Conflict Resolution building healthy relationships among healthcare workers

We do this job because we care.

An article in the International Journal of Caring Sciences calls bullying, “the antithesis of caring,” (Maykut, 2015). The article goes on to cite the American Nurses Association (2015) as characterizing bullying as, “the on-going health or career endangering mistreatment of an employee, by one or more of their peers or higher-ups and reflects the misuse of actual and / or perceived power or position that undermines a nurse’s ability to succeed or do good, or leaves them feeling hurt, frightened, angry or powerless,” (Maykut, 2015). This is a powerful characterization of what happens in the workplace for so many nurses and is exactly what seems to be happening in the scenario Finkelman describes in the text.

Retrieved on March 8, 2017 from: http://www.americansentinel.edu/blog/2015/10/06/conflict-in-the-workplace-resolving-the-nurse-physician-clash/

Finkelman (2016) gives us multiple acceptable reactions to conflict in the workplace with the goal being to eliminate or decrease the conflict, meet the needs of the persons involved, and to ensure that all parties feel positive about the resolution of said conflict (p.327). During a perceived conflict, that is one that is recognized to exist but hasn’t manifested overtly yet, the nurse manager has an obligation to act in such a way that fosters a collaborative working relationship, establishes boundaries, and negotiate agreements (Finkelman, 2016, pp.328-332).

Safety is the number one priority in negotiating conflict resolution.

Once the conflict is manifested overtly, as is the case in the case study Finkelman presents, the nurse manager needs to act with safety as the number one priority (p.329). When the conflict becomes hostile the manager must first isolate the conflict away from patient and public areas, establish an atmosphere for parties involved to walk away or cool down, and use active listening and clear communication to begin to negotiate the conflict (Finkelman, 2016, p. 329).

Once the situation is contained the nurse manager is absolutely right to seek interdisciplinary collaboration from the medical direct as she did in this case study. The response she received was a rightful one in that she could have intervened and collaborated with medicine sooner. In this situation the nurse manager should acknowledge the director’s concerns and examine how her own feelings about conflict may have played a role in her delay to intervene.

It's not always easier to just smooth things over

According to Finkelman, avoidance is a common coping mechanism for those who have a difficult time coping with the anxiety and fear that surrounds confrontation (2016, p. 329). Another coping strategies often seen in nurses purely in our nature as people pleasers is the use of accommodation. The nurse manager may have simply found it easier to smooth things over and accommodate both parties during the latent, perceived and felt stages of conflict as a means to establishing a working relationship if even momentarily (Finkelman, p. 326, 329). The manager may have been concerned about how the conflict between medicine and nursing would reflect on her and her staff. People will often be silent rather speak out in the face of conflict when they feel the reaction will be a negative one (Manojlovich, 2010,11). A review of conflict resolution literature finds several possible reasons for choosing silence over conflict including concerns about relationships, employment status and punitive action, (Manojlovich).

Role confusion between nursing and medicine may contribute to conflict.

Once her own feelings surrounding the conflict are examined and she can come at the problem objectively it is now time for the nurse manager and the medical director to problem solve. There are a few strategies that nursing and medicine management can explore including communication and role clarification. Finkelman suggests that role confusion between nursing and medicine exists because the, “structure of work is different for physicians and for nurses,” impacting each other's understanding, communication, collaboration and coordination (2016, pp.330-331). To combat these frustrations, nursing and medical management must find a way to communicate more effectively.

To make sense of all this conflict, we must make sense in our communication.

One such method currently being studied is the use of a communication tool called, “sensemaking,” (Manojlovich, 2010,11). This method is used in other high reliability environments such as air traffic controlling. The expected outcome of using this method of communication is to be, “cognizant of each other’s professional identity and unique contributions, regardless of title, hierarchical level, or power status,” (Manojlovich). Sensemaking uses a vocabulary that translate, “hunches, clues and intuition,” into an data based language that both disciplines can understand, appreciate and respect,” (Manojlovich). For example, while standing at the head of the bed, the physician may notice that a patient’s earlobes are dusky and request an arterial blood gas (ABG) be drawn. The nurse cannot see this assessment finding from the other side of the room that is less lighted. “Without the physician saying, ‘Please draw an ABG right away because the patient’s earlobes are dusky,’ or the nurse saying, ‘I’m going to finish up a few things first because the patient looks comfortable to me,’” neither provider is sharing the perceptions that led to their conclusion and decision making (Manojlovich, 2010,11).

Empowering nurses.

Staff can be involved in the incorporation of this communication technique into the culture of the unit. Staff current feelings and communication styles should be assessed. Staff should be asked about their concerns and possible conflict resolution solution proposals they may have. Getting the unit involved in the problem solving process will lead them to feel more validated in their position and thus more empowered to make a difference on their unit, in their healthcare organization and at the bedside. To attempt to problem solve this on a purely management level would be a mistake for both disciplines involved as, “one cannot ignore individual beliefs and attitudes brought to the metaphorical negotiating table, and their impact on corporate relationships,” (Hendel, 2007). Finkelman affirms that, “participative decision making empowers staff but only if staff really do have the opportunity to participate and influence decisions.” (2016, p. 328).

We must all remember our shared goal and work to acheive it daily.

Understanding the importance for healthy workplace environment and its impact on colleagues, patients, families is paramount in problem solving workplace aggression and bullying. We must all remember our shared goal that is the patient and assist one another in productive and inspiring ways to create an atmosphere for healing needed for not only the patients but us as the caregivers. We must nurture ourselves, our craft and our relationships before we can nurture others to our fullest abilities.

References

Adams, Lisa Y, RN, BN,M.Sc, PhD., & Maykut, Colleen A, RN, BScN,M.N., D.N.P. (2015). International Journal of Caring Sciences, 8(3), 765-773. Retrieved from http://ezproxy.liberty.edu/login?url=https://search-proquest-com.ezproxy.liberty.edu/docview/1732805875?accountid=12085

Finkelman, A. W. (2016). Leadership and management for nurses: Core competencies for quality care. Boston: Pearson.

Hendel, T., Fish, M., & Berger, O. (2007, 07). Nurse/Physician Conflict Management Mode Choices. Nursing Administration Quarterly, 31(3), 244-253. doi:10.1097/01.naq.0000278938.57115.75

Manojlovich, M. (2010, 11). Nurse/Physician Communication Through a Sensemaking Lens. Medical Care, 48(11), 941-946. doi:10.1097/mlr.0b013e3181eb31bd

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