Today's healthcare environment is a pressure cooker of cost constraints, quality and productivity demands, and complex clinical and ethical issues. Amid this pressure, professionals must work as a team. No wonder conflicts are on the rise! When effectively managed, conflicts yield creativity, effectiveness and positive energy. The aftermath of poorly managed conflict, however, is a drop in commitment, disrupted teamwork, diminished quality and decreased productivity. It has never been more important for nurses to be skilled at preventing and managing conflict.
Conflict in Nursing: A Hypothetical Case
Joan Smith, RN, and Frank Wilson, RN, are colleagues in a med/surg unit at a major hospital. While Joan has worked on this unit for the past 10 years, Frank is new to the facility and often needs to ask Joan for help. Whenever Frank asks a question, Joan snaps at him and says she is too busy with her own patients to help him. Joan seems oblivious to Frank's need for guidance and criticizes him in front of doctors, patients and their families.
Because he is new and she is so unapproachable, Frank is concerned about talking with Joan about her behavior. Instead, he dreads asking questions and sometimes just guesses what to do. Frank has recently been out sick a few times due to the stress. He is thinking about quitting and looking for a new job. Other unit staff share Frank's feelings of dissatisfaction and are resentful of Joan's unwillingness to mentor new staff. Conversations during break frequently focus on job opportunities listed in the newspaper. Over the past 3 years, seven nurses have either quit or transferred to other areas of the hospital.
Joan and Frank put a face on data coming from current nursing research. A study of 43,000 nurses from more than 700 hospitals in the United States, Canada, England, Scotland and Germany found that 40 percent of nurses in hospitals are dissatisfied.1 In another study of 907 current and former direct care nurses, 50 percent recently considered leaving direct care, for reasons other than retirement. In addition, 81 percent of this sample says that morale among nurses is fair to poor. Following understaffing, they cite stresses of the job as the second biggest problem with being a nurse.2 The data clearly show that real nurses experience a great deal of conflict in the professional role.
What is Conflict?
Conflict is a situation in which two or more parties' concerns - the things they want or care about - appear to clash.3 The parties can be:
- individuals (Joan and Frank);
- groups (the nurses working with Joan and Frank); or
- large systems (the thousands of nurses cited in current research).
The affective experiences of conflict can vary; the tone is not always negative. At times, conflict is neutral, or even positive, as when people creatively explore differences. Sometimes a conflict is fairly comfortable to address, "no big deal." At other times conflict arouses intense anxiety, hostility or defensiveness, as the story of Joan and Frank shows. Whatever the feelings, there are four steps in each conflict: frustration, conceptualization, behavior and outcome.
In step 1, frustration occurs when you perceive that the other has, or is about to frustrate one of your needs, interests or goals. In the above scenario, conflict begins when Joan ignores Frank's feelings of frustration and being overwhelmed, denies his requests for help, and embarrasses him in front of others.
This first step quickly moves to step 2, conceptualization.
The second step of conflict, conceptualization, occurs when you become aware of frustration and identify what the conflict means to you. Your definition is your reality. Do you define the conflict in terms of only your own needs, or do you also consider the other's needs? Do you know how the other person defines this conflict? Usually it is different than your definition. Is their behavior of little concern, or is it a huge issue to you? Is this situation likely to be resolved in a win-win outcome, or will one or both of you lose something in the exchange?
In the case of Joan and Frank, Joan views the issue egocentrically. All she can think of is her own workload. This seems to be a big issue for both parties, which generates intense feelings. Joan lets her perspective be known.
Frank seems to view the conflict as a lose-win situation in which Joan is likely to be the "winner." Thus, he avoids addressing it with her, keeps his perceptions to himself, and experiences increasing levels of job stress.
Step 3 in every conflict is behavior, the verbal and nonverbal messages both parties exchange in an interactive cycle. This step ends within moments, or can drag on for years. The words and behaviors you choose to address this, or any other conflict, are important.
Returning to the example, Joan uses aggressive, demeaning words and behavior when interacting with Frank. Frank, in turn, behaves passively and chooses to avoid addressing the issue. He also uses accommodation, (see Table 1) letting Joan focus on only her patients without asking that she honor his legitimate need for guidance.
Behavior choices shape the outcome of conflict, which is step 4. The outcome is the explicit or tacit ending, when both parties agree that the issue is solved or that they will change the subject and let the issue drop. The nature of the outcome determines the degree of continued frustration. Win-win outcomes yield the only complete ending of conflict. All other endings, win/lose, lose/lose, or win some/lose some, leave at least one party feeling that they have lost something.
In the above example, how Frank chooses to respond to his unhelpful coworker affects their working relationship and Frank's ability to function on the unit. Frank's concerns are not addressed, but Joan's needs are met. By employing avoiding and accommodating strategies, Frank experiences a net loss in the outcome of the conflict with Joan.
In conflict, if either party perceives a loss, there is "negative conflict aftermath," the harmful leftover feelings that taint subsequent conflicts between both parties. Because people remember past conflicts, each one is significant, and there are always detrimental consequences from poorly managed conflict. In the case of Frank and Joan, Frank's feelings about this med/surg unit are tainted by the series of negative exchanges they have with each other. The negative conflict aftermath is so strong that he is thinking of leaving. Moving out of the scenario and into the real world, this is an experience that many nurses have.
The cost of turnover and job dissatisfaction is too high to allow conflict to be poorly managed. It is critical for every nurse to become skillful at managing workplace conflict. Next are a dozen skills that foster an effective approach to conflict management.