Nursing Leadership and Conflict Management in Healthcare

Introduction

The complexities of communication in healthcare are accentuated by the urgency of providing expert-level care and continually sustaining a high level of professional competence among peers and within broader professional communities. The more time-sensitive a given field of nursing or medical practice, the more critical it is to have highly accurate, relevant, and timely patient data on which to base decisions (White & Thornbory, 2007). Across the entire medical industry, and specifically in nursing, the greater the competency a professional demonstrates, the greater the credibility they earn over time (McElhaney, 1996). This is what makes leadership so difficult in the nursing industry: excellent leaders will, over time, coach and develop highly effective nursing professionals who are honest about both their strengths and their weaknesses (Fuimano, 2005).

Authenticity and transparency are critically important for creating a solid foundation of trust in communication. The more intense the time pressures and the greater the demand for expertise in a given situation, the more a nurse's credibility is tested. When a nurse portrays themselves as more competent than they are and becomes defensive when errors occur in interpreting cardiac history and laboratory data — two areas of primary nursing competence — major conflict is inevitable. This is precisely the scenario that recently occurred involving physicians, an operating room team, and a nursing trainee who claimed to have nine years of experience.

Communication, Trust, and Credibility in Nursing

At the center of all successful communication strategies is shared meaning, common frames of reference, and an implicit trust of shared interest (Nicotera & Mahon, 2013). When any of these factors are absent or deficient, the potential for conflict escalates (Fuimano, 2005). What often causes conflicts to escalate is a mismatch between what is said and the experiences or perceptions that follow. Very often in nursing, these disconnects between expectations and actual performance occur in the areas of expertise or mastery of specific aspects of patient treatment and analysis (Conant & Kleiner, 1998).

In the end, every nurse's most valuable possession is their credibility. It is the currency with which they earn promotions and, over time, advance their career. It is earned through trust and solidified by years of consistent performance. When a nurse's credibility comes under attack, they will often react at a level disproportionate to the original challenge. In other words, an attack on a nurse's competency is tantamount to an attack on their future career. The more uncertain a nurse is about their mastery of a given area — even seemingly straightforward tasks such as checking dates on a chart or reviewing cardiac history and laboratory data — the more such questioning will feel like a major threat.

The Conflict Scenario: A Nursing Trainee's Defensive Reaction

In the case of the nurse who overreacted to questions regarding cardiac history and laboratory data, and who accused another nurse of deliberately embarrassing her in front of physicians, the conflict management approach needed to shift toward a collaborating model to prevent further escalation. Insecure about her expertise and interpreting a simple mention of a chart inaccuracy as cause to lose her temper, the trainee's behavior revealed deep self-doubt about her mastery of nursing. Her contention that the mistake was deliberately amplified before the physicians only underscored that self-doubt. Often, the most self-doubting nurses are the most contentious when confronted with their errors. All of these factors, taken together, create an explosive situation over time unless the supervising nurse intervenes with appropriate conflict management and resolution techniques.

Conclusion

The most costly aspect of conflict is when it is left unchecked and escalates rapidly into full-scale retaliation and outright anger. This is disastrous in a healthcare environment where every second needs to be focused on patients and their treatment. The intent of this analysis has been to provide insights into how a conflict arising from a nurse trainee's failure to review a fundamental element of a treatment program — cardiac history and laboratory data — was allowed to escalate and could have had catastrophic consequences. The issue of the nurse's credibility and the trust placed in her abilities is central, as these are among the most powerful forces driving conflict in healthcare settings today. Stepping back from accusation and moving toward structured conflict management must be done in the interest of patients, keeping their welfare as the highest priority for every healthcare provider.