This article discusses How to identify and manage conflicts arising in care delivery settings.
Describe an unresolved (recurring) conflict that you experienced or observed. Identify the type of conflict.
- Provide details of what happened, including who was involved, what was said, where it occurred, and what was the outcome that led you to decide the conflict was unresolved.
- Outline the four stages of conflict, as described in Finkelman, and how the stages relate to your example. Decide if delegation was an issue in the conflict. Be specific.
- Describe the strategies for conflict resolution and how you would collaborate with a nurse leader to resolve the conflict. Cites the course textbook and two scholarly sources.
- Provide a conclusion or summary about this experience and how you may deal with conflict more effectively in the future
Conflicts are common in all professions, including nursing. Although there is no common definition of conflict, it is characterized by actual or perceived objection or contradiction of values, interest or needs between two or more parties, resulting to unwanted reactions, stress and negative emotions between the antagonists. Studies on conflicts in various settings demonstrate that they could result to either positive or negative impacts between the parties involved. Collaborative professions such as nursing involve constant interactions with patients and colleagues and other healthcare practitioners. The interactions bring together individuals with diverse views resulting to conflicts, which could undermine the relationships.
This paper is a critical evaluation of a recurring conflict experienced in a healthcare setting. The conflict involved a physician and an advanced practice registered nurse in the healthcare organization I was working in. The issue of contention involved whether the nurse practitioner could attend to various clinical roles patients without the supervision of the physician. Essentially, nurse practitioners are involved in more specialized clinical roles, including assessment of patients, diagnosing and treating different health conditions and prescribing drugs. In addition nurse practitioners are allowed to order diagnostic tests and provide guidance on managing various clinical conditions. Although nurse practitioners are required to undertake the roles, supervision by physicians is required in various jurisdictions across the country, depending on the nurse experience (Shah, 2017).
In this situation, the physician wanted the nurse practitioner assess the patient and order diagnostic tests independently without the physician supervision. However, the nurse practitioner was reluctant on the grounds that she felt not experienced enough to perform those specialized roles without the physician’s guidance and supervision. The nurse had repeatedly informed the physician that although nurse practitioners are allowed to undertake the advanced medical roles in the state, she had not yet acquired enough experience under the physician’s supervision. This type of conflict in that case was interpersonal, involving the two professionals working in the same organization.
Interpersonal conflict usually develops from a disagreement between two individuals in an organization resulting significant dissatisfaction among the parties concerned (Shah, 2017). Some of the causes of interpersonal conflicts in a clinical setting include unfair distribution or allocation of responsibilities to the parties involved and power dynamics. Various empirical studies in clinical setting indicates that interpersonal conflict in healthcare setting is aggravated by various factors, including existence of vertical and horizontal violence, settings where staff are fearful of reporting because of reprisal from the senior management and where the staff lack awareness about conflict resolution and management(Shah, 2017; Cohen, 2014). Additionally conflict occurs in situations where is there is diverse practice views, which are further aggravated by difference in age, educational level and experience.
Another study conducted by Gerardi (2014) found that conflict among colleagues could worsen if the members are deliberately or unintentionally placed in challenging clinical situations beyond their skill level. Failure of senior nurses and other experienced clinicians to provide support to newly recruited graduates and employees has also been found to escalate interpersonal conflicts in healthcare setting. Although nursing is a collaborative profession, conflicts escalate in situations where there is inadequate collaboration and poor teamwork. In such situations, some of the team members are reluctant to support each other in achieving the set goals in the department.
In this particular instance, the physician was doing routine clinical rounds and noticed that a hospitalized elderly patient required an in-depth assessment of her reproductive system. The physician called on the nurse practitioner, who was about to complete her shift and was about to handover. The physician ordered the nurse practitioner to immediately undertake the assessment telling her (the nurse) that she was “taking ages to learn” and had “to be chaperoned “on how to become a competent nurse. The nurse practitioner shot back at the physician, shouting to him expletives to the effect that he was a “blood sucking chauvinist” eager who was only after her(the nurse) being punished and apprehended for negligence and malpractice should a patient get harmed. The nurse also accused the physician of being inhumane and inconsiderate of the fact that she had just come out of a tiring night shift. The physician responded that the health institution was not a holiday home for “spoilt nurses” not ready to take up roles of proper nurse practitioner. The nurse practitioner was not impressed and she went ahead to report the matter to the hospital’s chief clinical officer. Although the disagreement between the physician and the nurse practitioner had all along been evident among fellow registered nurses, appropriate conflict resolution had never been applied, resulting to the altercation.
Finkelman (2016) outlined the four stages of conflict, which are latent (anticipation); perceived; felt and finally, manifest. The latent stage of a conflict is characterized by uneasy peace between the antagonists involved in a disagreement. In this case, the parties are aware of their unique differences, although they are not enough to trigger a full blown conflict or disagreement. In the perceived stage of conflict, one of the parties involved in the conflict perceives that the other individual is likely to undermine or frustrate his or her goal (Finkelman, 2016). In the scenario presented above, the nurse practitioner noted that the physician intended to frustrate her career by insisting that she take up more advanced clinical roles. In this case, the nurse practitioner observed that the physician was aware that she (nurse practitioner) was not experienced enough in undertaking the medical assessment independently, without the physician’s supervision. Should the nurse practitioner make errors during the assessment, she could be liable for malpractice charges, which could undermine her career as a nurse practitioner.
The third stage of conflict is the felt phase, which is characterized by the awareness that an actual disagreement exists between the parties involved. In this case, one or both parties become cognizant and concerned about the disagreement, and hence they feel it as personal level. Manifest is the final stage, in which the parties involved in the conflict engage in irrational or abnormal behavior towards each other. It could be demonstrated by overt aggression, indifference, sabotage and withdrawal, or even unusual compliance to the stipulated rules and regulations in a particular organization (Finkelman, 2016).
Various approaches are used to resolve conflicts in workplaces, including healthcare settings. These include encouraging respectful working environment through deliberate adoption and demonstration of professional behavior. Senior employees in healthcare organizations should play an active role in mentoring, supporting and integrating new employees, including newly hired nurse graduates within the organization’s culture and practice. Another strategy of resolving and preventing conflicts includes creating a culture that promotes open communication between all levels of professionals, without fearing reprisal or victimization (Cohen, 2014)..
Nurses and other medical staff should also reflect on individual behaviors, beliefs, values and attitudes, which could affect their interactions with others, resulting to conflict (Cohen, 2014). In this case, individual nurses should identify personal areas requiring improvement and commit to change them to facilitate formation of a favorable working relationship with others. Additionally, it is important for people working together to become cognizant of personal issues and stressors, which could motivate an individual to behave irrationally and cause conflicts with colleagues (Shah, 2017). To resolve the aforementioned conflict, I would work with the nurse leader to create an effective conflict resolution mechanism that addresses the disagreements immediately and directly instead of postponing. Secondly, I would encourage open dialogue with nursing colleagues to validate assumptions instead depending on assumptions and misconceptions. Additionally, it is important to collaborate with other nurses to facilitate identification of the causes of conflict and even engage professional mediator to address the issue.
The conflict involving the nurse practitioner and the physicians indicated the importance establishing an organizational culture that encourages immediate resolution of disagreements instead of postponing issues. Organizations should promote a culture that encourages open communication among all levels of staff. This would encourage reporting of conflicts before they escalate. Additionally, organizations should clearly define and clarify roles to avoid misunderstanding and alleviate interpersonal conflicts. However, it is important to appreciate the fact that conflicts are inevitable in workplaces because of diversity and divergence in opinions, education and beliefs among others.
Cohen, S. (2014). Resolving conflict by setting ground rules. Nursing Management, 45(5), 17-21
Finkelman, A. (2016). Leadership and management for nurses (3rd ed.). Boston, MA: Pearson.
Gerardi, D. (2014). Using mediation techniques to manage conflict and create healthy work environments. AACN Clinical Issues, 15(2):182-195.
Shah, M.(2017). Impact of interpersonal conflict in health care setting on patient care; the role of nursing leadership style on resolving the conflict. Nursing & Care Open Access Journal, 2(2):44-46.