DEALING WITH CONFLICT MANAGEMENT IN NURSING

Can you imagine a world without conflict? How do we mange conflict so the organization and personnel don 't suffer? Can we actually benefit from conflict? Conflict is expected as long there are people with differing backgrounds, needs, values and priorities. Webster defines conflict as; a: fight, battle or war: competitive or opposing action of incompatibles: antagonistic state or action (as of divergent ideas, interests, or persons) b: mental struggle resulting from incompatible or opposing needs, drives, wishes, or external or internal demands c: the opposition of persons or forces that gives rise to the dramatic action in a drama or fiction (Webster). Nursing brings new meaning to conflict. Nurses are asked to work longer hours and still manage their home affairs. This paper will address common factors, some ways of handling conflict and some resolutions.

Is conflict good or bad? The answer is yes and yes. Don 't be confused by this illogical or impossible answer. Like so many areas in management, there is not clear cut answer because we are not dealing in absolutes. Conflict has many variables because we are dealing with the greatest variable of all...human beings. We can 't say conflict is either good or bad; it 's the individual 's reaction to conflict that determines this. People reactions to conflict are different. It can cause nurses to work harder or slower.

What do you think causes conflict? Let 's look at some common factors of conflict as it relates to nursing:

Role Conflict. This happens when two people have the same or related responsibilities. Nurses that work with patients ' regularly don 't want to give up control.

Communication conflict. Failing to discuss problems with each other can lead to problems with communication. Communication is a two-way street. If one person is unclear that equals drama. Has something you said ever been taken the wrong way?

Goal conflict. Each one of us has a goal we want to achieve at work. Conflict can occur when workers personnel goals are place above co-workers.

Personality conflict. Two people just don 't get along.

Ethical or values conflict. The job requires a worker do something that they don 't believe in. An example of this is working for a doctor that does abortions (Zerwekh 164).

Now let 's look at some behaviors in the workplace that can cause conflict:

Intellectual behaviors. One nurse is not sharp as the other and has a hard time dealing with it.

Emotional behaviors. This is the biggest one in nursing. Emotions just take over the situation.

Interpersonal behaviors. How does one nurse relate to others? Is there a culture problem? Maybe he or don 't like working with the opposite sex.

Managerial behaviors. The manager influence is used in a negative way. The manger may also show favoritism to some nurses (NCOA).

Conflicts in nursing may fit into one or more of these categories. You might even have some personal experiences to add to this list.

Now that we know what can cause conflict in the workplace, let 's address some things we can do to resolve it. Unresolved conflicts waste time and energy. It has been estimated that in most organizations, managers, who carry a primary responsibility for the performance of other employees spend 20% to 50% of their time overseeing conflict (Collins 10). That means that a manager who earns $50,000 a year $10,000 to $25,000 is spent on conflict (Collins 10). If a company has 5 managers they could bring in another manager just to handle all the conflict.

High

Satisfying the Other 's Needs.....................Low Accommodating Collaborating

Compromising

Avoiding Competing

Low...........................Satisfying our needs......................... High

Figure 1: Satisfying others and your needs. Noted from "Negotiations and Resolving Conflicts: An Overview"

The key to successfully managing conflict is responding to fit each conflict situation instead of just relying on one style. When dealing with conflict there are five styles that are available. Competition is a win-lose situation. The use of style can set up a competition between a nurse and the head nurse. The collaborating style involves and attempts to satisfy the concerns of both sides through honest discussion. It involves creative approaches to conflict reduction. For example, the sharing of resources may actually lead to both parties being materially better off. For this style to be successful, trust and openness are required of all participants. This style is a win-win situation. Avoiding is unassertive and uncooperative, and leads to a lose-lose situation. Avoidance is not considered a true form of conflict resolution because the conflict is not resolved and neither party is satisfied. Most of the time both parties will be frustrated and angry. There are some situations when tempers are flaring that using this style is appropriated but, this is only a short-term fix. Accommodation style combines unassertiveness and high cooperation. This style is a lose-win situation. In this style you accommodate the other person at your own expense and end up hating life. Using accommodation is useful when it is used to prevent arguing and causing disruption at work. Compromise or bargaining is the strategy that recognizes the importance of both the resolution of the problem and the relationship between the two people. It involves intermediated amounts of assertiveness and cooperation and strives for partial satisfaction of both parties by seeking middle ground. This creates a win-lose outcome. In order to succeed at compromising both parties must be willing to give up something. Collaborating style involves an attempt to satisfy the concerns of both parties through honest discussion. It involves creative approaches to conflict reduction. The needs, feelings, and desires of both parties are taken into consideration in order to come up with a resolution. This is a win-win situation. The goal is to turn the negative feelings to positive ones. Complete the style survey on page 9 to see what style you normally use.

Negative Feelings Before or During Conflict Positive Feelings After Proper Handling of Conflict

hurt cared for

scared confident

frightened relieved

ignored listened to

confused clear on things

isolated more intimate with others

challenged challenged to grow

threatened open to truth

unwanted accepted by others

disliked respected

put down supported

controlled understood

judgmental accepting of differences

Table 1. Results of handling conflict. Noted from "Coping.org Tools for Coping with Life 's Stressors"

In some situations one style works better than another. You might have to use accommodation or avoidance when you don 't have the power to change the situation. In nursing this can happen when you don 't agree with the nurse manager about a change at work. All these styles have an application to when you should use them. (Figure 1)It is important to get involved and take responsibility for dealing with a conflict situation. Complete attachment 1 to see what style fits you the most.

To accomplish this and at the same time manage conflict positively, consider the 5-step approach to successfully managing conflict:

Step 1: Take responsibility for dealing with conflict - You can 't turn conflict into a positive situation if you 're the leader and don 't take personal responsibility for dealing with the conflict.

Step 2: Uncover, discuss, and define the real problem - What may be worse that not acting on conflict may be having incomplete or inaccurate information about the situation.

Step 3: Ask questions and listen - To fully understand the conflict, one must ask open-ended questions and practice reflective listening.

Step 4: Set goals and create and action plan - Remember to focus on the attributes of specific, measurable and attainable goals.

Step 5: Follow-Up - Review the results of the solution to ensure the solution achieved its intended goal to resolve the conflict (NCOA).

Let 's discuss the different ways to handle difficult people. At one point or another we have all come across the supervisor from hell or better yet the doctor from hell. How do you deal with them? The important thing is to keep your fear and anger under control. Avoid confrontation about who 's right or who 's wrong. There are different types of people you might have to deal with. The first one is a Sherman Tank. According to Bramson (1981), Sherman tanks are the attackers. They are come out charging and are often abusive, abrupt and intimidating. These are something you should do:

- Don 't get run over, step aside

- Stand up for yourself. Defend yourself, but without fighting.

- Give them a little time to run down and express what they might be complaining about.

- Sometimes you have to be rude. Get your word in any way you can.

- Try to get them to sit down. Keep eye contact while you talk to them.

- Don 't argue or cut them down.

- When they finally hear you be ready to be friendly.

Next are the snipers. They are pot-shot artists. Their weapons are the smart little comments that are meant to hurt you. They use hidden tactics instead of the frontal attack. They will try to undercut you. If that happens call them out. Ask them, "Was that a put down? Because that 's the way I received it." Another is the constant complainer. A complainer points out real problems but does it from a very non-constructive stance (Bramson). To deal with them will suck the life out of you. First, listen to what they have to say and acknowledge them. Then ask them what they suggest as a way to fix the problem. Turn the complaining into a positive conversation. The most frustrating ones are the clams. They don 't respond to anything. They clam up and won 't answer when you need them or want conversation. Trying to deal with a clam takes patience. You will have to use open-ended questions and watch for body signals. Most of the time non-verbals will be the key.

Not dealing with conflict in the right way can make things worse. The problem can start at work but, being human you 'll drag it home with you. Divorce rates are up more and more nurses are on anti-depressants than ever before. Let 's not eat our young. When we graduate the opportunities will be endless. We as present and future management need to grasp a hold of the work place conflict and use it to develop other nurses in a positive way. Let 's deal with the Sherman tanks and complainers. Of course, this is not the end all of how to handle conflict but it should give you an idea in what direction to handle the situation. I have discussed different ways and ideas on how to handle conflict in the workplace. Please use this information and let 's let our junior nurses grow. Conflict is manageable and we should do our best to manage or workplace as efficiently as we can.

Conflict Management Style Survey

Rank items A through E for each item. Place the number 5 next to the best response for you, them 4 for the next best, then 3, then 2, then 1 for the least accurate one. Try not to agonize over these. There are not right or wrong answers, only truthful ones. Generally, your initial gut response is the most accurate one. Make your choices quickly. You must rank all 5 choices for each question - even those with which you struggle.

1. When you have strong feelings in a conflict situation, you would:

_____A. Enjoy the emotional release and sense of exhilaration and accomplishment.

_____B. Enjoy the challenge of the conflict.

_____C. Become serious and concerned about how others are feeling and thinking

_____D. Find it frightening because someone will get hurt

_____E. Become convinced there is nothing you can do to resolve the issue

2. What 's the best result you can expect from a conflict?

_____A. Conflict helps people face facts

_____B. Conflict cancels out extremes in thinking so a strong middle ground can be reached.

_____C. Conflict clears the air, enhances commitment and results

_____D. Conflict demonstrates the absurdity of self-centeredness and draws people closer together.

_____E. Conflict lessens complacency and assigns blame where it belongs.

3. When you have authority in a conflict situation, you would:

_____A. Put it straight and let others know your view

_____B. Try to negotiate the best settlement

_____C. Ask for other viewpoints and suggest that a position be found that both sides might try.

_____D. Go along with others, providing support where you can

_____E. Keep the encounter impersonal, citing rules if they apply

4. When someone takes an unreasonable position, you would:

_____A. Lay it on the line and say that you don 't like it

_____B. Let him or her know in casual, subtle ways that you are not pleased; possibly distract with humor; and avoid direct confrontation.

_____C. Call attention to the conflict and explore mutually acceptable solutions

_____D. Keep your misgivings to yourself

_____E. Let your actions speak for you, possible using depression or lack of interest

5. When you become angry with a peer, you:

_____A. Explode without giving it much thought

_____B. Smooth things over with a good story

_____C. Express your anger and invite a response

_____D. Compensate for your anger by acting the opposite of your feelings

_____E. Remove yourself from the situation

6. When you find yourself disagreeing with other members about a project, you:

_____A. Stand by your convictions and defend them

_____B. Appeal to the logic of the group in the hope of convincing at least a majority that you are right

_____C. Explore points of agreement and disagreement

_____D. Go along with the group

_____E. Do not participate in the discussion and don 't feel bound by any decision made.

7. When one group member takes a position in opposition to the rest of the group, you:

_____A. Point out publicly that the dissenting member is blocking the group and suggest that the group move on without him or her if necessary

_____B. Make sure the dissenting member has a chance to communicate his/her objections so that a compromise can be reached.

_____C. Try to uncover why the dissenting member views that issue differently so that the group 's members can re-evaluate their own positions

_____D. Encourage members to set the conflict aside and go on to more agreeable items on the agenda

_____E. Remain silent because it is best to avoid becoming involved.

8. When you see conflict emerging in your team, you would:

_____A. Push for a quick decision to ensure that the task is completed

_____B. Avoid outright confrontation by moving the discussion toward a middle ground

_____C. Share with the group your impression of what is going on so that

the nature of the impeding conflict can be discussed.

_____D. Relieve the tension with humor

_____E. Stay out of the conflict as long as it is of no concern to you

9. In handling conflict between group members, you would:

_____A. Anticipate areas of resistance and prepare responses to objections prior to open conflict

_____B. Encourage your members to be prepared by identifying in advance areas of possible compromise

_____C. Recognize that conflict is healthy and press for the identification of shared concerns and/or goals

_____D. Promote harmony on the grounds that the only real result of conflict is the destruction of friendly relations

_____E. Submit the issue to an impartial arbitrator

10. In your view, what might be the reason for the failure of one group to work with another?

_____A. Lack of a clearly stated position or failure to back up the group 's position

_____B. Tendency of groups to force their leaders to abide by the group 's decision as opposed to promoting flexibility, which would facilitate compromise

_____C. Tendency of groups to enter negotiations with a win/lose perspective

_____D. Lack of motivation on the part of the group 's leaders, resulting in the leaders placing emphasis on maintaining their own power positions rather then addressing the issues involved

_____E. Irresponsible behavior on the part of the group 's leaders, resulting in the

leaders placing emphasis on maintaining their own power position rather than addressing the issues involved.

Scoring:

Go back and total the numbers you have placed for each letter and record the totals below. (Record all the numbers for A and record, and so on.) For example, if you have placed the number 5 next to A for all ten questions, your score for A would be 50.

A. _____________ B. ________________ C. ________________

D. _____________ E. ________________

Look at your totals.

The highest number typically represents the conflict management style you perceive yourself to use most- most people see themselves as collaborators

Look at the second highest number. It typically move accurately represents your strongest conflict management style

The lowest number represents the style in which your skills are typically the weakest

Column A: Dominating style

Column B: Compromising style

Column C: Collaborative style

Column D: Obliging style

Column E: Avoiding style

What is your style? ___________________________________________

What is your weakest style? ____________________________________

References

Air Force Non-Commissioned Officer Academy (NCOA). Conflict Management. Maxwell AFB (2005)

Bramson, R. Coping with difficult people, New York, 1981, National Press Publication

Collins, J.A. (1996). The influence of moral orientation on conflict-resolution style preference at work and at home. Western Washington University, Bellingham.

Merriam-Webster Online http://www.webster.com/collegiate dictionary (16 March 2005)

Messina, James, & Messina, Constance. Tools for Relationships Handling Conflict (2005)

http://www.coping.org/relations/conflict.htm

Zerwekh, J. & Claborn, J. Nursing Today; Transition and Trends (2003), St. Louis, Missouri., Sauders Publishing

Wertheim, E. Negotiations and Resolving Conflicts: An Overview. H http://web.cba.neu.edu/~ewertheim/interper/negot3.htm

References: Air Force Non-Commissioned Officer Academy (NCOA). Conflict Management. Maxwell AFB (2005) Bramson, R. Coping with difficult people, New York, 1981, National Press Publication Collins, J.A. (1996). The influence of moral orientation on conflict-resolution style preference at work and at home. Western Washington University, Bellingham. Merriam-Webster Online http://www.webster.com/collegiate dictionary (16 March 2005) Messina, James, & Messina, Constance. Tools for Relationships Handling Conflict (2005) http://www.coping.org/relations/conflict.htm Zerwekh, J. & Claborn, J. Nursing Today; Transition and Trends (2003), St. Louis, Missouri., Sauders Publishing Wertheim, E. Negotiations and Resolving Conflicts: An Overview. H http://web.cba.neu.edu/~ewertheim/interper/negot3.htm