Collaborative Conflict Resolution- Engaging Nurses and Leadership for Effective Solutions
Conflict Resolution
As nurses, we must resolve to learn effective conflict resolution strategies on a daily basis. Conflicts in the workplace can range from a lack of conflict resolution skills to disagreements about patient care. Early intervention in conflicts can help to limit the amount of energy and focus diverted away from patient care. Many conflicts are easily resolved, but others have the potential to result in neglect and possibly harm to the patient or the nurse. “Handling conflicts in an efficient and effective manner results in improved quality, patient safety, and staff morale, and limits work stress for the caregiver,” wrote Mary Johansen, Ph.D., RN (Johansen, 2012, p. 50). Johansen explains conflict, conflict management strategies, how nurses manage interpersonal conflict, and recommendations for nurse managers in her article, Keeping the Peace: Conflict Management Strategies for Nurse Managers. She offers a plan of action for conflict resolution (Johansen, 2012)
At our facility, there is a recurring conflict between the emergency room and the medical-surgical department. It is usually just the two charge nurses, but the unit directors are occasionally called in. Finkelman defines this as an intergroup/organizational conflict that occurs between two units (Finkelman, 2012). The conflict is that they typically call for a bed request an hour before shift change, and they will occasionally call during nurse handoff to request a bed. It is my responsibility as a charge nurse to make bed assignments and assign nurses. It is extremely difficult to pull a nurse away from a bedside handoff to receive a new patient.
This problem repeats itself, shift after shift. Appeals to department heads have not resulted in a resolution to this conflict. The risk of patient harm has gone unnoticed, causing tension between the two department heads. The attitudes of the ED charge nurses have become increasingly domineering, resulting in a tense relationship between the departments. We med-surg charge nurses are afraid of receiving a phone call from the administrators if we refuse a bed request. It is now easier to give in and provide the requested bed regardless of the circumstances. These assignments near shift changes always add to the pressure on our nurses during the critical time of handoff report. It also causes a delay in patient care and an unsatisfactory patient experience.
The Four Conflict Stages
There are four stages of conflict, according to Anita Finkelman’s textbook, Improving Teamwork: Collaboration, Coordination, and Conflict Resolution. Latent conflict, perceived conflict, felt conflict and manifest conflict are the stages. The anticipation of conflict is the main theme of the latent conflict stage. Competing for resources or communication shortcomings can be predictors of conflict. This stage is characterized by an increase in tension, either by an individual or by a group. The perception or awareness of an existing conflict is involved in the stage of perceived conflict. It is critical to be aware of potential conflicts and the steps to resolve them. The emotional stage of the conflict is referred to as felt conflict. Individuals may experience feelings of anxiety or anger at this stage. Avoidance may be the most effective intervention in preventing a conflict from escalating to the next level. However, it may not prevent the conflict from reoccurring in the future. When using avoidance, open communication and trust can be beneficial. The final stage, manifest conflict, is referred to as “overt conflict.” The manifestation of feelings triggered by conflict is referred to as manifest conflict. This can manifest as either constructive or destructive behavior. Negative actions taken in response to a conflict are considered destructive. Constructive behaviors include teamwork and appropriate emotional expression. As nurse leaders, we should use our basic nursing training to seek constructive resolutions to daily conflicts.
During a shift, especially near the end, the nurse should use excellent organizational and time management skills to successfully complete patient care tasks. I work the day shift, so the charge nurse has a lot of work to do. Because we do not have a unit secretary, these responsibilities are shared by the charge nurse. Charts must be “broken down” and assembled for new patients, specialty consults are requested, staffing assignments for the next shift are made, and shift updates are received. If I had to choose one time during a shift when I could predict a critical event, it would be the hour before shift change.
During the last two hours of the shift, as the charge nurse, I can identify all stages of conflict. I start with the latent stage and “anticipate” a phone call from the ED for a bed request. At this point, the tension becomes palpable. During the perceived stage, I start checking the ED track board to see if any of the ED patients have a chance of being admitted. When a call comes in from the ED during this time, the felt conflict stage begins. Sometimes I can keep the conflict from escalating to the point where it becomes destructive. This is not a strategy I employ. It frequently happens by chance. Our staff nurses may be “maxed out” according to our nurse-to-patient ratio grid, or we may be unable to cover the next shift. I try to balance the needs of the nurses with the needs of the patients. I collaborate with the ED staff to reach a positive resolution while keeping the patient’s needs in mind. Only when a staff member disregards the authority of each unit leader does the conflict escalate into destructive behavior. When this happens, I’ll get a call from the ED’s DON. When the ED director calls, he usually tries to convince me that it is critical to “move” the patient and that it will “look bad” on our unit if we delay the transfer. I usually end up frustrated, but I am adamant that as the RN in charge, it is my responsibility to know and understand my unit’s strengths and limitations. My actions are guided by my resolutions to keep the unit under control, and I take time later to discuss issues with my own DON.
Potential Conflict Resolution Strategies
To avoid adverse events caused by unsafe patient care practices, a solution to the conflict of inpatient admissions occurring during the critical time of shift change must be found. The practice of transferring a patient from unit to unit has the potential to harm our patients with the implementation of bedside handoff at our facility. According to Beverly Johnson, chief executive officer of the Institute for Patient-and-Family-Centered-Care in Bethesda, MD, “conducting nurse change-of-shift report at the bedside with the patient and family should be viewed as a core safety strategy in hospitals today.” She goes on to say that studies have shown a decrease in the number of patient falls and that additional safety issues have been identified as being caught before patient harm. Patient satisfaction ratings improved as well (Landro, 2015). In her MSN capstone project, Connie Vazquez (2015) identified the establishment of a “blackout period” for inpatient admission transfers. Her theory was that by reducing the number of interruptions during this critical time of bedside handoff, she could lower the incidence of delayed patient care, patient dissatisfaction, and patient safety errors. She proposed a “blackout period” of 45 minutes before shift change and not accepting the new patient assignment until the next shift arrived (Vazquez, 2015). Her solution promotes safe and timely patient transfers and would be appropriate to present to our medical facility’s nurse leaders. My reasoning for selecting this strategy is that it would establish a standard of care for all nursing units. It would involve both physicians and nurses, reduce perceptions of time management misuse, and improve patient safety.
Conclusion
Finally, conflicts between units must not impede patient care and, ultimately, patient safety. Our patients’ safety is our top priority. This necessitates that the nurse be skilled at conflict resolution in order to be an effective patient advocate. Now that I’ve learned how to handle conflicts on my unit, I believe I’ll be able to influence how we transfer patients from unit to unit. I am feeling empowered and plan to meet with my clinical director to discuss potential solutions to this conflict. Our organization’s culture, I believe, needs to change. This hospital is extremely small. Everyone is acquainted with everyone else. For the sake of our patient’s safety, we must all work together. When conflicts arise, we must prioritize patient safety. If we keep patient safety in mind, there is little room for ego and the emotional responses that often accompany it.
References
Finkelman, A. (2016). Leadership and management for nurses: Core competencies for quality care (3rd ed.). Boston, MA: Pearson.
Johansen, M. L. (2012). Keeping the peace. Nursing Management (Springhouse), 43(2), 50-54. doi:10.1097/01.numa.0000410920.90831.96
Landro, L. (2015, October 26). The Most Crucial Half-Hour at a Hospital: The Shift Change. Retrieved March 17, 2018, from https://www.wsj.com/articles/the-most-crucial-half- hour-at-a-hospital-the-shift-change-1445887115
Vazquez, Connie M., “Decreasing Delayed Patient Transfers Prior to Shift Change” (2015).Master’s Projects and Capstones. 174. https://repository.usfca.edu/capstone/174
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Question 
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Conflict Resolution
Conflict setting :
I entered the emergency room for my 12-hour shift in the emergency department and found out that my assignment that day was quite heavy. I was assigned seven patients, including two who were unstable at that time. I noticed that my colleague had a light assignment with only five patients, all of whom were scheduled to be discharged home during the shift.
I felt frustrated because my patient load exceeded the ER guidelines regarding patient number and acuity. I had earlier noticed that my colleague often receives lighter assignments because she is known to be intimidating and aggressive. I decided to address the issue with the charge nurse who told me she was busy and “it is what it is.” Increasingly frustrated, I decided that it was time to approach the unit manager about this ongoing issue.
Insight
Collaboration is considered the most effective method of conflict management.
The manager could have an informal meeting with both the nurses and the charge nurse where they can discuss ways they can all come to an acceptable solution.
Each party can give input and feel their opinion is important and heard by management. With all involved parties included, each will be more willing to compromise for the overall benefit of everyone on the unit including other staff members and patients. This solution offers the best way for a speedy resolution while also improving patient care and patient outcomes.
Another important aspect could be negotiation.
Negotiation involves controlling reactions during the conflict, seeking to actively listen and understand the other party’s issues, identifying the unmet need, and being able to compromise and collaborate to come to a positive solution.
-Erin
References:
McLean, Scott. Exploring Interpersonal Communication v2.0. Available from: Bookshelf, Flat World Knowledge, 2018.Thomas, K. W. (1992). Conflict and Conflict Management: Reflections and Update. Journal of Organizational Behavior, 13(3), 265–274. http://www.jstor.org/stable/2488472