“Conflict arises when individuals hold incompatible or seemingly incompatible ideas, interests, or values, but conflict can only occur where interdependency exists. For this reason conflict resolution is necessary to preserve and improve relationships with others as well as meet one’s own needs” (Cushnie, 1988).
Whenever two people come together, there is potential for conflict. Although conflict is sometimes inevitable, it can result in valuable outcomes when handled in assertive and responsible ways.
Health care teams are composed of people with numerous different backgrounds. A variety of professional outlooks are found in a team of nurses, physicians, clergy, nutritionists, occupational and physical therapists, social workers, and others. In addition to the differences in socialization that these professionals bring, they carry personal views based on sex, age, cultural origins, socioeconomic situations, and life experience. This potpourri is a prospective source of conflict on any health care team.
This variety gives birth to different perceptions concerning an issue, and the role and obligations each should fulfill. While team members do not see eye-to-eye about the situation or their respective roles, then the potential for conflict is great.
Many times team members have different or opposing ideological views on a situation. Their views can come from having different objectives or from endorsing different priorities among the objectives. Conflict results while team members do not agree on what to do, how to do it, and when to do it.
Occasionally conflict will recur between team members who have had a long history of disagreement. The degree of trust and teamwork has been worn down between these people, and their competitiveness is sharpened. Such a situation fuels conflict.
Johnson (1990) points out that conflict can be an encouraging force for nursing if it is used to foster growth-producing change in the profession and in the organizations where nurses work. She cautions that nurses must know how to use conflict effectively if these benefits are to be realized. In addition to being knowledgeable about managing conflicts, nurses must develop a positive attitude toward conflict by distinguishing the potential gains to be realized from conflict. Nurses need to become more astute at predicting potential conflicts.
Shifts in power are taking place in the health care system that will be accompanied by more options for conflict resolution. The history of a power differential between nursing and medicine has made it difficult for collaboration to be used as an effective conflict management tool as collaboration rarely works well where there is a wide difference in power between the groups involved. Johnson advises that nursing as a discipline must be concerned about empowering all nurses in the work setting in preparation for handling workplace conflicts.
As a nurse leader, you know you cannot avoid conflict. What you can avoid is feeling impotent or uncomfortable when you encounter conflict situations. By now you are familiar with assertive and responsible communication. These approaches will help you resolve conflicts in constructive ways.
Resolving a conflict means acting in such a way that an agreement is reached that is acceptable and even pleasing, to both parties. If both parties cannot agree on a resolution, the conflict will continue. When conflict drags out and team members do not see a hopeful resolution on the horizon, then helplessness prevails. Any health care team that is stuck in this hopeless situation is not working at its full capacity. Harrington-Mackin (1994) advises dealing with conflicts in a timely way and suggests that most people find it difficult to openly discuss and work through conflicts. Instead, they collect grudges and use techniques such as procrastination and sniping to “get even.” Client care and morale suffer when conflicts are unresolved.
You can approach conflict resolution in three ways: win-win; lose-win; or win-lose. Although win-win is preferable, there can be times when a workable compromise is the best solution possible to avoid having both parties loses.
There may be times when you feel obligated to insist on your solution to a problem, in parenting a small child, for example. There may be times when you choose to allow the other person to win, such as when you recognize that a colleague has been pushed to the limit and your position seems less important than the peace of mind of your colleague.
The win-win approach to conflict resolution requires you to be assertive and responsible. This approach results in a solution with which you and your colleagues are happy. Not only is the outcome satisfactory, but using a win-win approach uses your full creativity and often results in a unique and innovative resolution.
The lose-win approach is one where you allow your colleagues to resolve the conflict at your expense. Either you are not happy with the outcome or you permit your colleagues to walk all over you. This approach is non-assertive and irresponsible.
The win-lose approach is the opposite of the lose-win approach. You may resolve the conflict in a way satisfying to you, but in the process you bulldoze right over the rights of your colleagues. This approach is aggressive and irresponsible.
Any win-lose/lose-win approach creates forces that aggravate the struggle and do little to discover constructive solutions acceptable to all involved (Likert, Likert, 1976). A conflict is more constructive when the outcome is satisfying to all the participants than if it is satisfying to only some. Conflict at some point is inevitable, so it helps to know how to use it as an opportunity to be constructive because the alternatives have unpleasant consequences.
Moreover, nurse leader must have assertive behavior that is contrasted with nonassertive or passive behavior, in which individuals disregard their own needs and rights, and aggressive behavior, in which individuals disregard the needs and rights of others.
Assertive communication is a lifelong learning skill that requires time and practice and also helps to communicate with other team members. Be willing to accept the fact that you will make mistakes. Be patient. When a person accustomed to behaving passively tries on this new behavior, the results may seem abrupt and abrasive, or shy and tenuous. The goal is not to be continually confrontational. When learning this new skill, you must be assertive all the time or you will be seen as nonassertive. When practicing techniques to learn to become more assertive, it is helpful to begin in a supportive environment with people who are accepting of you. Consider sharing your reading material on assertiveness with a roommate, spouse, or friend with whom you can begin practicing your assertive behavior. Start with small issues such as returning a damaged product to a store or offering a compliment.
Assertiveness is a matter of choice. It is important to feel confident that you can speak up for yourself, yet it is not necessary or even wise to speak your mind in every situation. With each person we encounter in any situation, we have the choice of communicating in an assertive or nonassertive style. The words we choose and the way we express them can be assertive, nonassertive, or aggressive. Realistically, you may not always have the energy or desire to assert your rights or express yourself fully. There are times when people cannot respond rationally, such as when they are experiencing high levels of anxiety, or panic. A person might fear retaliation from a manager or fear the loss of a job. You must choose what issues, when, where, and with whom you’re assertive behavior is appropriate.
As a nurse leader, it is your responsibility to ensure that a thorough assessment is made of your clients’ health concerns, that suitable nursing actions are chosen and implemented to help your clients, and that an evaluation of the results is carried out. Assuming this leadership does not mean that you take over and do for, or to, your clients. The quality of your nursing care is determined by the completeness of the interchange of knowledge, attitudes, and skills between you and your clients.
To be most helpful to all your clients, make sure that you solicit their knowledge, become aware of their feelings and attitudes, and take into account their strengths and limitations in caring for themselves. You must use this information in order to tailor your nursing care to suit your clients. In addition, you need to be aware of how your knowledge, attitude, and skills affect your ability to be helpful.
Effective nursing requires being assertive and responsible. Your goal is to help your clients achieve their best possible health status and do so in a way that allows expression of your professional competence. It is expected that you attempt to meet both of these desired outcomes.
In the realm of affective support, nurses are demanding acknowledgment for the work they do. Nurses as a leader need continued support and confirmation of their important role in today’s world, where nursing practices are changing, client acuity is higher, and nursing shortages are real. Respect, honor, and recognition of employees by acknowledgment of positive performance are needed frequently, not merely during an annual review. Expressing gratitude and appreciation can create feelings of goodwill and nurturance among nurses that is a form of job gratification, making them feel better about their workplaces, clients, and colleagues.
Callahan (1990) believes that burnout occurs when nurses realize that, no matter how developed their talents are, they aren’t recognized. She urges hospitals to initiate a system of Positive Incident Reports that can be posted on the unit’s bulletin board and then be included in the staff nurse’s personnel file.
Health care employers are realizing that nurses’ input is invaluable in the pursuit of continuous quality improvement. Nurses need to have a say in administrative and clinical decisions affecting client care and to be recognized for their contribution. One hospital has fulfilled its dedication to listening to and involving nurses by incorporating their input and approval in the development and implementation of a dynamic, professional practice model (Huttner, 1990).
Professional autonomy and inclusion in policy development and decision making, as well as quality assurance programs, are some of the key elements of a successful workplace for attracting and retaining nursing staff (Corcoran, Meyer, and Magliaro, 1990). Schroeder (1994) saw participation in quality improvement as an activity that will be “energizing and supportive to nurses in particular.”
Quality improvement involves “constant attention to better meeting the customer’s needs careful analysis of process of care and service, empowerment of front-line providers, and collaboration with others” (Schroeder, 1994). These are the issues that are important to nurses, and participation in interdisciplinary quality improvement teams is an opportunity to be heard.
The nursing literature abounds with articles related to cognitive and affective support for nurses in the workplace. Staffing requirements, an essential aspect of physical support, are discussed in the abundance of articles on retention. In this era it is believed that the provision of adequate cognitive and affective support will attract nurses. The requirements for supplies, equipment, and environmental conveniences have likely been secured in most nursing workplaces through the efforts of technology, computerization, and stringent occupational hazard and safety regulations.
As competitive nurse leaders, we need to be assertive about securing the support necessary to function comfortably and confidently at work. The clearer we are about what support we need to do our job, the more likely we are to secure it. We spend a lot of energy attempting to improve the health status of our clients. Getting the support we need to do our work can help us maintain our health and enhance how we feel about both our work and our co-workers.
Conceptualizing cognitive, affective, and physical components of support provides you with a leading organizing framework for your individual support assessment. The first step in your systematic approach is to determine whether you are satisfied with the quality and quantity of support for each facet. Quality refers to the nature or characteristics of the support; quantity refers to the amount of support.
References:
Callahan M: Applauding the artistry of nursing, Nursing 90 20(10):63, 1990.
Corcoran NM, Meyer LA, Magliaro BL: Retention: the key to the 21st century for health care institutions, Nurs Admin Q 14(4):23, 1990.
Cushnie P: Conflict: developing resolution skills, AORN J 47(3):732, 1988.
Harrington-Mackin D: The team building tool kit: tips, tactics, and rules for effective workplace teams, New York, 1994, American Management Association.
Huttner CA: Strategies for recruitment and retention of critical care nurses: a cardiovascular program experience, Heart Lung 19(3):230, 1990.
Johnson M: Use of conflict as a positive force. In McClosky JC, Grace HK, editors: Current issues in nursing, St Louis, 1990, Mosby.
Likert R, Likert JG: New ways of managing conflict, New York, 1976, McGraw-Hill Book Co.