Conflict Management

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There is a better approach to conflict resolution than fighting it out.
After completing this chapter, you should be able to:
• Identify common factors that lead to conflict.
• Discuss five methods to resolve conflict.
• Discuss techniques to use in handling difficult people.
• Discuss solutions and alternatives in dealing with anger.
• Identify situations of sexual harassment in the workplace, and discuss possible solutions.
Can you imagine a world without conflict? Why, it would be a world without change! Conflict is inevitable wherever there are people with differing backgrounds, needs, values, and priorities.
A stereotypical perspective of conflict related to nursing is that “nice” nurses avoid conflict. According to Beauregard and colleagues (2003), although caricatured images of the nurse may encompass the “old” battle-ax, the control freak, the naughty nurse, or the doctor’s handmaiden, the primary perception of the nurse by the public is one of the caring angel who is gentle and kind. Conflict within the nursing profession has traditionally generated negative feelings to the extent that many nurses use avoidance as a coping mechanism because of their feeling that the “public’s stereotypical image of them demanded that they be ‘nice,’ self-sacrificing, and submissive nurses and that if they engaged in conflict they would be branded emotional or unfeminine women” (Kelly, 2006, p. 27).
The presence of conflict in a situation is not necessarily negative but may, in fact, have some positive results. As a process, conflict is neutral. Following are some possible outcomes of conflict:
Disturbing issues are brought out into the open, which may avert a more serious conflict.
Group cohesiveness may increase as individuals resolve issues.
New leadership may develop as a consequence of resolution.
The results of conflict can be constructive, occurring when productive outcomes are achieved, or destructive, leading to poor communication and creating dissatisfaction.

Conflict

What Causes Conflict?

Let us look at some common factors of conflict as they relate to nursing.

Role Conflict

When two people have the same or related responsibilities with ambiguous boundaries, the potential for conflict exists. For example, a nurse on the 11 PM to 7 AM shift may be uncertain whether he or the nurse on the 7 AM to 3 PM shift is responsible for weighing a patient.

Communication Conflict

Failing to discuss differences with one another can lead to problems with communication. Communication is a two-way process; when one person is unclear in a communication, the process falls apart. A recent graduate may find that with a busy schedule, numerous patient demands, and a shortage of time, it is easy to forget to notify a patient’s family of a change in visiting hours—a great annoyance to the family members who cannot visit when they arrive.

Goal Conflict

We all have unique goals and objectives for what we hope to achieve in our places of employment. When one nurse places his or her personal achievement and advancement above everyone else’s, conflict can occur. An example of this can be seen in the newly graduated nurse who pursues an advanced nursing degree immediately following undergraduate education; the experienced nurse in the unit may feel that the new graduate nurse requires a minimum length of time at the bedside before advancing his or her education.

Personality Conflict

Wouldn’t it be great if we got along with everyone? Of course, we all know that there are just some people with whom we have a difficult time. The situation is all too familiar, and many times we may find ourselves with such thoughts as “I’ll try to overlook her negative, lousy behavior; after all, she doesn’t have much of a family life.” Trying to change another person’s personality is like guaranteeing an unhappy ending to a story.

Ethical or Values Conflict

During a cardiac arrest, a graduate nurse has a conflict with the physician’s order of “No Code,” on a young adolescent patient. She has difficulty taking care of the adolescent, because he reminds her of her younger brother who died tragically in an automobile accident.
Conflicts in nursing may fit into one or more of the aforementioned categories. Consider some common areas of conflict among nursing staff, including scheduling days off, determining vacation leave, assigning committees, patient care assignments, and performance appraisals, to name just a few.

What Are Common Areas of Conflict Between Nurses and Patients—and Between Nurses and Patients’ Families?

Guttenberg (1983) identifies five common areas of conflict among nurses and their patients and families.
1. Quality of care. This is by far the most common area of conflict and the easiest to remedy. Families typically are concerned with how well their loved one is being attended to, how friendly the nurses are, how well the hospital or home health services are provided and coordinated, and how flexible the hospital is with visiting hours and meeting their special needs.
2. Treatment decisions. This area of conflict often arises between the family of an older adult and the nurse. A physician may order a treatment with which the family does not agree. In this situation it is very important that the nurse not defend the physician’s orders or attempt to persuade or convince the family that the physician or nurse knows what’s best for the patient. In these situations, the issue is rarely the treatment itself but rather the family’s desire to decide what is right for the loved one. Be sure to clarify the orders and explain to the family that you are supposed to carry them out unless the family negotiates directly with the physician to change them. Conflict may also exist between the nurse and physician regarding care of older adults. For example, a physician may decline to perform a medical procedure on an older patient secondary to advanced age or preexisting comorbidities.
3. Family involvement. For example, when a young adult is diagnosed with cancer, numerous issues may arise concerning the presence of family members during procedures and the extent of their involvement in the overall care. Such issues are based on the family’s real need to feel significant and adequate in meeting the young adult’s needs.
4. Quality of parental care. This can become an issue when nurses are unhappy with how parents are participating in their child’s care. It is helpful to offer parenting classes that can encourage parents to meet other parents and can model positive parenting techniques. Fear of being a bad parent, by not responding to every cry an infant makes, is a good example of an area where the nurse can educate the parents on responding to their infant’s physical and emotional needs.
5. Staff inconsistency. This is another issue that is easily prevented. Make sure that staff members on each shift are consistent in enforcing hospital policies and that they notify other shifts of any attempts at manipulation by family members or patients.

Conflict Resolution

What Are Ways to Resolve Conflict?

Unresolved conflicts waste time and energy and reduce productivity and cooperation among the people with whom you work. In contrast, when conflicts are resolved, they strengthen relationships and improve the performance of everyone involved (Kim, Nicotera, & McNulty, 2015). The key to managing conflict successfully is tailoring your response to fit each conflict situation instead of just relying on one particular technique. Each technique represents a different way to achieve the outcome you want and to help the other person achieve at least part of the outcome that he or she wants. How do you know which technique to use? That depends on the following:
• How much power do you have in this situation compared with the other person?
• How much do you value your relationship with the person with whom you are in conflict?
• How much time is available to resolve the conflict?
An example of a model for conflict resolution can be found in Fig. 13.1. This model incorporates several views of conflict resolution. Filley (1975) described three basic strategies for handling conflict, according to outcome: win-win, lose-lose, and win-lose. Various others have identified the following five responses to resolve conflict: competition, accommodation, avoidance, compromise, and cooperation. In a recent study, the prevalent style for conflict resolution used by nursing students was compromise, followed by avoidance (Hamilton, 2008). As noted in this research study, compromise attempts to meet the needs of individuals on both sides of a conflict, whereas collaboration, which may take more time, offers the best avenue or approach to settling the conflict that will satisfy both participants (win-win solution). A research study by Iglesias and Vallejo (2012) examined predominant conflict resolution styles used by a sample of Spanish nurses in two work settings, academic and clinical, in order to determine differences between these environments. Their findings indicated that conflict management styles varied according to work setting, with nurses in an academic environment using most frequently the compromising style and nurses in the clinical environment using the accommodating style most frequently.
Let us look at an example and apply the model.
Suppose the charge nurse on your unit has posted the vacation schedule for the month of December. You, as a recent graduate, have requested to be off during the week of Christmas. You notice on the schedule that none of the recent graduates has received the Christmas holidays off. You feel that this is unfair, because you will not have an opportunity to be with your family during the Christmas holidays. How can you resolve this conflict?
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FIG. 13.1 Model for conflict resolution. (Modified from Douglas, E., & Bushardt, W. (1988). Interpersonal conflict: Strategies and guidelines for resolution, J Am Med Rec Assoc 56(18); Sullivan, E., & Decker, P. (1988). Effective management in nursing. Menlo Park, CA: Addison-Wesley.)

Competition

This is an example of the win-lose situation. In this situation, force—or the use of power—occurs. It sets up a type of competition between you and your charge nurse. Typically, competition is used to resolve conflict when one person has more power in a situation than the other. In the given situation, the charge nurse refuses your request for Christmas vacation, explaining that the staff members with more seniority have priority for vacation at Christmas time.

Avoidance

Avoidance is unassertive and uncooperative and leads to a lose-lose situation. In some situations, avoidance is not considered a true form of conflict resolution because the conflict is not resolved and neither party is satisfied. In the given situation, you would not have approached the charge nurse with the Christmas schedule issue. Usually, both persons involved feel frustrated and angry. There are some situations in which avoiding the issue might be appropriate, such as when tempers are flaring or when strong anger is present. However, this is only a short-term strategy; it is important to get back to the problem after emotions have cooled.

Accommodation

Accommodation is the lose-win situation, in which one person accommodates the other at his or her own expense but often ends up feeling resentful and angry. In the given situation, the charge nurse would put her own concern aside and let you have your way, possibly even working for you during the scheduled slot. The charge nurse loses and the graduate nurse wins in this situation, which may set up conflict among staff and other recent graduates. When is accommodation the best response? Is it when conflict would create serious disruption, such as arguing, or when the person with whom you are in conflict has the power to resolve the conflict unilaterally? In this response to conflict, differences are suppressed or played down while agreement is emphasized.

Compromise

Compromise or bargaining is the strategy that recognizes the importance of both the resolution of the problem and the relationship between the two people. Compromise is a moderately assertive and cooperative step in the right direction, in which one creates a modified win-lose outcome. In the given situation, the charge nurse compromises with you by allowing you to have Christmas Eve off with your family but not the entire week. The problem lies in the reduced staffing that will occur for a short period. The compromise may not be totally satisfactory for either party, but it may be offered as a temporary solution until more options become available.

Collaboration

Collaboration is the strategy that involves a high level of concern for the problem, the outcome, and the relationship. It deals with confrontation and problem solving. The needs, feelings, and desires of both parties are taken into consideration and re-examined while searching for proper ways to agree on goals. Collaboration is a win-win solution with a commitment to resolve the issues at the base of the conflict. It is fully assertive and cooperative. In the given situation, you and the charge nurse discuss the week of Christmas vacation and the staffing needs and agree that you will work the first three days of that week and the charge nurse will work the second half of that week. You also agree to be there the first part of the week to complete the audit on the charts from the previous week for the charge nurse. In this situation both persons are satisfied, and there is no compromising what is most important to each person. That is, the charge nurse gets her audit completed, and the recent graduate is able to spend half of the Christmas week with her family. What is your particular style for resolving conflict? (See Critical Thinking Box 13.1.)
 
icon CRITICAL THINKING BOX 13.1Conflict Questionnaire
Directions: Consider situations in which you find your wishes differing from those of another person. For each of the following statements, think how likely you are to respond to each situation in the manner described. Check the rating that best corresponds to your response.

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From Thomas, K. W. (1977). Toward multidimensional values in teaching: The example of conflict behaviors, Academy of Management Review, 2, 487.

What Are Some Basic Guidelines for Choosing the Technique to Use?

In some situations, certain techniques and responses work best. You may have to use accommodation or avoidance when you lack the power to change the situation. When you have conflict in a relationship that you value, it might be more helpful to use accommodation, compromise, or collaboration. When there is no immediate, pressing sense of urgency to solve an issue, then any of the five techniques can be used. However, when you are facing an emergency situation or a rapidly approaching deadline, your best bet is to use competition or accommodation. Just remember the following key behaviors in managing conflict:
▪ Deal with issues, not personalities.
▪ Take responsibility for yourself and your participation.
▪ Communicate openly.
▪ Avoid placing blame.
▪ Listen actively.
▪ Sort out the issues.
▪ Identify key themes in the discussion.
▪ Stay focused in the present; don’t dwell on the past.
▪ Weigh the consequences.
▪ Identify resolution options.
▪ Develop an outcome and obtain consensus.
Suppose that you follow all of these suggestions and you still are confronted with that difficult situation or that difficult person. Read on.

Dealing with Difficult People

What Are Some Techniques for Handling Difficult People?

Now that we have discussed types of conflict-management techniques, we are ready to look at techniques for handling difficult people. How do you deal with an abusive physician or supervisor? How do you react when someone constantly complains and gripes about something? How do you handle the know-it-all who will not even listen to your thoughts about an issue? (See Research for Best Practice Box 13.1 for suggestions on managing difficult employees.)
I am sure, if you have not already, you will run into in the near future a Sherman tank (Fig. 13.2). According to Bramson (1981), Sherman tanks are the attackers. They come out charging and are often abusive, abrupt, and intimidating. But more important, they tend to be downright overwhelming.
Remember Dr. Smith, who flew into a tirade because you forgot to have a suture removal set at his patient’s bedside at 8 AM sharp? Remember how you felt? “My heart was beating so loud I could hear it, and I was sure everyone else around could hear it, too. I was so furious at him for the comments he made.”
In understanding Sherman tanks, it is important to realize that they have a strong need to prove to themselves and to others that their view of the situation is right. They have a very strong sense of what others ought to do but often lack the caring and the trust that would be helpful in getting something done. They usually achieve what they want, but to do so causes them a lot of disagreements, lost friendships, and uncomfortable relationships with their co-workers. Sherman tanks are often very confident and tend to devalue those whom they feel are not confident. Unfortunately, they demean others in a way that makes them look very self-important and superior. How do you cope with a Sherman tank? The most important thing is to keep your fear and anger under control and to avoid an outright confrontation about who is right and who is wrong. The following are some specific things you should do:
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