Traditionally, conflict has been viewed as a destructive force to be ignored or silenced; today, many are redefining conflict as an opportunity. Once conflict is approached as a cooperative effort, nurses and other healthcare professionals can restructure trust to enhance professional relationships. By understanding the dynamics of negotiation in areas such as leadership, power, and conflict management, healthcare professionals will improve the quality of their professional practice, relationships and their working environment.
This article, written by Diana Ward-Collins, RN of Legal Nurse Network to present an overview of conflict resolution by introducing:
- Conflict management concepts and principles
- Strategies for effective negotiation
- Useful techniques for conflict management
Healthcare organizations, although extremely complex, have as their mission nothing less than improving the health of patients and their communities. Unfortunately, this lofty goal can be lost amid the conflicting agendas and value systems of individuals and disciplines within the healthcare system. This is, understandably, a frustration for many healthcare professionals.
Professionals who are, or should be, working together to provide healthcare services for patients must develop a set of skills for effective communication. These skills include:
- Conflict management
- Consensus-building through collaboration
These essential skills not only improve patient care, but are vital for personal, professional, and organizational success.
Collaboration—one method of conflict management—is a process by which people and groups work together to achieve a common goal. Collaboration works best when each person involved takes responsibility for his or her own working relationships and quality patient services. For example, imagine there is insufficient staff on a unit. By working collaboratively, nurses can prioritize patient care needs, pool available resources, and ultimately match those resources to achieve the mutually defined common goal of quality patient care.
Negotiation--Problems can arise, however, when healthcare professionals disagree on how to achieve that goal. This calls for another method for conflict management—negotiation. During negotiation, healthcare professionals must engage in honest communication, adjusting their differences to eventually reach consensus. Negotiation works best when the people involved in a conflict tell each other their goals, needs, and wants.(1) Individuals can then adapt their needs and wants so that the common goal can be achieved.
These processes take time to learn and practice. Even so, every healthcare professional has the power and responsibility to “step up to the plate” and negotiate disputes or differences of opinion, even while organizational decisions are being made. For some individuals, this might represent a new approach for professionally relating to others. Yet taking a chance—possibly even a risk—can be liberating and empowering.
We negotiate with others every day, usually without even thinking about it. Occasionally an impasse does occur, and then we realize that finding a solution isn’t always easy. This is especially true when people perceive the same thing differently, or if we are not sure what action is expected from us or required of another.
Examples abound. Do any of these sound familiar?
These situations can be emotionally draining. And, over time, our reactions to these situations intensify, creating an atmosphere of:
- Polarization of staff
Negative emotions and feelings start to affect a work group. For example, we begin to see different staff members as belonging to two or more work groups pitted against each other defining themselves as “we-they” in their communications.
Once “we-they” positioning occurs, effective communication deteriorates. The stress level in the workplace escalates to the point that, ultimately, patient care is affected. (2,3) Until issues are addressed and collaborative agreements reached, the problem worsens, affecting more professional relationships and personal well-being.(4)
When conflict arises, professionals have the opportunity either to affect change by taking action or do nothing and maintain the status quo. This choice puts us in a powerful position to assist or obstruct the negotiating process and thereby expand or diminish our own potential.
If we choose, we can remain silent, feeling victimized, powerless, and pressured. Realize that taking no action is a decision—in essence, an act of avoidance. By giving away our voice, we give away our power. By staying caught in the middle, we lose our voice, our options, and the chance to make a positive difference. Regardless of the strategy used, effective professionals understand the connection between the choices we make and the results we live with.
Most conflict involves power, either directly or indirectly. Here are a few basic thoughts on the nature of power:
- Every relationship involves power issues on some level.
- Sometimes power issues are covert and hidden, and other times they are overt and clear to all.
- When we use our power for personal advantage, others are affected, either negatively or positively.
- Power is neither good nor bad.
- We tend to associate the idea of power with strength and ability.
- The purpose of power is to get another person or group to do what we want.
When conflict occurs in healthcare organizations, professionals respond according to their belief and understanding of how power is distributed. One’s strategy for managing conflict is often influenced by one’s understanding of who has the power and how they will probably wield it.
As healthcare professionals, we have a responsibility to not stop at simply understanding organizational power. We need to develop our own bases of power. Here are some resources various professionals have found helpful as they develop their own power bases:
- Reliable and trusted sources such as leaders and seasoned experts
- Participation in professional associations
- Participation in organizational projects or committees
In any industry, people can seek power by (5,6):
- Giving something of value to another
- Threatening negative consequences or disciplinary action
- Becoming experts in their field
- Developing inspirational personalities using charisma to influence others
- Acquiring formal positions of authority
- Obtaining support from others who have power
- Establishing autonomy and independence from others
As professionals seeking to manage conflict among coworkers, we can be strengthened by a variety of other resources within our organization, such as:
- Seeking out wise and seasoned persons who have demonstrated a commitment to balancing patient needs with organizational resources
- Forging alliances with persons or committees having similar goals
- Developing relationships with individuals with formal authoritive power to influence organizational resources and decisions
When we develop alliances with trustworthy resources, we begin to build a shared strength and power. By collaborating with these resources, we build credibility for ourselves and strengthen our own bases of power.
Clinical professionals such as nurses, physicians, and physical therapists working at the bedside have the power to influence decisions for patients, work units, and organizations by getting involved. Empowerment (a term frequently used in nursing) is defined as “giving individuals the authority, responsibility, and freedom to act on what they know and instilling in them belief and confidence in their own ability to achieve and succeed” (7). Self-empowerment includes learning about and participating in decision making. Taking responsibility for our own empowerment can transform us and our coworkers, patients, departments, organizations, nursing profession, and even society in general.
How Gender Affects Power and Conflict Management Style
Men and women tend to handle power differently.(8,9) Women define themselves through relationships and networking, whereas men define themselves by the tasks they accomplish. Men often see conflict as a means to engagement and competition whereas women experience this competition as threatening to relationships. Although some men prepare for “battle,” some women prepare for “retreat.”(7,8) Conflict management styles among nurses are heavily influenced by the fact that many nurses are female, and females in our society are socialized to handle conflict in specific, sometimes negative ways.(9,4) As one researcher explained it, “Nurses are typically socialized to press for consensus, which may make them appear tentative. In contrast, physicians often focus on justice issues and are intent on ruling out alternatives.”(4)
Studies that focus on working relationships in healthcare settings reveal patterns of female aggression and bullying that consistently result in destructive and counterproductive influences on nurses and other females.(10) As one writer has explained, “Conflicts arise because women have behavioral expectations for other women [which] we do not have for men. Simply put, we make allowances for men being different from us, but when women are different, it makes us uncomfortable.”(11) Valuing each other’s differences is part of collaborating and negotiating for a common good.
At times, when a woman does decide to speak out and address concerns, she may be left to fend for herself, which can make her feel betrayed. The conventional model for many women to remain quiet and not speak up has a silencing effect on others.(8)Yet, not all men are competitive; thus, stereotypical patterns of behavior that frustrate communication and damage teamwork must be addressed and redefined for both genders. The solution lies in raising awareness among both men and women and encouraging them to learn new ways of talking with each other.
When conflict arises, we naturally look to leaders for resolution. Effective leaders, however, understand that their jobs are not merely to “fix things” but rather to equip others to creatively manage their own conflicts and thus develop their skills.(12) Leadership is more than a position on an organizational chart; it is a learned skill that is best developed when it is shared.
Shared leadership, also known as shared governance, tends to flatten the bureaucracy of an organizational chart, and helps employees become empowered stakeholders. When leaders are willing to share their power, followers learn to manage issues such as control, authority, and influence.(13) Professionals who successfully practice shared governance have developed the following skills:
- Decision making about patient management issues
- Standards of practice knowledge
- Quality assurance abilities
- Excellent conflict resolution skills
- Excellent negotiation skills
A leader’s commitment to shared governance supports professionals as they seek to work and negotiate within all disciplines of their organizations. Distributed power can be one of the most inspiring and encouraging endorsements a healthcare professional can receive.
Conflict in the healthcare industry presents some unique challenges simply because there are so many people involved in the delivery of services, making it impossible for any one provider to have total control over decisions affecting patient care.(12) Because of this dynamic, conflicts surface, calling for negotiation skills. If managed well, the conflict can be resolved constructively. If not managed well, the conflict may result in disaster.
Whether managed well or not, conflict changes things. It calls into question the status quo. We are motivated by the tension it creates to move from our current situations to the situations that we desire.
The Benefits of Conflict
What are the benefits of conflict? By courageously and honestly discussing conflict, nurses can:
- Increase awareness of problems
- Improve preparedness to cope with problems
- Initiate organizational change and adaptation
- Strengthen relationships and improve morale
- Promote awareness of self and others
- Enhance personal growth
- Encourage psychological development
Destructive Malfunctions with Unmanaged Conflict
The downside of conflict occurs when it is unmanaged. Then conflict can (14):
- Set in motion a win/lose approach
- Cloud the truth with misperception and bias
- Polarize coworkers
- Isolate us from those with differing opinions
- Blur the issues
- Magnify our differences instead of focus on our similarities
- Escalate the conflict
Unmanaged conflict is costly and stressful. Research indicates that the single greatest cause of job stress is unhealthy workplace practices and conditions.(15) The real costs of healthcare conflict are the losses for each staff member in terms of (16):
- Employee turnover/retention
- Meaningful professional relationships
These costs do not include the impact of compromised patient care. In addition, for the patient, a communication breakdown among caregivers results in a patient’s increased sense of vulnerability, anxiety over interrupted care, and health status.(17)
Listed below are the five basic styles of managing conflict.(18) Do you recognize yourself in any of them? Do you recognize any of your coworkers?
|Conflict Management Styles||BEST USED WHEN…|
Allows one person to pursue his or her own concerns without regard for others by using whatever power seems appropriate to win
Encourages working together or merging resources to reach a common goal that satisfies each party’s interests
Promotes reaching a settlement in which both parties agree to relinquish something they originally wanted, so that together they can attain a goal
Requires setting aside one’s own concerns to satisfy those of another: self-sacrificing, yielding, or bending to the will of another, despite inner restraint
No single style for managing conflict is correct in all situations. Some personality types prefer one style; others prefer another. The style we choose is largely influenced by (9,19,20):
- Personality trait development
- Gender factors
When conflict is approached as a cooperative effort, the goal becomes doing as much as possible for everyone involved, instead of engaging in destructive win/lose struggles.(21) What becomes important are the problem-solving and decision-making aspects of healthy negotiation.
People in conflict often think in terms of win/lose. This mindset is especially true when the issue involves something that people take a position on or have a belief about. If the issue only involves people’s interests, they will be more willing to compromise. But if their beliefs are at stake, they often hold tenaciously to their position. Under these circumstances, the conflict intensifies because one side wants something the other side opposes, or both sides want something that cannot be shared. Both sides then become further entrenched in their positions, moving further apart by making more extreme statements in an effort to win support from others.
For example, the following debate is ongoing in healthcare:
- What is the correct number of staff caregivers need to provide quality nursing services?
- What should be the mix of RNs, LPNs, and NAs to provide safe quality services?
- Who should decide the mix and what criteria should be used to influence the decision?
Nurses would probably argue this debate based on a belief that greater numbers of staff would make the difference in promoting safe quality patient care services, whereas administrators would possibly argue from a position based on their belief in limited financial resources. Both sides would believe they were correct, and, oftentimes, both sides would gather information to defend their positions. Defending one’s side, or position, is called positional bargaining, and eventually affects other people, departments, patients, and the organization because the focus is on defending a position instead of negotiating a solution.
People view situations differently depending on:
- Situational specifics
Unlike positions or beliefs, interests are the reasons why people want something. When we understand why another person wants what he or she wants, we can recognize ourselves in the others. This recognition makes negotiating for a solution, or even a partial solution, much easier.
This ability to “walk in another’s shoes” is called interest-based bargaining. We negotiate by understanding the other person’s interests or why they want what they do. Understanding why someone wants something motivates us to find creative ways to work together. Interest-based bargaining brings out the human meaning behind the conflict.
Values are at the core of most conflicts, which can be a problem because values can be hard to articulate. Everyone at times struggles between contending values such as truthfulness, fair-mindedness, and autonomous self-directed behavior. Individual values and beliefs about conflict affect behavior. Many beliefs are deep-seated in a culture and period of time. Generational and gender differences also exist about the behavior that is acceptable in conflict. Values also affect how direct one can be about concerns, feelings, hopes, and ideas. By clarifying values, each party is given an opportunity to identify and appreciate the similarities with and differences from other parties. Usually the values that underlie personal or professional interests, although not easily detectable, emerge during open discussion and negotiation.(5) By simply asking the question: “Help me understand what this means to you?” opens the door to values clarification.
Framing the Problem
To effectively begin negotiation, individuals in conflict must separate the problem from the person. They must also agree to temporarily suspend judgment on who is right and who is wrong. This allows people to set aside distractions and anger and to enter into direct dialogue and negotiation.
Setting these distractions aside requires awareness and participation on the part of everyone involved. Preparing to negotiate, also called framing the problem, sets the stage for constructive negotiation.
Listed below are seven strategies for framing problems (22):
- Try to see the situation from the other party’s perspective. Although you do not have to agree with another’s perception, it is important to understand what others think and feel and why they do so. Listen.
- Try to not operate from a suspicious assumption. Operating from suspicion makes it more difficult to accurately distinguish another’s real intentions or openly begin dialogue. Don’t jump the gun.
- Avoid the blame game. Blame, even if deserved, will only make your opponent defensive, and worse, your opponent may attack you in response. Blame is counterproductive. Be respectful of the other person.
- Openly discuss each other’s perceptions. Take your time to explicitly discuss perceptions to gain a greater understanding. Such discussions may reveal shared perceptions and goals. By acknowledging shared perceptions, you will facilitate collaboration. It is OK to respectfully disagree.
- Use the element of surprise in a positive way. By changing your opponent’s worst beliefs and expectations about you, you can begin to set the stage for mutual agreement.
- Give the other party(ies) a stake in the outcome. Make sure all participate in the negotiation process. Investment in the outcome requires involvement in the process.
- Make the proposals consistent with the principles of self-image. All parties to a negotiation need to feel the agreement is consistent with their own personal and professional principles of integrity. Proposals consistent with all parties’ principles are more likely to be accepted.
When negotiation takes place in a safe, respectful setting, individual strengths and abilities emerge, and people work together. In essence, “Each healthcare professional has information the other needs to possess in order to practice successfully.”(5) Rather than engaging in power struggles, nurses can negotiate from positions of strength when they recognize the substantial power they possess, remain confident in their abilities, and believe in the meaningful contributions they can make.
Hospitals are complex structures with overriding missions to improve the health care of patients and community. Personal, professional, and organizational success requires:
- Core nursing skill competencies of leadership
- Consensus building
- Conflict management
Power used constructively is crucial for survival and success for healthcare professionals and organizations. Traditionally, conflict has been viewed as a destructive force to be ignored or silenced; today, many are redefining conflict as an opportunity. Once conflict is approached as a cooperative effort, nurses and other healthcare professionals can rebuild trust and create a future of enhanced professional relationships.
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