Shelley Cohen is a founder and educator at Health Resources Unlimited, LLC, in Hohenwald, Tenn.
The author has disclosed that she has no financial relationships related to this article.
The word conflict can mean different things to different people. According to the Merriam-Webster dictionary, conflict is a struggle for power, property; strong disagreement between people, groups, and so on, that results in often angry argument; a difference that prevents agreement: disagreement between ideas, feelings, and so on. Ask any nurse manager to define conflict and he or she can provide you with a multitude of scenarios and examples that represent conflict in the healthcare workforce. Do any of the following seem familiar to you? Would you define these examples as conflict?
- For the third time this month, a day shift nurse is in your office complaining, “night shift never stocks supplies.” This employee also expresses, “they seem to get away with not doing a lot of the work just because they're willing to work nights.”
- A seasoned nurse, who's approached by a new hire he's preceptoring, tells the novice nurse to “figure it out yourself—that's how I had to learn.”
- At a staff meeting, discussion is ongoing related to a change in the admission policy. Tension is mounting and voices are now being raised expressing, “registration staff always get their way, our opinion never seems to count for anything. Why even bother talking about this anymore?”
As a novice leader, staff members will typically sit back and await your response to all conflict. There's no magic wand to wave to ensure there's never any conflict, and we don't necessarily want it all to go away. As leaders, we learn that these encounters can stimulate staff members to challenge the status quo and engage in exchanging ideas. However, a common unrealistic expectation many managers have of staff members is that they can resolve conflict without any guidance, ground rules, or support. Unfortunately, conflict resolution techniques for the workplace aren't commonly taught in nursing school, leaving staff members to resort to what's comfortable for them. When conflict does arise, many staff members use the same unsuccessful approaches they reach for in their personal lives. These methods may range from avoidance to body language or verbal responses that display unprofessional behaviors.
Leaders need to encourage conflict resolution that shifts from a culture of avoidance or inappropriate resolution methods to scenarios that mentor professionalism, personal growth, and respect. In addition, individual managers must be willing to self-evaluate their own approaches, expectations, and methods to resolve conflict when it arises. You can begin this process by reviewing Table 1. As the leader, it's imperative to recognize the knowledge gap staff members have related to conflict and appropriate communication skills/techniques necessary to resolve it. The opportunity to enhance these skills can be presented through the Strong Foundation's Self-Assessment Test for Conflict Management (see supplemental content on the Nursing Management website and iPad app) or by placing the topic of conflict on your next meeting agenda. Ask staff members to answer the following question: How do we handle conflict around here? Encourage discussion and conclude with examples of constructive methods and techniques for confronting and resolving conflict.
Don't keep them guessing
As a new leader, staff members shouldn't have to guess what you expect from them—it should be clearly defined and in writing. Whether it's expectations related to policy compliance, attendance, or managing conflict, it's essential that you specifically communicate your requirements to staff members.
In the area of conflict, written ground rules become the foundation of this communication and are equal in importance to written policies, procedures, and so on. You can build this groundwork by involving staff members in determining acceptable and unacceptable behaviors. A key to the success of these rules is a commitment from yourself and staff members to no longer use the term “attitude.” It can't be defined in writing, it's nebulous, and, therefore, not appropriate when describing or discussing performance concerns. Consider replacing the word attitude with “unacceptable behavior,” which is easily defined, described, and clearly denotes what needs to be changed by that person.
Using the process of nominal technique you learned in “Creating Worthwhile Staff Meetings” (Manager Matters, August 2013), have staff members identify behaviors they perceive as unacceptable. You can initiate this exercise by listing one or two behaviors to get the momentum going. Consider beginning the list with profanity at work and verbally belittling a coworker in front of others. What are five other items you hope staff members contribute to the list? The culture of your department's work behaviors will impact this. After the majority of staff members agree on the top 10, type them up, have everyone sign that they agree to not support/tolerate these behaviors, and post it somewhere highly visible.
As the leader, your role is to also coach and educate staff members about how to handle unacceptable behaviors. You must clearly define ground rules:
- All staff members must agree not to support the unacceptable behaviors as a condition of employment.
- All staff members will actively contribute to updating this list as needed. As the manager, you expect staff to identify the behavior, confront it professionally, and bring to your attention how it was resolved.
- Staff members will attempt to confront/resolve any future conflict, related or unrelated to the behaviors on the list. Should guidance be required by the manager, staff members are expected to do the following:
- – meet with manager
- – be prepared to offer two realistic approaches to resolving the conflict.
Laying down the rules
Communicating with staff members about your new approach and ground rules related to conflict is a must and should include referencing resources, such as the employee handbook, nurse practice act, mission statement, and so on. Part of this communication must also include teaching staff members appropriate techniques and methods of confronting and resolving conflict. This can be done through role-playing scenarios along with eLearning options and/or a live presentation. If you're fortunate enough to have an employee-assistance program or psychiatric NP within your organization, he or she can serve as an excellent resource for a live educational presentation related to conflict management.
Use of ground rules moves staff members to a level of accountability as professionals and encourages resolution skill development that becomes a lifelong attribute for them. The following example demonstrates the power and effectiveness of ground rules related to conflict:
Staff member: I'm sick and tired of dealing with nurses who refuse to clean up after themselves, I have enough of my own work to handle.
Manager: You sound angry and frustrated with coworkers who don't clean up their work areas, is this correct?
Staff member: You got it—something needs to be done about this!
Manager: What happens when you approach these individuals with your concerns?
Staff member: Well, I haven't done that—I need you to talk with them.
Manager: As you know, this issue is on the department's list of unacceptable behaviors that staff members have agreed to no longer tolerate. Have you tried using the skills taught at the last meeting?
Staff member: I just don't think this is something I have to do, I'm not the manager.
Manager: They're not leaving a mess for me to clean up—this is affecting you and it's your place to confront them. I understand that you may not be comfortable confronting them by yourself because these techniques are new. I need you to come up with two realistic options to resolve the problem and then I will arrange to meet with all of you. However, you'll be expected to do the talking; I'll simply serve as a resource. Do you feel this is doable?
This scenario also reminds us that just because a skill is taught, it doesn't mean that staff members are comfortable with its application in the beginning. That's one of the reasons the leadership role also requires coaching and mentoring skills. We can't take all of the conflict away, however, as leaders, we must utilize methods to minimize it. The leader who engages in the following methods will find less conflict among staff:
- educate staff members on conflict
- ensure adequate policies/guidelines exist
- define in writing clear departmental objectives and/or goals
- walk the mission
- don't tolerate the “status quo”
- consistently enforce policies
- don't delay in confronting issues.
Conflict arises when any of the following collide: goals, personality differences, scarce resources, personal styles, and values. This requires the leader to commit to a conflict management style that's consistent and dependable. Your flexibility when approaching each conflict episode is necessary for success and only comes about with a self-awareness of the patterns you elect to use for resolution. Make a commitment to your conflict management style through clearly defined expectations of staff member accountability. The ground rules developed in conjunction with staff members' input on unacceptable behaviors will contribute to a healthier workplace for all.