NR 510 Conflict Resolution Strategies Discussion

The purpose of this posting is to address an organizational strategy that would help to address the issue put forth in the scenario. I will also look at management skills which may help to resolve some of the conflicts that are causing the distractions and compromising patient care. The foundational strategy for any healthcare providing organization is to provide the best quality care to their patients. Anything that prevents the organization from striving toward that goal is an issue which needs to be addressed. In the situation we are discussing, there are interpersonal conflicts which are inhibiting the organization and these must be stopped. As a manager it is not my desire to get involved in the personal issues of the employees. I would make this point clear to the MA and try to make it understood that when these events take place at work they are forcing my hand. I would try to suggest ways in which they situation could be deescalated before it gets to yelling (Thomas, 2015). I would also attempt to find ways for workers who do not function well together to not be placed in close proximity if that is possible. I would also make it clear that patient safety is first and that the situation with the low BP will not be tolerated for any reason. We are a team and there is potential conflict within all teams. Regardless of the issues, it is important to understand that we win or lose as a team and not individuals. A mistake by one can reflect on all and that is why we must all function as professionals at all times. Close teams look out for the best interest of each other. When we are all on the same page we mind not only our obligations, but we look for opportunities to help other team members reach their full potential. Interpersonal conflict which festers can destroy this cohesion and eat at the fabric which holds the unit together. This is among the greatest lessons one can learn from the military and is applicable in any organization.

Thomas, C. (2015). Identify Conflict Resolution Styles used by Nursing Professionals working in Clinical and Academic settings of selected Hospitals and Nursing Colleges of Southwestern Rajasthan. International Journal of Advances in Nursing Management, 3(3), 273. doi:10.5958/2454-2652.2015.00015.3

Like stated in the last answer, there are many different strategies to help prevent work incivility. If work incivility is prevalent on a certain unit, this can cause issues with proper patient care. For example, on my floor, I have seen where a nurse and a PCA started arguing in front of the nurses station. It was a simple issue that quickly escalated into name calling and yelling. The call light had went on and the PCA told the nurse that the patient was requesting for the nurse. The nurse told the PCA to go see first before she goes in there that as charge, she is busy making the assignment. The PCA refused and told the nurse to go and this was where the argument ensued. Patient care was also delayed because either did not want to go into the room in the heat of the argument. Management did not directly deal with it but just let it simmer down. I also seen recently where two nurses got into it because of patient assignment in the middle of the hallway, right in front of management. I also seen where one nurses would try to engage staff into heavy gossiping and in turn, staff would come to not like her and act uncivil towards her because she was gossiping. However, management would attempt to turn a blind eye by mildly addressing when it was happening, but what I have come to find was that there is no set standard for how to prevent or stop workplace incivility. For the most part, the staff seems to get along, however, because of the high stress level of med-surg, sometimes, employees get besides themselves with stress. Now that I think of it, the unit as a whole should speak to management about preventing work incivility. The unit should work together to make a more productive and positive place as possible.

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There should be a set standard or even protocol when it comes to workplace incivility. First and foremost, when it does occur, the parties involved should be taken out of patient care area and into a conference room/break room. If the argument or incident is becoming too heated, the parties should be separated to defer or cool off because this can help the employees involved to cool off and prevent escalation of the issue. Maybe the team members can talk thru the issue, right then and there with a mediator involved. If the situation is extremely tense, maybe management should consider temporarily separating staff till conflict/issue is resolved. Often, staff would rather not involve themselves in the work incivility incident and become a bystander. 95% of nurses report to have witnessed a work incivility incident but did not report it. However, being a bystander does not help the situation, rather enables for future issues to arise or occur. There should be a protocol. There should also be zero tolerance in constant arguments. For the first time, a warning, education and a personal meeting with the parties involved should take place. If it keeps happening, a write up and if it keeps going, higher consequences like suspension or termination should occur. Staff should work together to keep a positive flow and energy on the unit as this will help with proper patient care. Combating against workplace violence takes the whole unit to put in positive effort. (McNamara, 2016)

Referances:

McNamara, S. A. (2016). Column: Incivility in Nursing: Unsafe Nurse, Unsafe Patients. AORN Journal, 95535-540. doi:10.1016/j.aorn.2012.01.020

According to various surveys, nursing leaders and managers spend 25 to 40 percent of their time dealing with staff-on-staff and patient-on-staff conflicts (Baddar, Salem, & Villagracia, 2016). It only makes sense as a future nursing manager that I examine ways to resolve employee and patient conflicts. Healthcare experts who study ways in which people respond to conflict state the Thomas-Killman Instrument (TKI) is a model that identifies five different tactics people typically use when handling conflict (Baddar et al., 2016). Accommodating, compromising, collaborating, avoiding, competing, each of these conflict styles comes with advantages and disadvantages (Baddar et al., 2016). Since the scenario focuses on ways to resolve co-worker conflict, the strategies I employ must promote a work productivity and patient safety. The two styles that are best applied to addressing conflict among healthcare co-workers are compromising and collaborating because of the team-based environment (Baddar et al., 2016). Compromising is a bargaining process in which both parties make concessions to reach a mutual agreement (Baddar et al., 2016). Compromise is a good way to solve a complex issue quickly, as it gives both parties equal power and allow them to stay committed to their position and duties. Collaborating is the best way to solve conflicts since its goal is to find a mutual solution (Baddar et al., 2016). This process often needs the assistance of a mediator and involves high amounts of cooperation from the conflicting parties (Baddar et al., 2016). Collaborating takes the time to communicate and seek to fix the small or underlying reasons to the conflict. As a nursing manager, promoting and teaching communication among team members is vital (Amestoy et al., 2014). In healthcare environments in which nursing managers include communication and interpersonal skills training in orientation sessions, nursing managers report a 10 percent improvement in how nursing co-workers handle difficult issues (Amestoy et al., 2014). This change has also made a significant impact on patient satisfaction and employee productivity (Amestoy et al., 2014). The authors also suggest listening, openly showing respect, and teaching democratic mediation skills as positive EBP conflict resolution strategies and management skills.

References:

Amestoy, S. C., Schubert-Backes, V. M., Thofehrn, M. B., Martini, J. G., Schlindwein-Meirelles, B. H., & De Lima Trindade, L. (2014). Conflict management: challenges experienced by nurse-leaders in the hospital environment. Revista Gaúcha de Enfermagem: Publication of The Federal University of Rio Grande do Sul, 35(2). Retrieved from http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1983-14472014000200079Links to an external site.

Baddar, F., Salem, O. A., & Villagracia, H. N. (2016). Conflict resolution strategies of nurses in a selected government tertiary hospital in the Kingdom of Saudi Arabia. Journal of Nursing Education and Practice, 6(5), 91-99. Retrieved from http://www.sciedu.ca/journal/index.php/jnep/article/viewFile/8238/5269

I have seen this behavior many times in clinical settings, especially when doctors go on a rant about the incompetency of a particular nurse or medical staffer. I have also seen the effects of such behavior on the morale of staff. When staff members develop low morale due to multiple on the job conflicts, affected members develop poor communication with management and other team members, complain incessantly about little issues, call out of work often, ignore the needs of patients, and consistently produce a poor quality of work. As the supervisor in charge, I must not allow employees to insult each other for any reason (Attri, 2015). Even when employees conflict, they must follow basic guidelines to air out their disagreements and come to a resolution. I should remind the staffers involved that each must consider the other’s point of view (Attri, 2015). I must remain calm and not become agitated because it will turn into a three-way argument. Mediating the conversation between the staffers, which allows them to state their separate points of view without them interrupting each other (Attri, 2015). This will also give me a chance to understand what the issue is from both vantage points. After each person has stated what the problem is. I can propose specific solutions and invite the people involved to propose their solutions (Attri, 2015). These actions encourage listening, positive communication, and compromise.

Reference

Attri, J. P., Sandhu, G. K., Mohan, B., Bala, N., Sandhu, K. S., & Bansal, L. (2015). Conflicts in operating room: Focus on causes and resolution. Saudi Journal of Anaesthesia, 9(4), 457–463. http://doi.org/10.4103/1658-354X.159476

I believe that having zero tolerance to verbal attacks is the foundation to preventing this kind of situation from occurring. Like stated before, I have seen where two nurses got into it in the hallway and management was witnessing the situation. At the time, management should have stopped the situation from escalating and separating the two nurses once yelling and verbal attacks ensued. Once management did not stop the situation while it was occurring, it was hard for other employees to stop the situation because management was not trying to stop it. This helps when it comes to the resolution process. I also believe that certain rules should be set when it comes to meeting for the resolution process. No personal attacks or yelling, and if that occurs, again management or the mediator involved should stop it. Also it would be good not to wait and delay the resolution process as it would be harder to help come to a resolution. Delaying may cause more conflict to arise as the situation at hand is not being addressed. I believe that set standards are what can help tackle and combat against work incivility and create a more professional and work-friendly environment. (Morin, 2018)

Reference: Morin, K. (2018). Association of the nurse work environment with nurse incivility in hospitals. Journal Of Nursing Management, 26(2), 219-226. doi:10.1111/jonm.12537

Ideally, nursing managers should enforce a zero tolerance policy about employees verbally degrading each other. However, many times nursing managers are not aware of the “behind the scenes drama” that is the underlying reason for the conflict before it is too late. Nursing managers become involved in having to mediate conflict situations as they reach the point of escalation. I believe if nurses had an opportunity to voice their opinions on matters, such as things that should be changed or worked in the clinical environment, difficult patients, actions that caused problems, things co-workers are doing well or are effectively, the clinical environment would have less tension. This would also keep the nursing manager informed about the “little things” that may be festering and potentially create problems. In a work setting, most people are passive-aggressive and internalize their discomfort or frustration until it reaches a boiling point. Employees must be given opportunities to address their grievances in order to maintain a functional and productive work environment (Bönigk, & Steffgen, 2013).

Reference

Bönigk, M., & Steffgen, G. (2013). Effects of habitual anger on employees’ behavior during organizational change. International Journal of Environmental Research and Public Health, 10(12), 6215–6234. http://doi.org/10.3390/ijerph10126215

According to Simpao (2013) there are five sources of conflict: communication, emotions, values, structure, and history. Communication errors happen when a message is received incorrectly, or the sender was not clear in their message. Simpao (2013) state that collaboration is the most useful method for conflict management, but compromise is also important. He states, “negotiation is integral to compromise and collaboration, and consists of efforts to manage the give and take between two conflicting parties to either a partially satisfying or fully satisfying solution” (p. 56). In this situation patient care was affected and whatever solution is found, improved patient care must be a priority.

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Resource:

Simpao, A. (2013). Conflict management in the health care workplace. Physcian Exchange Journal, 54-58.

Working together for so long breeds familiarity and people can get tired of being around each other. The consequences of too much conflict include dysfunctional team members, reduced patient care and satisfaction, and increased employee turnover (Overton & Lowry, 2013). EBP research results on conflict management styles demonstrates that training in conflict resolution skills results in improved teamwork, employee satisfaction and productivity, and patient satisfaction (Overton & Lowry, 2013). The team supervisor needs to find ways to bolster employee morale and minimize conflicts, while the co-workers need to remember the value that each person respectively brings to the team. The ability to work as a team and minimize conflicts starts with examining levels of performance in various nurses’ and healthcare workers’ roles (Overton & Lowry, 2013). A popular conflict strategy implemented by healthcare managers is to increase the degree of organization or to restructure organizational units, which integrates different viewpoints on how to manage work goals and roles (Overton & Lowry, 2013). When assisting conflict parties, conflict management intermediaries can apply the six-step evidence-based practice conflict management model (Hansen, 2017). Step 1 is to interrogate the process by turning the disagreement into answerable questions (Hansen, 2017). Step 2 is to refer to scientific or professional based evidence when addressing the team members involved and answering their questions (Hansen, 2017). Step 3 is analyzing the arguments and evidence that each team member has presented, making sure not to take sides (Hansen, 2017). Step 4 is to involve the team members in collaborative decision making and conflict management implementation, but to also to maintain authority as the manager in charge (Hansen, 2017). Step 5 Monitoring and evaluating the implemented conflict management strategies (Hansen, 2017). Step 6 is meeting in an agreed upon time with the conflicting team members to discuss outcomes and lessons learned (Hansen, 2017). This is a six-step process that can be used in varying sequences.

References

Hansen, T. (2017). Evidence based conflict management practice. Journal of Conflict

Management, 5(1), 43-62. Retrieved from http://jocm.net/v5/no.1/v5n1_Hansen.pdfLinks to an external site.

Overton, A. R., & Lowry, A. C. (2013). Conflict management: Difficult conversations with difficult people. Clinics in Colon and Rectal Surgery, 26(4), 259–264. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3835442/

Conflict and disagreement will happen when people work in a team oriented setting (Kumar, Adhish, & Chauhan, 2015). Co-workers handle conflict differently because people have different viewpoints (Kumar et al., 2015). While a person’s openness to accept different viewpoints is a positive interpersonal attribute, not every co-worker sees it this way. Whenever there is a disagreement and a co-worker chooses to ignore it and the other to complain about it, management must get the two workers on the same page to find some sort of resolution. The first thing is to approach the party who feels the issue is minor and ask that person if he or should would join in the conversation. Openly communicating with the employee and letting him or her know that the other party still wants to talk is the most direct way to handle the situation (Kumar et al., 2015). You don’t want the employee to feel ambushed or plotted against. Most people don’t want to talk because they feel the other parties won’t listen (Kumar et al., 2015). As the nursing supervisor, I can only assure the employee that I will mediate the conversation and encourage open, non-accusatory or derisive speech (Kumar et al., 2015). No one likes to be lectured or bullied, especially during tense conversations, so I will do my best to help both employees to communicate with each other openly and calmly.

Reference:

Kumar, S., Adhish, V. S., & Chauhan, A. (2015). Managing bosses and peers. Indian Journal of Community Medicine : Official Publication of Indian Association of Preventive & Social Medicine, 40(1), 14–18. Retrieved from http://doi.org/10.4103/0970-0218.149263

NR 510 Conflict Resolution Strategies Discussion