Dr. Marin was surrounded. The once sedate critical care committee, which comprised eight tight-knit physicians and no one else, now had a membership that included two nurses.
"How did this happen?" he barked. "Why are you people on this committee? You are not allowed." It was true that as the critical care director, I had added some new members to this good old boy's committee, not asking permission and not looking for forgiveness. I had included a respiratory therapist and social worker, as well, quietly converting the committee membership to a multidisciplinary one. I even aspired for a true interprofessional committee. Dr. Marin was mad, but if he had attended the last three meetings, he wouldn't have been so surprised. So, there he was, red faced and splattering insults all over the room. Managing open conflict is just unpleasant, but I was stuck. What to do? I'll address my strategy at the end of this blog.
First, let's define conflict
Conflict, the struggle between two opposing points of view, is an essential characteristic of organizations. It is so pervasive that its occurrence and resolution is one of the six components of shared governance. The ubiquity of conflict that whirls around nurses would suggest they become experts in its resolution as an essential part of their professional practice. The intersection of the very roles of nurses as independent professionals and as organizational employees can be a conflict in itself. Despite the most stellar work environment, inevitable conflict is often associated with negative consequences, such as burnout. Nurses hate managing conflict and, in particular, dislike dealing openly with it. In fact, avoidance is their No. 1 strategy. But the avoidance of open conflict doesn't always resolve it or make it go away. Avoided conflict often stays with the nurse, percolating just beneath the surface, causing even more stress and anxiety. On the other hand, nurses are often forced to manage conflict, especially when there is no other way forward. A good example of a nurse facing conflict head on occurred last year when Salt Lake City, Utah, emergency department nurse, Alex Wubbels, confronted an overzealous detective who, in violation of hospital policy, insisted that she allow blood to be drawn from her unconscious patient. Alex didn't shy from open confrontation in upholding policy and her patient's rights, even when it resulted in her arrest. We'll address what strategy she used at the end of this blog.
Methods you can use to manage conflict
Nurses usually confront conflict that is interpersonal or intergroup, its most frequent sources being between nurses and patients and their families, their managers and physicians. Fortunately, models exist that prescribe strategies for resolving conflict grouped into five approaches:
- Avoidance is nurses' most commonly used mechanism for dealing with conflict. This method is used when one side is uncooperative, denies that a problem exists, or withdraws from the situation so that there's no active resolution of the conflict. Personal needs are ignored, as well as any potential contribution to the working relationship with the other person. Avoidance can increase stress among healthcare providers. This may happen when a less powerful person involved in a conflict responds with accommodation and avoidance to avoid possible retaliation, even at the risk of sacrificing his or her interests or the interests of others. Avoidance is a negative conflict management style that leads to a lack of communication and can result in poor patient outcomes.
- Confrontation approaches conflict head on and may invoke high emotional levels. It can be construed as not being considerate of the other person's viewpoint.
- Compromise involves negotiation, trade-offs and swapping. Each person gets something, but gives something else up in the process, creating a win-lose/win-lose situation for the two sides.
- Collaboration occurs when each party meets the problem head on with equal concern for both the issues and maintaining a working relationship. This approach allows everyone to win by identifying areas of agreement and differences, evaluating alternatives and selecting solutions that have the full support and commitment of both parties. It requires emotional intelligence and high self-concept.
- Accommodation occurs when one person or group is willing to yield to the other. This conciliation, or giving in, involves listening and accepting without resistance.
If you can think about and commit to a strategy, you can eliminate ambiguity and increase your chances of achieving the goal that accompanies the strategy. A good resolution usually prevents avoidance or confrontation.
Here's a checklist for resolution:
Strive for the best professional work environment possible. There is evidence that positive professional practice environments predicted nurses' constructive conflict management and, in turn, greater unit effectiveness.
Ensure you have well-honed conflict resolution skills. Although interactive sessions might be best in this situation, online learning is available in independent self-study articles.
Identify the issue creating conflict with all its attentive detail. Ensure you have included all the players, so the resolution leaves no one out, creating further conflict.
Commit to a strategy that fits the situation. If you can just think about and commit to a strategy, you can eliminate ambiguity, focus your efforts and increase your chances of achieving resolution.
Find a common, nonthreatening arena to stage your resolution, including buffered time away from distractions. It might just be a few minutes in the break room or manager's office.
Enlist the aid of non-partial support and, if necessary, people who are savvy in negotiation.
Look for alternative resolutions before initiating a meeting. Always have a plan B.
Rehearse your dialogue before initiating.
Don't leave until a resolution has been achieved or a plan for further negotiation scheduled.
What did I do about Dr. Marin?
I had anticipated his resistance and knew an open confrontation from me during the committee meeting would go badly. This was 30 years ago, and this old-school physician would never engage me then as an equal in a public forum. Personally, I avoided the whole thing. However, I had enlisted the aid of top leadership, who told Dr. Marin it would be best if they could discuss this after the meeting. He later told him how it would go (quiet, behind-the-scenes confrontation). Sometimes, it is best to pick your battles, if you can. One thing that Dr. Marin picked for me was my nickname. He called me the weasel.
Take these courses on managing conflict:
- Surviving and Thriving with Conflict on the Job (0.5 contact hr) Conflict is part of every work environment, including healthcare organizations. In the past, conflict in the workplace was regarded as dysfunctional, representing a breakdown in communication that would either go away by itself or be resolved with someone winning and someone losing. Conflict should be an expectation in a dynamic organizational environment that when handled correctly, can be managed in order to achieve beneficial outcomes. Conflict can be a motivator for change and growth, a medium for airing problems, and a dynamic force to prevent stagnation. Conflict resolution is considered a necessary element in a healthy work environment and requires good communication and leadership skills to successfully navigate workplace conflict.
- Developing Your Leadership Potential (1.25 contact hrs) As the largest healthcare profession in the U.S. and the profession positioned on the front line of patient care, nurses are crucial for leading change and advancing health. The Robert Wood Johnson Foundation and the Institute of Medicine made recommendations to transform the nursing profession in their report "The Future of Nursing: Leading Change, Advancing Health." A key message from the report is the recommendation that nurses be full partners together with physicians and other healthcare professionals in redesigning the country's healthcare system. This activity will provide practical strategies to help you develop your personal plan for developing your leadership potential regardless of your chosen career path.
