The objective of this study is to examine conflict resolution and to describe a situation where conflict resolution has been encountered related to nursing and how the situation was handled. This work in writing will identify any patterns of behavior and the applicable of patterns to any other conflict situations and provide supporting evidence. Steps that could be taken to improve the situation will be outlined as well as what has been learned about conflict resolution and negotiation.
The work of Johansen (2012) entitled "Keeping the Peace: Conflict Management Strategies for Nurse Managers" states that handling conflicts "in an efficient and effective manner results in improved quality, patient safety, and staff morale, and limits work stress for the caregiver." (p.1) It is important that the nurse manager approach this challenge in a thoughtful manner since it involves "working relationships that are critical for the unit to function effectively -- the nurse and other members of the interdisciplinary healthcare team who must collaborate while navigating responsibilities and roles that often overlap." (Johansen, 2012, p.1) The nurse managers must possess skills that assist in effectively resolving conflicts.
I. Requirements of Effective Resolution and Conflict Management
The stated requirements of conflict resolution that are effective are stated to be inclusive of "clear communication and a level of understanding of the perceived areas of disagreement." (Johansen, 2012, p.1) Conflict resolution is stated to be "an essential element of a healthy work environment because a breakdown in communication and collaboration can lead to increased patient errors." (Johansen, 2012, p.1) Johansen reports that the American Association of Critical-Care Nurses standards for healthy work environments recognize the importance of proficiency in communication skills and The Joint Commission's revised leadership standards place a mandate on healthcare leadership to manage disruptive behavior that can impact patient safety." (2012, p.1)
It is important that nursing leaders assess "how nurses deal with conflict in the healthcare environment in an effort to develop and implement conflict management training and processes that can assist them in dealing with difficult situations." (Johanasen, 2012, p.1)
II. Defining Conflict
Johansen (2012) writes that while it is typically accepted that conflict "…is an inevitable and integral part of the work environment, it's important to clarify just what conflict means. One definition of conflict is a disagreement through which the parties involved perceive a threat to their needs, interests, or concerns. However, this definition encourages a tendency to narrowly define the issue as one of task or substance." (p.1) Conflicts in the healthcare environment are reported as having a tendency to "be far more complicated because they often involve ongoing, complex relationships that are based in emotion." (Johanasen, 2012, p.1) Conflict is reported to be such that is comprised of "substantive, procedural, and psychological dimensions that participants in conflict respond to on the basis of their perceptions of a particular situation." (Johanasen, 2012, p.1) According to Johanasen, it is this "perception that's filled with thoughts and emotions that guide the individual to a solution. Understanding the types of conflicts that the direct care nurse commonly encounters and the way he or she responds to conflict is an important element in identifying effective strategies to manage conflict in the healthcare environment." (Johansen, 2012, p.1)
III. Center for American Nurses Conflict Resolution Survey
Johansen (2012) reports that the Center for American Nurses "conducted a conflict resolution survey to identify challenges related to conflict encountered by the professional RN. A total of 858 nurses responded to both open-ended and closed-ended items in a web-based survey." (p.1) Following the data being coded and analyzed it is reported that a thematic analysis was conducted and that identification was made of four themes including those as follows:
(1) anguishing through unhealthy conflict and its effects,
(2) longing for a better path to address conflict in a productive manner,
(3) understanding and welcoming channels to address conflict, and (4) suggesting improvements to address workplace conflict. (Johansen, 2012, p.1)
IV. Most Common Types of Workplace Conflicts
Johansen (2012) states that the most common type of workplace conflict and the conflict found to be most problematic was that of "interpersonal conflicts." (Johansen, 2012, p.1) Stated, as the three primary situations involving interpersonal conflicts, which were identified in the survey, were those stated as follows:
(1) patient and family;
(2) nurse manager; and (3) physician. (Johansen, 2012, p.1)
Johansen (2012) write that conflicts that involved nurse and their patients, patient's families, and patient visitors "was reported to occur as a result of the disparity in perceptions regarding which patient-care issue needed to be addressed first, limiting visiting hours, and restrictions surrounding disclosure of confidential information." (p.1) Stated as the second most frequent interpersonal conflict "was between the direct care nurse and the nurse manager." (Johansen, 2012, p.1) It is reported that this conflict was found to be in regards to the leadership team lack of support and failures in communication. The third stated interpersonal conflict was reported to be that existing between "other healthcare providers and the direct care nurse." (Johansen, 2012, p.1) Failure to handle these conflicts effectively or ignoring these conflicts are reported to have resulted in "a toxic work environment." (Johansen, 2012, p.1)
V. Conflict Management Strategies
Conflict management styles are reported to be complex in nature and it is also reported that one style may be used more so than others depending on the "situation and the participants." (Johansen, 2012, p.1) Stated to be five styles of conflict management are those stated as follows:
(4) compromising; and (5) integrating. (Johansen, 2012, p.1)
Stated as specific recommendations for nurse managers in the area of conflict resolution are the following:
(1) Engage in dialogue. Nursing leaders and direct care nurses need to engage in dialogues that address conflict and conflict management behavior as a first step in creating a healthy work environment. The lack of communication and prevalent use of avoidance by today's nurses as a conflict management strategy prevents the root of the problem from being properly addressed and resolved, thus the conflict situation remains. This is important for the acute care setting because it's particularly susceptible to conflict due to the chaotic nature of the environment that includes constant change, poor communication, and multidimensional tasks. (Johansen, 2012, p.1)
(2) Engage in coaching. The nurse manager can minimize escalating conflict by educating nurses to learn how to effectively resolve conflict themselves. This can be accomplished through case scenarios and working with the education department on role-playing exercises. Because managers usually arrive after a dispute is in evolution, they may not have a clear understanding of the issue. Nurses who don't have the opportunity to learn about how to deal with conflict find it expedient and perhaps even necessary to have the manager intervene. Having the nurse leader walk the direct care nurse through a variety of conversations to resolve a dispute or disagreement provides the opportunity for alternative solutions to be considered. (Johansen, 2012, p.1)
(3) Identify potential conflicts. Because conflicts are normal, inevitable experiences in the healthcare work environment, they're usually predictable. Situations that naturally occur as the nurse strives to manage complex patients are to be expected. Procedures and processes for identifying potential common conflicts need to be developed to transform these situations into opportunities for growth and learning. (Johansen, 2012, p.1)
(4) Education and training. Nurses need to be educated in the topic of conflict and conflict management strategies to address and effectively resolve conflict. Learning conflict management strategies empowers nurses to resolve conflict early and influence the work environment in which they deliver patient care. The training shouldn't be limited to the handling of interpersonal conflicts; it should include all types of conflict commonly encountered in the healthcare setting. In addition, individuals who have a propensity for managing conflict well should be identified and developed. (Johansen, 2012, p.1)
VI. Interaction Process
The work of American Sentinel University states that the use of the following steps in the interaction process are key to conflict resolution:
(1) Open. In this step you make sure the discussion has a clear purpose and a clear goal -- that you're all talking about the same thing. (It may seem obvious, but others may have a very different idea of what's going on!) If you've initiated the discussion, you can clearly state your purpose. If someone else initiates the discussion, ask them to define their purpose. For example, you might start your response with, "Let me be sure I understand -- you want to talk about…"
(2) Clarify. This is a fact-finding step, in which you'll want to explore every side of the issue, and every stakeholder's concerns. (Remember that people's feelings about the situation are also valid information!) This is an especially important step in group discussions, where every member might bring different insights and facts to the table.
(3) Develop. This is the point at which ideas are presented for resolving the conflict. Even though you'll have your own solutions in mind, be sure to involve others…