Leadership conflict management in nursing

Leadership -- Conflict Management in the Field of Nursing

The Tools for Dealing with a Host of Conflicts

The Impact of these Principles on a Health Care Environment

A major challenge that all nurses will face in the field of health care is conflict management. The reason why is from interacting with everyone inside a health care environment more than any other staff member. This means that during the course of performing their daily tasks is when the odds are high of the nurse experiencing some kind of abuse. In most cases, this occurs through: patients being verbally abusive or doctors making comments that are considered harassing in nature. Evidence of this can be seen with the fact that 90% of nurses reported some form of verbal abuse at least once a year. Out of this number, 30% reported that this kind of abuse came from interacting with doctors. This is in the form of inappropriate comments or touching. These figures are significant in showing how nurses must be able to have effective conflict management skills.

As a result, all nurses need to possess certain attributes that will help them to always deal with these kinds of situations. To determine the most appropriate tactics requires looking at specific tools that can be utilized during the process and the impact that it will have on the health care environment. Together, these elements will provide the greatest insights as to how a nurse should be using these techniques to improve conflict management.

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For all nurses, learning effective conflict management is one of the keys for ensuring that situations do not spiral out of control. The main issue is from patients and staff members, who are stressed out, about the events that are unfolding. This increases the chances of some kind of conflict occurring inside with these frustrations boiling over. Once this happens, is when there will be the possibility of some kind of conflict. This is when there is the chance that a situation could become verbally abusive eventually turning into violence. (Rancer, 2010, pp. 245 -- 246)

A good example of this can be seen in a study that was conducted by U.S. Department of Labor. They found that health care environments are one of the most likely places for conflicts to occur from:

The pervasiveness of handguns (which is as high as 25%).

A conflict about patients taking their medication.

Low staffing.

Health care staff working in remote locations with the patient (such as Hospice).

Long wait times for treatment.

Unrestricted movement of the public inside health care facilities. (Rancer, 2010, pp. 245 -- 246)

These elements are highlighting how there are a number of ways that conflicts can occur inside a health care environment. To prevent a situation from spiraling out of control requires conducting conflict management. This is when nurses can be able to effectively deal with a host of situations and reduce the chances of an incident taking place. (Rancer, 2010, pp. 245 -- 246)

The Tools for Dealing with a Host of Conflicts

To effectively deal with these issues requires using a number of techniques in conjunction with one another. The most notable include: accommodation, pressing, avoidance and negotiation. The combination of these elements can be used in combination with one another to address a variety of situations that will be encountered. Those individuals who are able to master these skills will reduce the chances of situations spiraling out of control. This is when the odds are decrease of having some kind of verbal or physical confrontation. (Daniels, 2004, pp. 485 -- 486)

Accommodation

Accommodation is one of the more popular conflict resolution strategies used in a health care environment. The basic idea is to give the other party whatever they want in the hope that it will go away. For example, if a patient is demanding to see a doctor and is becoming verbally abusive most health care professionals will find someone that can assist them. In the majority of cases, this could be a resident, who is helping to tone down the patient's intensity. (Daniels, 2004, pp. 485 -- 486)

The problem with using this approach is that the other party could feel emboldened by these actions and begin demanding more. Using the previous example, the patient could become upset with the fact that they are speaking with a resident vs. An experienced physician. They could also believe that their aggressive behavior from earlier is being rewarded. Once this happens, is when there is the possibility that the conflict could begin to escalate out of control. (Daniels, 2004, pp. 485 -- 486)

To prevent these kinds of situations, a nurse must be able to let the other party know that you will accommodate them. The reason why is because this strategy will help to defuse the situation. However, once the patient has calmed down is when you will assist them. This will help to change the intensity of conversation and refocus the patient. It is at this point that the conflict will have been toned down and effective communication can occur. (Herzog, 2000, pp. 162 -- 166) (Daniels, 2004, pp. 485 -- 486)

Pressing

Pressing is when the nurse will have the flexibility to create relationships with everyone out of their own self-interest. This means that an individual will work with others and certain groups based upon what they can do for them. For example, inside a health care organization is often a sub-culture of doctors, nurses, administrators and hospital personnel. A nurse who is thinking about career advancement will often use this flexibility to forge alliances because of convenience. This helps to give the appearance that they are a team player. Yet, in reality these individuals are not. Once a particular person or organization is not a benefit to them, is when they will no longer have any interest in the other party's well-being (creating a win - lose situation). (Daniels, 2004, pp. 485 -- 486)

In a health care environment, this kind of behavior should never be tolerated. The reason why is because, everyone will become focused on their own self-interests and ignore the needs of patients. This is when the overall quality of care will decline. To prevent these situations from happening requires focusing on limiting individual self-interests inside the organization. The best way that this can be achieved is to encourage everyone to work together and create win -- win situations. This will show honesty and integrity. While at the same time, it is forging critical alliances with staff members inside the organization. Over the course of time, this will change the atmosphere and focus of everyone by demonstrating true leadership. (Daniels, 2004, pp. 485 -- 486) (Heidi, 2008, pp. 250 -- 257) (O'Mara, 1999, pp. 451 -- 459)

These elements are important in illustrating how forging alliances and improving communication can change the environment inside the organization. The way that this can be used to reduce conflict is to effectively listen to the other party and then objectively communicate your thoughts. This will help to form a bridge of trust (creating the setting for a win -- win situation to develop).

Avoidance

Avoidance is when the nurse believes that if they ignore the problem long enough that it will go away. In some situations, this kind of strategy is effective in dealing with certain individuals (such as an irrational patient that is talking to themselves). However, the problem with using this basic approach is that this could create even larger issues in the future. The main reason is because these problems have been compounded and there is concern about the lack of action. This gives the appearance that the nurse does not care or have the skills necessary in dealing with these problems. (Cavanaugh, 1988, pp. 118 -- 123) (Daniels, 2004, pp. 485 -- 486)

For example, in a busy health care environment an inexperienced nurse could have communication issues with a family. In these kinds of situations, they could tell them that the procedure should last three hours. However, once the surgery begins is when it takes much longer than expected. During this process, is when the nurse does not communicate with the family and ignores their requests for information. This only makes the situation worse based on the lack of communication that is taking place. (Cavanaugh, 1988, pp. 118 -- 123) (Daniels, 2004, pp. 485 -- 486)

To avoid these kinds of problems, nurses need to be able to understand when certain issues can be ignored. This means placing a priority on everything involving care and critical treatment at the facility. While in situations that are deemed as unimportant can be overlooked (i.e. keeping up with latest gossip among the staff). This is prioritizing how nurses can be able to reduce conflict by showing that they are a team player (who is willing to do more). (Cavanaugh, 1988, pp. 118 -- 123) (Daniels, 2004, pp. 485 -- 486)

Another example of avoidance can be seen with compromise. In these kinds of situations, the health care professional is taking the middle ground to satisfy both parties (which will lead to a number of challenges). This is from both sides feeling that they have won and will want more down the road. The only difference is that they are more emboldened in their position. This is problematic, because it can make the underlying situation worse in the future. (Feldman, 2008, pg. 128) (Daniels, 2004, pp. 485 -- 486)

To avoid these kinds of situations requires that compromise should be used as a solution when both sides agree to accept the proposal. This does not mean coming back in the future and exhibiting the same kind of behavior to achieve what they want. Instead, both parties have to be willing to accept the compromise completely. If this kind of approach can be taken it will create win -- win situations. While at the same time, it will establish a basic foundation of improving communication between the two parties. This is when the health care professional is exhibiting true leadership. (Feldman, 2008, pg. 128) (Daniels, 2004, pp. 485 -- 486)

Negotiation

A negotiation is when the nurse is working with both sides to create a compromise. The way that this takes place, is with everyone agreeing to give up a certain amount on their position in order to meet the other party half way (which is similar to something that happens in avoidance). The only difference is that nurse is trying to create a solution that will resolve a potential conflict inside the facility. (Garcia, 2006, pp. 201 -- 206) (Daniels, 2004, pp. 485 -- 486)

For example, suppose that a nurse is member of a team that works in the ICU. One of the patients wants to be able to see visitors other than his immediate family (i.e. his girlfriend). The problem is that she is not considered to be family, beyond the romantic relationship that the two have. The nurse wants to make the patient happy and follow the rules of the hospital. One possible strategy that she could use is to discuss with her supervisor the possibility of making an exception to the policy this time. While letting the patient know that if she is allowed on the ward. That this not the policy of the ICU and should be kept in confidence. This kind of approach is seeking a compromise from both the administration and the patient. (Garcia, 2006, pp. 201 -- 206) (Daniels, 2004, pp. 485 -- 486)

To prevent both sides from becoming out of control, we have focused on using tactics that will allow everyone to receive what they want. At the same time, we are letting them know that this is a one-time exception that will not be repeated in the future. In this aspect, the nurse is showing true leadership by working with both parties to come to a mutually agreeable solution. While letting everyone know, this not something they should not take advantage of at another time. This is when all the parties will follow the conditions outlined and understand the boundaries of the agreement that is in place. (Garcia, 2006, pp. 201 -- 206) (Daniels, 2004, pp. 485 -- 486)

The different skills that are mentioned above can provide nurses with an effective strategy for dealing with a host of challenges. However, some kind flexibility and common sense must be utilized at all times. This means that nurses must understand the drawbacks of using the different techniques and when to apply them. At the same time, the individual must be able to remain calm and allow the other party to explain to them what is on their mind. This will help everyone to lower the intensity of the conversation and seek out some kind of solution.

The Impact of these Principles on a Health Care Environment

The impact of the above leadership principles is that they will transform a health care environment. This is because we are focusing on improving quality, communication and effective team building. As time goes by, this will prevent any kind of situations from spiraling out of control. Evidence of this can be seen in a study that was conducted by DiMatteo (1998). He found that communication is a part of effective leadership that helps to improve the overall quality of care that is provided. Commenting about this he said, "Communication is seen as an essential component of the health care professional's role. Further, we found that the public's ratings of the medical profession depend heavily on their experience with health care staff members." This is important, in showing how applying these techniques will transform a health care environment. (DiMatteo, 1998, pp. 328 -- 333)

However, during the process anyone who is advocating these kinds of changes must be demonstrating that they are willing to practice what they preach. This means that the individual has to continually show on a daily basis that they are committed to changing the health care environment for the better. When this is happening, the person must be willing to go the extra mile and effectively communicate with all staff members. If this kind of approach can be taken, it will ensure that the nurse is demonstrating effective leadership.

Applying these Ideas in a Modern Health Care Environment

Applying these ideas in a modern health care setting can be challenging. This is because there is rising demand from more patients coming to the facility and less amounts of staff. Over the course of time, this can place increased strains on the nurse (as they are continuously overwhelmed from the challenges they are dealing with). To prevent these kinds of issues, they must be able to use the techniques of: accommodation, pressing, avoidance and negotiation. The way that this will take place, is nurse must first understand the weaknesses of using these different approaches.

Next, they will utilize flexibility and common sense when applying these tools to a potential conflict they are dealing with. For example, suppose that a nurse needs to be able to communicate their thoughts about a difference of opinion on treatment options to the doctor. The best way that this can be achieved is to ask the doctor why a particular kind of therapy was chosen. After listening to the different reasons, is when the nurse could express their concerns that this could be a mistake and the reason why. The conversation will take place in a non-confrontational and inquisitive manner (reducing the chances of escalating the conflict further). This is when they will highlight their differences of opinions and suggest another approach that is along the same lines. As a result, this is offering the nurse a solution that they can use to be able to reach out to everyone.