type of conflict that became another type as it continued. Initially, the conflict was an “Individual Conflict”, which typically “…occurs when there is incompatibility between one or more role expectations.” (Finkelman, 2016, 323). Kacey felt like Erin wasn’t pulling her weight in the inbasket and didn’t understand why. This caused Kacey to feel stressed and then become critical of Erin even though Erin was working on her other job responsibilities.
When the conflict wasn’t recognized and resolved, it became an “Interpersonal Conflict”, a conflict that “…occurs between people…due to differences and/or personalities; competition, or concern about territory, control, or loss.” (Finkelman, 2016, 323). Kacey was able to bring other people into her conflict, mainly Robin, and they worked together to boycott the responsibility they felt Erin wasn’t taking on.
There is a third type of conflict: Intergroup/organizational Conflict. This type of conflict occurs on a larger scale involving teams such as different units within a hospital, professional organizations/groups, different healthcare systems, etc. Intergroup conflict can occur due to “…competition, lack of understanding of purpose for another team, and lack of leadership with a team or across teams within an HCO.” (Finkelman, 2016, 323).
Stages of Conflict
Conflict starts out slowly then builds and escalates if left unresolved. Finkelman describes four stages of conflict: Latent Conflict, Perceived Conflict, Felt Conflict and Manifest Conflict. (Finkelman, 2016). Latent conflict is the beginning stage of conflict where at least one person is anticipating the impending conflict. There may be verbalization of frustration or the person may internalize this. (Finkelman, 2016). After latent conflict is perceived conflict which occurs when a perception or recognition that there is actually a conflict. At this stage, one needs to decide what the conflict is about and come up with options to reach resolution. This may be more about one’s feelings rather than verbalization about the conflict. Once those involved begin to feel anger or anxiety the next stage, Felt Conflict, has begun. Staff begin to feel stress and one’s ability to trust others comes into play. Will everyone ignore/avoid the conflict? While this may sometimes be appropriate, it may also cause escalation. Does the staff feel comfortable voicing thoughts and opinions? Will the conflict reach an effective solution? If the conflict is allowed to continue without resolution, Manifest Conflict, the final stage occurs. When a conflict reaches the manifest stage it is “…overt conflict” that can be “…destructive or contructive…” (Finkelman, 2016, 326). Individuals can choose to act out ignoring policy, or other individuals, talking negatively about staff or the unit/clinic, or they can identify the issue, brainstorm ways to solve the conflict and encourage others.
Conflict Resolution Strategies
Resolving conflict involves moving those who disagree towards agreement. These strategies include: competition, avoidance, compromise, accommodation and collaboration. (Simpao, 2013). Competition involves using any power available to make personal gains at the expense of others. While most of the time this tactic is seen as uncooperative and ruthless, it may be appropriate in order to stand up for someone’s rights or defend a position you feel strongly about. Avoidance happens when one doesn’t acknowledge the issue or their feelings about it. This strategy is also uncooperative but may be utilized to establish a “cooling off” period prior to other strategies. Compromise requires give and take on the parts of the disagreeing parties to reach a mutually agreed upon solution. It is thought of as being “middle ground” in a disagreement. Accommodation involves putting one’s concerns aside to appease the other party. This can be viewed as yielding to another’s position or selfless charity (playing the martyr). Collaboration involves both parties trying to work together to find a solution that wholly satisfies everyone. Collaboration is intensely time consuming and requires a great deal of personal energy yet is seen as “…a key strategy for many major conflicts in healthcare because it builds understanding of complex issues and interdependent systems.” (Simpao, 2013, 56). While all of these strategies/styles can be used to resolve conflict, one study found the two most frequently used by nurses are compromise and competition, while the least frequently used was collaboration. (Iglesias & Vallejo, 2012). This may be due to the time commitment necessary for collaboration and the limited time to deal with conflict in the clinical setting.
Resolving the Conflict
With the earlier situation involving Kacey and Erin, the major source of the conflict was the lack of knowledge/understanding for each teammate’s individual roles within the clinic. In this instance, collaboration and ultimately possibly compromise is the best way to resolve the conflict at hand. It is important to make sure all teammates can sit down and have a clear understanding of the tasks that need to be accomplished within a shift and what everyone is currently doing. Once the responsibilities and roles are explained, in order to make sure everyone is on board, the nursing staff should come up with several solutions for how to handle the current workload and discuss how they feel about each plan. The pros and cons can be discussed as well as individual’s feelings about how the workload is divided. Even though Erin does not like conflict and would typically use avoidance or accommodation to handle workplace conflicts, she should be encouraged to explain what she is doing when some of the other staff feels she isn’t working on anything. Utilizing collaboration would allow everyone to have a say or ownership in the clinic workflow and would also afford them an opportunity to understand everyone’s roles.
While the nurses weren’t delegating work to each other, Erin’s provider delegating work specifically to her as his nurse was an issue in this conflict. Since Kacey’s provider wasn’t also delegating responsibilities to her, she may have felt somehow slighted or that Erin was working on better things than the inbasket. Ultimately this was a breakdown in communication about what tasks were being delegated to one nurse and why.
In collaborating with a nurse leader to reach a consensus on the best strategy to employ to deal with the conflict, I would encourage a team meeting with the clinical (nursing) staff. The non-clinical/front staff could be brought in to the discussion so everyone is on the same page with regards to clinical staff responsibilities and workflow, but that could be presented at a later time. Teammates should be encouraged to prepare for the meeting by being able to concisely state what their currently responsibilities and workflow preferences are. They should be prepared to have an open mind and respond to questions if necessary. The clinical staff could work in pairs to come up with suggestions on how to assign and complete the daily workflow in the inbasket as well as who would be responsible for what aspect of the daily duties. The leader should serve as a mediator in this process so the nursing staff can collaborate with each other and arrive at a resolution for the conflict.
Conclusion
Conflict is inevitable yet having strategies in place for recognizing and defusing the conflict before it can escalate is an important skill for not only leaders but all healthcare workers to have. In the healthcare field, we see people on some of their worst days. Our patients need to feel that their entire healthcare team is working together to take care of them and that they all want the best possible outcome for them. Conflict can disrupt productivity, impact morale and ultimately impact patient care. While it was uncomfortable to observe this recurring conflict within the healthcare setting, I now understand how important it is to recognize conflict in its early stages, before it becomes overt or manifest conflict. There were several places along the way in the observation where having a nurse leader step in could have avoided the bad feelings between employees and kept the patients from feeling like the vibe in the clinic was “off”.
In the future, I will be more observant and alert for possible conflict. As a future nurse leader I will encourage my team to come talk to me if there is an issue or if they feel something is unfair/unjust. Developing trust and confidence in a leader can also assist in stopping conflict or at the very least keeping the conflict from developing into full blown battle. Learning that nurses are more likely to employ compromise and competition as conflict resolution strategies was eye-opening and understanding why nurses choose those two styles makes me very interested to learn more about all of the different resolution strategies and when they may be appropriate which will help me as a nurse leader to know which strategy to use in which situation.
References
Finkelman, A. (2016). Leadership and management for nurses: Core competencies for quality
care (3rd ed.). Boston, MA: Pearson.
Iglesias, M. & Vallejo, R. (2012). Conflict Resolution Styles in the Nursing Profession.
Contemporary Nurse, (43)1, 73-80.
McKibben, L. (2017). Conflict Management: Importance and Implications. British Journal of
Nursing, (26)2, 100-103.
Simpao, A. (2013). Conflict Management in the Health Care Workplace. Physician’s Exective,
(39)6, 54-58.
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