Conflict within Nursing Work Environment - Essay Example

Nursing - Leadership and Management in Practice Identification of Scenario and Leadership and Management Skills and Strategies to Address Issues within It Introduction: A nurse as a manager in the healthcare environment assumes two important responsibilities of a mediator and a negotiator. These are key roles of a nurse as a manager, since as a manager, she is expected to maintain a positive working relationship among the various stakeholders within a healthcare team, when the standards of healthcare are fulfilled only when the team works in the present-day scenario of technical advancement in healthcare. When different people are brought together in a team, invariably, people will have a different mix of beliefs, lifestyles, values, ethnic backgrounds, and goals that may interact with one another to lead to inevitable conflicts of different categories. With the remarkable changes and the economic impact that this area is going through, in the healthcare delivery systems, it is expected that there would be heightened professional values and competition for resources. Nurses are assuming a significant position in this system and its complex transitions. Therefore, as expected, nurses regularly experience conflicts during the course of their work, whether it is during their day-to-day practice or due to larger organizational conflicts. Interpersonal conflicts occur between individuals in the work environment. If two stakeholders are on an equivalent power level, interpersonal disagreements may simply cause irritation and annoyance. However, if one of the stakeholders has some actual or perceived authority over the other, this situation can potentially lead to what is called as conflict (Caplan G., 1964). This work is a critical reflection of a conflict event in work place that I had experienced. Before going into analysis of that particular event, the process of a conflict and its results needed to be known, since the idea of this reflective article is to explore how a conflict can be managed in practice and why. The incidence that I am going to state involves workplace interpersonal conflict, and this took place in our ward. A female senior nurse found an elderly female patient very upset, complaining about a male physician who had treated the patient in a rude manner. The patient asked for more medicine for her pain, but did not get it, and was told to accept the pain and stop nagging. The patient started to cry, but the physician let the room ignoring that she was hurt with his comments and her pain was real. The nurse confronted the physician about his conduct, and the physician began by trivializing the incident and continued by indicating his disagreement with the underlying organizational policy, and ended with a personal attack on the behaviour of the nurse to a physician. The stake holders in this scenario are the nurse, the physician, and the patient. It is obvious from the above scenario that there has been incompatible preference ordering between the nurse, the physician, and the patient. This is a situation where the patient has perceived that the physician has frustrated her concern. This is a destructive conflict, since this issue has been amplified, broadly defined with the addition of tangential items, and emotionally charged. When it comes to the nurse and she tries to manage the conflict, it becomes constructive when she confronts the physician to solve the issue between the patient and the physician. Here the same issue is focused and kept at a manageable size. Only peripheral issues that relate to the main point are discussed, and the process of choice is action, rather than a reaction. In contrast to destructive conflict, here when the nurse plans to resolve it, there is no competition and demonstration of power that is constructive. Her discussion with the physician about this issue is characterized by solutions that respond to the needs of all stakeholders in this conflict in an attempt to finding an acceptable solution that may be a compromise or a new one without imposing the nurse's personal needs on the patient or the physician. The nurse did not plan to change the situation through threats or coercion. There had been no blame whatsoever from the nurse on the physician, and it was clear from their discussion that she decided to confront the physician not due to her personal needs. As opposed to having mutual distrust, misperception, and escalated emotional charges, the nurse desired to manage the conflict in a constructive manner, where she had an open and honest dialogue designed to share individual concerns, at the same time listening with the desire to understand the physician. The intent was to get the problem out in the open, so it can be dealt with effectively (Almost, J., 2006). Conflict as demonstrated in this incident is constructive when the differences are resolved in outcomes favourable to group cohesiveness and organizational innovation that would lead to increased performance or productivity. This is an example of interpersonal conflict that has generated within the structure and function of the organization. When conflicts occur within an organization, it is important that the conflict be resolved in a constructive way in order to maintain the team's motivation. Conflict may not be always resolvable to the satisfaction of all parties, but as in this case, if there is willingness to appreciate another's point of view and a focus on shared goals are present, there is a good chance that at least an acceptable compromise can be reached as in this case. Examining the physician's behaviour at the confrontation, obviously, the organizational structure is the source of the conflict. Often this is seen as a conflict over territory (Kelly, J., 2006). Everyone tries to protect his or her current territory and would want to expand it. Conflict for nurses in the workplace should always be resolved with the emphasis on patient safety and quality of care first, and then with regard to what would be the best outcome for the majority of the staff. This scenario presented here involves both these parameters that the nurse explains. Although compromise for a win-win situation is often promoted as the preferred option of conflict management, this option should be very carefully examined in certain situation. The whole idea of the necessity of conflict management in the healthcare scenario is to achieve best team performance for the quality care for the patient. In situations such as this, where patient care is jeopradised, an urgent and even a non-consultative decision needs to be made. In such situations, as demonstrated in this scenario, the authority of the nurse leaders needed to be invoked and implemented (Cox, KB, 2001). Conflict is beneficial in an organization provided that the leader is skilled in facilitating constructive conflict resolution. When different opinions on an issue are voiced and when problems are aired, this indicated involvement of people. Energy derived through effective conflict resolution can be used positively toward goal accomplishment. This stimulates problem solving that would result into creative solutions. There are many strategies that can be utilized to resolve a conflict. These can be compromise and collaboration where the conflicting parties work together to reach a mutually satisfactory outcome. The next is competition, when one party attempts to defeat the opposition. Cooperation and accommodation involve giving in of one party and smoothes over the conflict (Sportsman, S and Hamilton, P., 2007). Avoidance and withdrawal is a strategy where the individual avoids any attempt to resolve the conflict and pretends it does not exist. The effective conflict management also involves recognition of other factors, the urgency with which the conflict must be resolved, the power and status of the person being conflicted with, how important the issue is perceived to be, previous experience and comfort with conflict situations, and personal factors (Willers, L., 2004). Literature is replete with conflict management strategies in nursing or healthcare scenario. The causes of conflict are unique and compounded in every situation. These may be one or more of the many, such as, specialization, multitask roles, role interdependence, task blurring, task differentiation, scarcity of resources, change, rewards, and communication. Constructive conflict resolution is an important aspect of nursing management responsibilities. Contingency contracting and management by objectives are important steps in conflict management. However, it is to be recognized that there is no best or established method of conflict resolution in all kinds of interpersonal conflicts that may arise in today's healthcare scenario. The leader must have knowledge of possible strategies together with the processes involved in leading and managing people, and the most efficient manager would choose and implement the best strategy given the unique environment of the scenario (Walczak, MB and Absolon, PL., 2001). Sherif at al. revealed that conflict occurs when two competing parties drift from common goals forgetting the responsibilities to promote group cooperation, and they have mutually incompatible goals. If the conflict is related to the goals of the organization or the department, long and short-term goals need to be arrived. However, ambiguities relating to misunderstanding may occur, and for that reason, communication, review, and clarifications are necessary (Sherif M, Harvey OJ, White BJ, Hood WA, Sherif CW., 1988). One of the five choices can be made to develop a strategy for conflict management. The basic goal is to develop a desirably good outcome and a good relationship. Collaboration: This leads to a win-win resolution, where the stakeholders agree collaboratively to a mutually acceptable goal with rewards that are mutually anticipated. This method encourages the parties to work towards common goals. This is a win-win situation, and although the most difficult to achieve, is usually the best one, specially when the issue requires consensus. This demands a discussion between parties who are willing to examine issues thoughtfully and work in a task-oriented fashion to solve the problem. Although time consuming and the decision has chance to be delayed, this is the best method producing most sustained results with a solution that neither of the parties have considered. This is the ideal objective of conflict management, where both the parties are winners and emerge mutually satisfied (Hewison, A and Stanton, A., 2003). Accommodating or Smoothing: This strategy involves attempting to eliminate anger and expressions of differences without addressing the issue itself and usually involves giving in to the wishes of another to preserve harmony for the time being with a plan to approach the conflict issues at a later time. This is an appropriate approach when one of the stakeholders is wrong and the other is right. This is designed in such a way that it is wise to give in now when the chances of gaining more are there in the future times. Obviously, in such strategies, concerns for relationship are maximum, and the manager is willing to provide a favourable outcome to her adversary in order to maintain a good relationship. The outcome would invariably produce a loser and a winner. The problem with this strategy is that it would generate only a temporary solution to the immediate encounter. The issues or the conflicts would still exist, and the feelings would intensify in future. This is most suitable when agreement is impossible, and to ultimately resolve the conflict, use of power would be necessary (Valentine, PE., Richardson, S., Wood, MJ., and Godkin, MD., 1998). Forcing the Issue or Competing: This involves working for a particular desired solution exclusively. This strategy is chosen when one stakeholder believes in her values in such a way that no compromise is possible in outcomes. This, however, has an element of emphasis on personal goals, routinely ignoring opinions or needs of others. Since the concern for the outcome is high, this mode demands the use of authority by the forcing individual. As a result, the user of this strategy is firm, not at all willing to give ground, very focused and intent to pursue her goals. This is frequently used between peers, and when both parties pursue the same strategy, there is a chance of considerable hostility since each one would be trying to gain upper hand over the other. In the short run, this can be an effective strategy to solve interpersonal conflicts in the healthcare arena, but it is evident that it often builds up resentment and hostility. One group would be unhappy with the outcome (Blake AR, Mouton JS., 1964). What happened in this particular conflict was interesting. If I would be handling the conflict management, I would escalate the issue with the physician in that discussion, and I would have asked the physician persistently what he could do for the patient. In response, the physician might become personal saying that I was not there when this incidence took place. He might as well complain that I did not even know what exactly happened, and in his opinion, I had no right to ask what the physician is going to do for the patient, her pain, and her mind that would have been hurt. I in response would state that I was just trying to hear both the sides of the story, and since I had already heard that of the patient, it was now the turn of the doctor's. I would also communicate to the physician that I wanted to let the physician know the effects of his behaviour on the patient (Wlody, GS., 2007). By the fact that I was a nurse, I had all the rights to stand up for the patient, and I could as well become her advocate. I would close by saying that I feel both me and the physician should feel the need for doing something for the patient, both in terms of pain relief and in the context of the mental hurt she had received from the physician's behaviour. While being cared for, she should not be crying as a result of some physician's behaviour to her. The physician would have suggested in response that I should discuss this issue, and I took this opportunity to explore this issue very amiably. In the middle of this discussion, the physician might show signs of withdrawal by looking at his watch sending a cue that he was in a hurry, and he would be willing to be leaving. I would respond by saying that I understood that the physician was in a hurry. I would close my descriptive exploration by saying that at that point in time, I just wanted to highlight and stress on two issues. The first was that it would be appreciated from both the patient and the nursing staff if the physician paid a visit to the patient again the same day. The second was that I was very much willing to explore this issue with the physician more broadly in the staff meeting. I would close the discussion by asking the physician whether I could trust the physician to see the patient on the same day (Vivar, CG., 2006). The physician would leave the meeting expressing his consent in this, saying he would see what he could do. In this dialogue, I have intended to use and blend the component of problem solving by expressing concerns about the mutual goal to be advocates of the patient and at the same time there is a component of competition by expressing my desire to stand up for the cause of the patient and by asking him whether I could trust him to see the patient that day itself without blaming him. I would desire to remain descriptive, explorative, and content oriented, even after the person-oriented remarks by the physicians and his signs of withdrawal. At the same time, I would use power to pressurize the physician to call on the patient that very day, and I would like to send an indication that I was working on behalf of the patient and the staff, in order to project myself organizationally effective in observing my role (Mrayyan, MT et al., 2008). The combination of problem solving and competition yields effective management by maximising both the tendency of problem solving to produce issue-focused togetherness and to generate a focused agitation (Blake AR, Mouton JS., 1964). Conclusion: Conflicts are bound to happen in the workplace in the present healthcare scenario, and constructive conflict management is important for organizational functioning. Even though interpersonal conflicts can occur between two or more stakeholders, the issue may be organizational. Literature suggests analysis of a conflict event by providing the theoretical backup, and it also suggests strategies to handle it. A knowledge about the strategies could allow the nurse to handle interpersonal conflicts in the workplace, that would definitely help achievement of quality healthcare. Reference List Almost, J., (2006). Conflict within nursing work environments: concept analysis. J Adv Nurs; 53(4): 444-53. Blake AR, Mouton JS., (1964). The managerial grid. Houston, TX: Gulf Publishing. Caplan G., (1964). Principles of preventive psychiatry. New York: Basic Books. Cox, KB, (2001). The effects of unit morale and interpersonal relations on conflict in the nursing unit. J Adv Nurs; 35(1): 17-25. Hewison, A and Stanton, A., (2003). From conflict to collaboration Contrasts and convergence in the development of nursing and management theory. J Nurs Manag; 11(1): 15-24. Kelly, J., (2006). An overview of conflict. Dimens Crit Care Nurs; 25(1): 22-8. Mrayyan, MT et al., (2008). Readiness of organizations for change, motivation and conflict-handling intentions: senior nursing students' perceptions. Nurse Educ Pract; 8(2): 120-8. Sherif M, Harvey OJ, White BJ, Hood WA, Sherif CW., (1988) The Robbers cave experiment. Middletown, CT: Wesleyan University Press. Sportsman, S and Hamilton, P., (2007) Conflict management styles in the health professions. J Prof Nurs; 23(3): 157-66. Valentine, PE., Richardson, S., Wood, MJ., and Godkin, MD., (1998). 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