Nursing is a high-stress profession that requires working with patients and other staff in stressful environment that can lead to conflict. Such situations can easily cause a loss of focus and disrupt the care process which needs to be efficient and organized in a hospital setting. Conflicts can emerge from a variety of causes and in different situations which makes it difficult to control and prevent. However, a skill essential for nursing staff is conflict resolution which can mitigate and manage any arising issues without disruptions to the delivery of health care. This paper seeks to evaluate a nursing workplace conflict and provide strategies for its resolution.
There was a period of time, when the hospital where I work at experienced an increased rate of hospital-acquired infections. The most prevalent ones were post-surgery wound infections and urinary tract infections. The hospital administration directed nursing managers to adopt means of prevention for these infections, including more frequent routine changes of catheters and bandaging.
However, the nursing department was desperately understaffed and overworked. As a shift manager, I was required to ensure that all applicable patients were checked for infection and had routine changes. This job was often given to certified nursing assistants or other qualified low-level staff. Despite efforts to reduce the issue of hospital-acquired infection, its incidence rates did not fall significantly.
After review, it was determined that many times the staff chose to ignore orders and not perform routine catheter and bandaging changes unless it was extremely needed. Partially, this occurred due to lack of time because of understaffing. Nursing management chose to implement a system of reminding staff to perform the routine changes as well as a system of checks by shift managers. The staff was mostly friendly with each other and there was a level of trust.
Most shift managers simply asked the staff member to confirm that the patient was examined. However, impromptu checks showed that the staff simply quickly evaluated patients and often did not perform the time-consuming changes. This resulted in a conflict since the staff purposefully deceived the shift managers as well as ignored direct orders and compromised patient safety.
Stages of Conflict
The four stages of conflict are latent, perceive, felt, and manifest.
- Latent are the antecedent conditions or events which can lead to conflict behavior. Often caused by difference in value or some sort of injustice. In my example, the severe understaffing of the nursing department can be considered as latent since it seemed to be the cause of insubordination.
- Perceive is when there is a cognitive awareness of the conflict. In my example, this stage occurred when checks by management showed that low level staff incompetently fulfilled their duty in addressing the issue of catheter changes. The staff ignored regulations or orders, choosing to prioritize other duties in the limited time they had.
- Felt are the emotions and attitudes experienced throughout the conflict. In the example, management was frustrated by what they felt was direct insubordination and a failure of their efforts to reduce infection rates. Meanwhile, the nursing staff believed it was unjust to demand additional workload from a department that was struggling to manage the workload as it was without any potential support in terms of new hires or additional compensation.
- Manifest conflict is the negotiation and resolution stage of the conflict. The problem is solved through beneficial and mutually agreeable terms. In the example, there were tough ongoing negotiations which led to more efficient clinical practice, appropriate support for the department, and understanding between staff and management.
Strategies for Resolution
Delegation was a significant issue in this case since the workload of evaluating the patients and changing catheters and equipment was passed down upon low level staff. Delegation is a mechanism which is used in the complex realities of modern healthcare environments where there are not enough resources and a variety of tasks to fulfill. However, delegation also bring with it the authority and accountability to ensure safe delivery of care. Delegation must be enacted with the principle of public protection as well as responsibility by the delegator (Mueller & Vogelsmeier, 2013). Therefore, all factors which may impact the task, including barriers to its fulfillment, are part of the nurse leader’s responsibility when delegating.
Effective resolution of conflict management can be extremely beneficial for the organization and clinical practice. However, it should be managed practically with emphasis on transparency of communication, understanding, and listening. Any sources of escalation and disagreement should be noted and prevented. There should be no attempt at condemnation and challenge amongst the involved parties. The conflict negotiations should focus on identifying the optimal solution and establish cooperation amongst both sides in order to achieve set objective. Nursing practice is a team concept which requires a careful approach of planning and leadership (McKibben, 2017).
The end outcome is considerably influenced by how the team is managed. The use of effective leadership is one of the most optimal methods for the resolution of a conflict. A leader can overlook negotiations and then introduce necessary changes to the practice. This includes management functions, such as staffing and budgeting. Both sides are inherently interested in a resolution in a presence of a leader which can competently relay the demands and demonstrate appropriate management strategies so that the conflict does not reoccur. Using the Evaporating Cloud Framework, the negotiations can lead to an accommodating compromise that leads to better outcomes (Day & Leggat, 2015).
Collaboration with Nursing Leader
Conflicts most usually manifest in a gradual manner within the context of interpersonal relationships or dimension of the workplace environment. In nursing, a conflict most often arises during times of change when professional duties begin to shift from operational to strategic area. A conflict is a phenomenon that arises due to behaviors, facts, and attitudes in the organization parameters and is acknowledged by involved parties. Conflict is an inherent part of the profession because the autonomy and extent of nursing duties will undoubtedly interfere with centralized decision-making and control of management (Johansen & Cadmus, 2015).
Therefore, efforts should be made to align the interests of staff and management with a compromise for both sides. Nursing leaders should seek to account for staff capabilities within the healthcare demands and available resources or workforce. Meanwhile, despite the necessity to achieve results, management should not focus on blindly implementing initiatives and pressuring the staff to fulfill expectations.
This experience has shown me that conflict can arise out of a variety of clinical situations and organizational practices. Often, when considering the aspect of conflict, people consider interpersonal differences to be a significant factor. However, in this situation, all the staff were friendly and trusting of each other. Nevertheless, a conflict emerged due to poor planning and organizing on behalf of the hospital administration.
As a shift manager, I was trapped in the middle. Upper management pressured me to delegate duties and perform checks, but I also realized that my staff simply could not manage the additional workload in the existing organizational conditions. It was not so much a conflict of interest but a conflict of expectations and reality. As a result, quality of patient care and safety decreased. Therefore, one of the primary things I learned from the situations is to ensure that delegated tasks can be competently fulfilled based on the realities of the workplace and staff capabilities.
Day, G. E., & Leggat, S. G. (Eds.). (2015). Leading and managing in health services. Cambridge, UK: Cambridge University Press.
Johansen, M. L., & Cadmus, E. (2016). Conflict management style, supportive work environments and the experience of work stress in emergency nurses. Journal of Nursing Management, 24(2), 211-218. Web.
McKibben, L. (2017). Conflict management: Importance and implications. British Journal of Nursing, 26(2), 100-103. Web.
Mueller, C., & Vogelsmeier, A. (2013). Effective delegation: Understanding responsibility, authority, and accountability. Journal of Nursing Regulation, 4(3), 20-27. Web.