“Healthcare professionals have estimated that more than 50% of their workday is spent dealing with conflict and that the majority of that is conflict with each other,” says Debra Gerardi, RN, MPH, JD. The chair of the Program on Healthcare Collaboration and Conflict Resolution at Creighton University in Omaha, NE, Gerardi says that in her experience, those conflicts affect everything from lengths of stay to staff retention.
“Research repeatedly supports the effectiveness of a team approach to clinical care: It improves outcomes, shortens lengths of stay, improves patient compliance, and increases the likelihood that patients will refer others to the facility. All of this improves the bottom line,” she says. “Collaborative work environments have also proven to be more attractive to workers and increase retention of experienced staff.”
Physician disputes
When it comes to conflict between nurses and physicians, Gerardi says much depends on whether there is a clear plan of care for the patient. According to her research, problems can pile up because physicians and nurses tend to have different views of collaboration.
“Physicians tend to think of collaboration as anticipating needs and following through on what was ordered; nurses define collaboration as joint decision-making and respect for contribution,” Gerardi says. “Until we develop some collective understanding around what collaboration means, we will continue to generate conflicts resulting from unmet needs.
“Healthcare professionals tend to be conflict avoiders. Because of this, conflicts often fester, sometimes for years, before they boil up into what feels like an unmanageable situation. Developing skills for negotiating differences and engaging in difficult conversations improves the likelihood that people will engage with each other sooner. We must move toward cultures of engagement rather than continue with our tendencies toward silence and avoidance.”
Engagement, not resolution
When asked for tips about ending discord, Gerardi says that is not necessarily the answer.
“Resolution of conflict is a misnomer,” she says. “Conflict is often linked to tensions or polarities that have to be balanced, such as the tension between cost and quality. There is not an end or solution to this tension, so resolution is not the goal. Staying engaged in conversations and becoming comfortable with managing polarities is a more realistic option. Conflict is a symptom of a system out of balance; balance is restored by improving trust and communication with each conversation.”
When to engage
Although training can improve comfort when entering a conflict, Gerardi admits that it alone will not cut the amount of time nurses spend dealing with conflicts.
“I think we’re already expert at conflict avoidance,” she says. “The goal is to recognize when it is appropriate to avoid a conflict situation, and when it is necessary to step up and address the real issues. The steps in engagement include self-reflection, open listening, acknowledgment, and negotiation of differences.”
Assessing when to step into a conflict is crucial, and Gerardi says nurses should ask themselves three questions before taking action:
- Is this a recurring situation that is affecting patient care?
- Does interacting with this person or situation keep me awake at night?
- What is my intent in wanting to resolve this situation?
Effective negotiation
When engaged, how the conflict develops (or doesn’t) depends on your negotiation style.
“Effective negotiation requires an ability to listen deeply and ask questions rather than to merely take sides or stake claims,” says Gerardi. “Negotiation with colleagues requires that we balance our assertive drive to get all that we can with the cooperativeness necessary for preservation of much needed working relationships. It is important to recognize that every interaction is an opportunity for building trust, and our choices in the current conversation impact the next negotiation with that person.”
Source: Case Management Monthly, an HCPro, Inc., publication. For more information about effective communication, be sure to check out Stressed Out About Communication Skills.
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