Confronting Problems Nicole A. Broome, Liberty University

Finkelman's Case Study: "As a nurse manager in a busy operating room (OR), you have to ensure that all staff are collaborating and communicating well. In the past six months, you have noticed more problems with poor communication between nurses and physicians, which had an impact on the quality of care. Nurses are also frequently complaining that they are 'second-class citizens' in the department. The number of last-minute call-ins has increased by 25% over the past six months, causing staffing problems. Today was the last straw when a nurse and a surgical resident had a shouting match in the hallway. The nurse left the encounter crying, and the resident said he would not work with the nurse anymore. The nurse manager went into the OR medical director's office. They have had a positive collaborative relationship over several years. She went in and said, 'We have a problem!' As she described the problems, he said, "I was unaware there was so much tension and lack of collaboration. Why didn't you tell me this earlier?'" (2016, p. 331).

So what's the problem here?

According to Finkelman, lack of communication is one of the two greatest sources of interpersonal conflict (2016). It appears here that the initial lack of communication was occurring between the nurses and physicians, but that there was a secondary lack of communication between the nurse manager and her OR medical director. This lack of communication resulted in a breakdown in team collaboration, and ultimately a heated, and rather public confrontation between a nurse and a physician.

"Nurse-physician relationships are complex. There is overlapping focus in that both are concerned about the patient, though each may come from different points of view, which is not always understood or appreciated" (2016, p. 323).

Understanding Conflict

  • The latent conflict stage is when communication is initially breaking down. No direct conflicts have happened.
  • The perceived conflict stage is when the conflict is just becoming recognized. Trying to recognize conflict at this stage can be helpful to negotiating/mediating.
  • When conflict reaches the felt stage, it is already manifesting by way of staff anxiety, anger, and stress. Avoidance of the conflict at this point can be damaging.
  • Lastly, manifested conflict is when the conflict becomes overt, as in the textbook scenario. Resolution is necessary (Finkelman, 2016).

From a management standpoint, there are three goals of conflict management:

  • Decreasing or eliminating the conflict
  • Meeting the needs of patients, staff, and the organization
  • All parties feeling positive about the resolution of the conflict moving forward (Finkelman, 2016)


"Negotiation is the critical element in making conflict a nightmare or an opportunity" (Finkelman, 2016, p. 332).

Before taking steps to try to counteract future conflicts of this nature, and resolve the issue between the unit's staff, it is necessary to deal with the immediate issue: the conflict existing between the specific nurse and specific physician. Dealing with conflict will most likely take the form of negotiating or mediating--which is negotiating with the help of a third, unbiased party (Finkelman, 2016). It is very likely that if the conflict has gotten to the point of a shouting match in public, there will need to be mediation. Finkelman lists a number of ideas to help guide mediating/negotiating:

  • Understand that in seeking to find a reasonable solution, there is no winner or loser of the negotiation.
  • Individuals must be separated from their "position" in order to ensure "power" is distributed equally.
  • Mutual trust and respect must be maintained.
  • The mediator, and conflicting parties, must ensure that they give adequate time for both sides to be heard, and incorporate active listening when the "opposing party" is sharing their point of view.
  • Parties should be encouraged to share data, facts, and evidence, not rhetoric.
  • The focus of the negotiations should always be on shared patient care interests, and identifying shared goals, and should always be steered away from personal attacks.
  • Parties should be encouraged to speak their viewpoints, and consider others' as well, from a standpoint of flexibility and fairness, and should never involve finger-pointing or judging (2016).

Crucial Conversations lead to conflict resolution.

Patterson, et. al., wrote an entire book on conflict resolution entitled Crucial Conversations. Below are some tips for navigating conflict negotiations in the midst of those high-stakes, high-opinion, high-emotion crucial conversations.

  • Be able to recognize when the parties no longer feel safe expressing their feelings/opinions.
  • Establish mutual purpose, focusing on shared goals and ideals.
  • Maintain mutual respect. "Respect is like air. As long as it's present, nobody thinks about it. But if you take it away, it's all that people can think about" (p. 79).
  • Brainstorm strategies for resolution together, allowing everyone equal input.
  • Separate fact from story.
  • Reinforce the idea that understanding someone's point of view does not necessarily support it. (2012)

Moving Forward

Steps that should be taken now to help curb potential conflict and address the issues between nurses and physicians on the unit include:

  • Mandatory training for nurses and physicians, specifically in the areas of communication, conflict resolution, and team building
  • Developing common values and patient goals as a team before conflicts arise
  • Recognizing physicians and nurses within the organization who are exemplary collaborators

"The complex healthcare delivery system requires many competencies, and no one health care profession has all the necessary competencies to provide all the care that is required" (Finkelman, 2016, p. 320)

Interdisciplinary teamwork is not easy. Not only do personalities have to be meshed together and managed, but it seems for every medically different background, there is a different approach to patient care. It is only when nurses and physicians can focus on the mutual goals of patient care, safety, and satisfaction that they will be able to move toward a respectful and beneficial professional relationship, hopefully reducing the potential for conflict, and preventing public displays such as the one presented in the Finkelman scenario.


Finkelman, A. (2016). Leadership and management for nurses: Core competencies for quality care (3rd ed.). Boston, MA: Pearson.

Patterson, K., Grenny, J., McMillan, R., & Switzler, A. (2012). Crucial conversations: Tools for talking when stakes are high (2nd ed.). New York, NY: McGraw Hill.

Created By
Nikki Broome


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