Conflict and Stress in Hospital Nursing

Introduction

Conflict is an unavoidable consequence in healthcare teams working in high-stress environments. If not appropriately managed, conflict can cause severe dysfunction and poor results in the workplace. Conflict can arise due to an interpersonal relationship or inadequate management. However, with strong leadership, conflict can also be used as an opportunity for growth and respect, aimed at building positive relationships with the objective to maximize care delivery (McKibben, 2017). This paper will seek to identify, examine, and propose rational strategies for resolution for a conflict in a nurse practice setting.

Conflict Description

I work in a hospital setting in urban Miami, a large facility that encompasses various departments. At one point, the hospital administration sought to institute new guidelines for the prevention of hospital-acquired infections through improved sanitation. A strong focus was made on catheter (central line) care, introducing stricter rules for sanitation of the area, and increasing frequency of change. The department I worked in oversaw care for many post-surgery patients that required more dedicated attention after the new hospital policy was adopted. However, the department was understaffed, and many nurses felt overworked. The new measures meant additional duties for nurses already struggling to fulfill the necessary responsibilities.

As a department, it was agreed that a sort of rotation would be established to increase catheter replacements and sanitation of post-surgery patients. As the hospital policy was implemented, nurse managers would sometimes check whether proper procedures were done to fulfill the requirements. The nature of the conflict arose when after a period of time, the rate of HAIs was not decreasing despite new measures.

Furthermore, routine checks found that catheter change frequency and appropriate sanitation were not completed accordingly. There was tremendous pressure on the department, and higher-level hospital administrators were involved as threats were made to determine who failed to follow guidelines. The department was divided and very dysfunctional as many felt being put under pressure in an already high-stress environment of working understaffed.

It was determined that some nurses, faced with the overload of work chose to delegate the responsibility to unlicensed assistants who often lacked the experience and judgment to monitor central line care. Constant disagreements and verbal altercations occurred as well, leading to a breakdown of collaboration and communication which further decreased the department’s performance.

Type and Stages of Conflict

This type of situation can be characterized as an intragroup conflict. It fits the description of a conflict that occurs among individuals inside a collective group. Incompatibilities, misunderstanding, and negative behavior amongst team members lead to interpersonal conflicts and the group fails to work together to achieve common objectives. Intragroup conflicts are defined by a high-level of engagement in the conflict situation and immense emotional intensity (Marques, Lourenço, Dimas, & Rebelo, 2015).

The latent stage of the conflict occurs before any open disagreements arise and can be characterized by the difference in needs and values for involved parties. In the described case, this stage can probably be attributed to the understaffing of the department and burnout from the nurses. The perceived stage is the action that one side sees as an attempt to frustrate their goals from the other party, leading to a misunderstanding. In this scenario, it was the announcement of new guidelines by the hospital. While the hospital administration and nurse managers wanted to improve quality indicators, frontline nurses did not see the value-added of such interventions.

Felt conflict is when the dispute is not only perceived but felt at a cognitive level. For the scenario, this could probably be attributed to a short period of time once the policy was implemented when nurses tried their best to fulfill responsibilities. The tension was felt, and there were minor complaints at first. The manifest stage the central core of the conflict, leading to open disagreements, with personalized attacks and improper behavior. This stage was clearly evident in the description as the intragroup disagreements arose as well as conflicts with the hospital administration.

The delegation was a significant contributing factor to this conflict since it directly dealt with nurses struggling to fulfill assigned duties. The primary care responsibilities of nurses consist of an array of tasks that are shared amongst team members to fulfill a specific objective for patient care. Based on the principle of public protection and medical skill or judgment required for the task, it is delegated from nurse managers to registered nurses, who can then pass down the task to unlicensed assistive personnel. Delegation often encounters the challenge of poor role clarity and confusion in communication and responsibility.

While registered nurses can relieve fatigue by delegating tasks, being delegated to is associated with increased burnout and negative implications for care (Edwards et al., 2018). This occurred in the conflict scenario as overwhelmed registered nurses were delegated to, increasing burnout. In order to cope, some chose to delegate to unlicensed assistants leading to miscommunication and failure to follow guidelines. Eventually, everything erupted into a high-tension intragroup conflict.

Strategies

The best strategy would be to find a compromise between hospital policy and nursing staff capabilities and demands. Implementation of best practices consists of a multi-step approach that evaluates staff understanding of new roles and provides appropriate support systems in place. The implementation plan should have tools to improve a smooth transition and minimization of practical barriers (Agency for Healthcare Research and Quality, n.d.). This was not done in the described case, resulting in a dysfunctional change process at the front line which caused the conflict.

A team-based approach to conflict resolution is encouraged, which would gather the department staff in meetings and workshops for the betterment of communication and provide a platform for employees to voice opinions. Furthermore, organizational models such as Weick’s model can specifically help build communication and practice in a fair manner that does not exclude any staff members and can be helpful for understanding stress-related conflicts (Moreland, 2016).

I believe the best strategy would be to use a competent implementation plan that would provide initial information on the capabilities of the department to fulfill the new responsibility. This would have eliminated the tremendous pressure and initial causes of conflict.

Cooperation with leadership is critical since conflict management style, and a strong leadership role can be helpful to the resolution of disputes, providing a supportive work environment, and decreasing work stress. However, a combination of various leadership styles and different approaches to the situation can be effective at conflict management, as transformational or transactional models are used (Saeed, Almas, Anis-Ul-Haq, & Niazi, 2014). Nursing leaders can bridge a compromise between hospital administration and frontline staff. Therefore, collaboration is critical to achieving an appropriate conflict resolution.

Summary

Conflict can have significant negative consequences in the workplace, leading to poor communication and a drop in performance. The described scenario describes an issue of delegation and inadequate planning of interventions from the hospital which placed nurses in situations of having to sacrifice care for patients. Immense pressure and interpersonal disagreements led to the conflict until strategies such as better communication and stronger leadership were used to resolve the differences. From this experience, I learned that conflict is inevitable in hospital settings which often places nurses in high-stress environments.

However, conflicts can be managed through team collaboration and working with administration to ensure that the necessary resources are available to fulfill the tasks without compromising patient care. Finally, a strong leadership role is effective at uniting teams towards a common objective and overcoming their differences.

References

Agency for Healthcare Research and Quality. (n.d.). How do we implement best practices in our organization? (continued). Web.

Edwards, S. T., Helfrich, C. D., Grembowski, D., Hulen, E., Clinton, W. L., Wood, G. B.,… Stewart, G. (2018). Task delegation and burnout trade-offs among primary care providers and nurses in veteran’s affairs patient aligned care teams (VA PACTs). The Journal of the American Board of Family Medicine, 31(1), 83-93. Web.

Marques, F., Lourenço, P. R., Dimas, I. D., & Rebelo, T. (2015). The Relationship Between Types of Conflict, Conflict Handling Strategies and Group Effectiveness. Journal of Spatial and Organizational Dynamics, 3(1), 58-77. Web.

McKibben, L. (2017). Conflict management: importance and implications. British Journal of Nursing, 26(2), 100-103. Web.

Moreland, J. J. (2016). Conflict and Stress in Hospital Nursing: Improving Communicative Responses to Enduring Professional Challenges. Health Communication, 31(7), 815-823. Web.

Saeed, T., Almas, S., Anis-Ul-Haq, M., & Niazi, G. (2014). Leadership styles: Relationship with conflict management styles. International Journal of Conflict Management, 25(3), 214-225. Web.