How to deal with conflict in various forms

Paper instructions

please used this book ,i paste the information with the reading below thanks LEADING and MANAGING in NURSING
6th ed.
Patricia S. Yoder-Wise
Texas Tech University Health Sciences Center, Lubbock, Texas

2. Prepare interventions that enhance team spirit and prevent incivility and horizontal violence.

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3. Examine the nurse manager’s role in applying conflict management strategies.

4. Investigate how nurse managers and leaders prevent moral and ethical distress.

As a manager, it is important to understand how to deal with conflict in various forms. Through this Assignment you will have to resolve a conflict using evidence from the literature, and the ANA positions statement:

Incivility, Bullying, and Workplace Violence. American Nurses Association. Retrieved from:

Sue is one of the best clinical staff nurses and a team leader. However, staff has complained that she is often rude and abrupt with staff especially new nurses on the floor. They are also upset that she gets away with treating them so poorly. Several new nurses are threatening to quit. Several nurses on the unit are upset and the morale on the unit is low. No one is picking up extra shifts anymore and patients are noticing that the nurses do not talk to each other and are often hostile to each other.
Describe how you, as the nurse manager, solved the problem. Be sure to use evidence-based research, conflict research, and nursing ethics to support your solution.
Analyze how the situation involves all three types of conflict. (intrapersonal, interpersonal, and organizational). Give two examples for each type of conflict.
Describe and analyze the ethical dilemma in this situation. As a manager, how will you address this dilemma? Be specific and use literature to support your answer.
State an intervention that can be used to increase morale and stop incivility on the unit. Be sure to support your interventions with evidence-based research.

Codes of Ethics
Professional codes of ethics are formal statements that articulate values and beliefs of a given professional, serving as a standard of professional actions and reflecting the ethical principles shared by its members. Professional codes of ethics generally serve the following purposes:
•Inform the public of the minimum standards acceptable for conduct by members of the discipline and assist the public in understanding a discipline’s professional responsibilities
•Outline the major ethical considerations of the profession
•Provide to its members guidelines for professional practice
•Serve as a guide for the discipline’s self-regulation
The Code of Ethics for Nurses (ANA, 2001) should be the starting point for any nurse faced with an ethical issue. The first American nursing code was adopted in 1950, and it focused on the character of the nurse and the virtues that were essential to the profession. In 1968, the focus shifted to a duty-based ethical focus, and the current Code of Ethics for Nurses (ANA, 2001) has blended these duty-based ethics with a historical focus on character and virtue. The Code of Ethics for Nurses (ANA, 2001) has nine points that guide nurses in understanding the extent of their commitment to the patient, themselves, other nurses, and the nursing profession. Further provisions in the code assist nurses in understanding that patients, whether as individuals or as members of families, groups, or communities, are their first obligation and that nurses must not only ensure quality care but also protect the safety of these patients. Nurses and their nurse managers should ensure that the provisions of the code are incorporated into nursing care delivery in all clinical settings. Along with establishing the ethical standard for the disciplines, the nursing codes of ethics provide a basis for ethical analysis and decision making in clinical situations.
Ethical Decision-Making Framework
Ethical decision making involves reflection on the following:
•Who should make the choice
•Possible options or courses of action
•Available options
•Consequences, both good and bad, of all possible options
•Rules, obligations, and values that should direct choices
•Desired goals or outcomes (Guido, 2006)
When making decisions, nurses need to combine all of these elements using an orderly, systematic, and objective method; ethical decision-making models assist in accomplishing this goal.
For most nurses, ethical decision-making models are considered only when complex ethical dilemmas present in clinical settings. In truth, however, nurses use ethical decision-making models each time an ethical situation arises, although the decision-making model may not be acknowledged or fully appreciated. Ethical dilemmas involve situations in which a choice must be made between equally unacceptable alternatives that an individual perceives he or she can accept and reasonably justify on a moral plane or in which there is not a more favorable or appropriate choice that dominates the situation.
Ethical decision making is always a process. To facilitate this process, the nurse manager must use all available resources, including the institutional ethics committee, and communicate with and support all those involved in the process. Some decisions are easier to reach and support than others. Allowing sufficient time for the process contributes to a supportable option being reached.
nflict: The Cutting Edge of Change
Victoria N. Folse
Appropriate conflict-handling strategies are essential in professional nursing practice because conflict cannot be eliminated from the workplace. To resolve conflicts, nurse leaders must be able to determine the nature of a particular issue, choose an appropriate approach for each situation, and implement a course of action. This chapter focuses on maximizing the nurse leader’s ability to deal with conflict by providing effective strategies for conflict resolution.
Learning Outcomes
• Use a model of the conflict process to determine the nature and sources of perceived and actual conflict.
• Assess preferred approaches to conflict, and commit to be more effective in resolving future conflict.
• Determine which of the five approaches to conflict is the most appropriate in potential and actual situations.
• Identify conflict management techniques that will prevent lateral violence and bullying from occurring.
Key Terms
horizontal violence
interpersonal conflict
intrapersonal conflict
lateral violence
organizational conflict

The Challenge
Miranda J. Kennedy, BSN, RN, CCRN
Staff Nurse, Medical Surgical Intensive Care Unit, Presence Saint Joseph’s Medical Center, Joliet, Illinois
Fresh out of orientation, I was walking down the hall and I heard the wife of one of my patients holler, “Miranda!! In here quick! It’s happening again!” I raced into the room to find my patient diaphoretic and hypotensive, but still coherent. I quickly called my charge nurse and then called a rapid response. It was another busy day on the unit; I had just finished giving two stat meds to two different patients and recognized that another one of my patients required a sitter. Because the charge nurse was busy, the assistant nurse manager came in the room to assist. The MD happened to be nearby so he was also present for the rapid response along with two critical care nurses. While we were reviewing what had occurred, the MD asked what medications that patient had received that AM, his 0800 vitals, and symptoms at the time of the episode. As I was looking vitals up, the assistant nurse manager said to me, “Yeah, did you even check your blood pressure before you gave all of his meds?!?”
What do you think you would do if you were this nurse?
Conflict is a disagreement in values or beliefs within oneself or between people that causes harm or has the potential to cause harm. Folger, Poole, and Stutman (2012) add that conflict results from the interaction of interdependent people who perceive incompatibility and the potential for interference. Conflict is a catalyst for change and has the ability to stimulate either detrimental or beneficial effects. If properly understood and managed, conflict can lead to positive outcomes and practice environments, but if it is left unattended, it can have a negative impact on both the individual and the organization (Scott & Gerardi, 2011a, 2011b; Wright, 2011). In professional practice environments, unresolved conflict among nurses is a significant issue resulting in job dissatisfaction, absenteeism, and turnover. Patient dissatisfaction is lower in hospitals in which nurses are frustrated and burned out, which signals a problem with quality of care (McHugh, Kutney-Lee, Cimiotti, Sloane, & Aiken, 2011; Wright, 2011). Successful organizations are proactive in anticipating the need for conflict resolution and innovative in developing integrated conflict resolution strategies that apply to all members (Brinkert, 2010).
Conflict can be desirable at times and can be a strategic tool when addressed appropriately. Some of the first authors on organizational conflict (e.g., Blake & Mouton, 1964; Deutsch, 1973) claimed that a complete resolution of conflict might, in fact, be undesirable because conflict also stimulates growth, creativity, and change. Seminal work on the concept of organizational conflict management suggested conflict was necessary to achieve organizational goals and cohesiveness of employees, facilitate organizational change, and contribute to creative problem solving and mutual understanding. Moderate levels of conflict contribute to the quality of ideas generated and foster cohesiveness among team members, contributing to an organization’s success (Almost, 2006). An organization without conflict is characterized by no change; and in contrast, an optimal level of conflict will generate creativity, a problem-solving atmosphere, a strong team spirit, and motivation of its workers. Conflict on an interdisciplinary team can result in better patient care when collaborative treatment decisions are based on carefully examined and combined expertise (Tschannen, Keenan, Aebersold, Kocan, Lundy, & Averhart, 2011).
The complexity of the healthcare environment compounds the impact that caregiver stress and unresolved conflict has on patient safety. Conflict is inherent in clinical environments in which nursing responsibilities are driven by patient needs that are complex and frequently changing and in practice settings in which nurses have multiple professional roles (Brinkert, 2010). Healthcare providers are exposed to high stress levels from increased demands on a limited and aging workforce, a decrease in available resources, a more acutely ill and underinsured patient population, and a profound period of change in the practice environment. Conflict among healthcare providers is inevitable and is compounded by employee diversity, high nurse-to-patient ratios, pressure to make timely decisions, and status differences (Wright, 2011). Nurses employed in better care environments report more positive job experiences and fewer concerns about quality care. Interprofessional collaboration has been characterized by effective communication and is a key factor in reducing error and improving patient outcomes (Tschannen et al., 2011). Moreover, hospitals with good nurse-physician relations are associated with better nurse and patient outcomes, making collaboration and conflict resolution among nurses and physicians crucial in promoting quality of care outcomes (Aiken et al., 2012).
An important factor in the successful management of stress and conflict is a better understanding of its context within the practice environment. The diversity of people involved in health care may stimulate conflict, yet the shared goal of meeting patient care needs provides a solid foundation for conflict resolution. Because nursing remains a predominately female profession, this may contribute to the use of avoidance and accommodation as primary conflict handling strategies. An international study, however, found that both physicians and nurses were likely to use avoidance as the main strategy to handle conflict (Kaitelidou et al., 2012). The stereotypical self-sacrificing behavior seen in avoidance and accommodation is strongly supported by the altruistic nature of nursing. Avoidance may be appropriate during times of high stress, but when overused, it threatens the well-being of nurses and retention within the discipline.
Types of Conflict
The recognition that conflict is a part of everyday life suggests that mastering conflict-management strategies is essential for overall well-being and personal and professional growth. A need exists to determine the type of conflict present in a specific situation, because the more accurately conflict is defined, the more likely it will be resolved. Conflict occurs in three broad categories and can be intrapersonal, interpersonal, or organizational in nature; a combination of types can also be present in any given conflict.
Intrapersonal conflict occurs within a person when confronted with the need to think or act in a way that seems at odds with one’s sense of self. Questions often arise that create a conflict over priorities, ethical standards, and values. When a nurse decides what to do about the future (e.g., “Do I want to pursue an advanced degree or start a family now?”), conflicts arise between personal and professional priorities. Some issues present a conflict over comfortably maintaining the status quo (e.g., “I know my newest charge nurse likes the autonomy of working nights. Do I really want to ask him to move to days to become a preceptor?”). Taking risks to confront people when needed (e.g., “Would recommending a change in practice that I learned about at a recent conference jeopardize unit governance?”) can produce intrapersonal conflict and, because it involves other people, may lead to interpersonal conflict.
Interpersonal conflict is the most common type of conflict and transpires between and among patients, family members, nurses, physicians, and members of other departments. Conflicts occur that focus on a difference of opinion, priority, or approach with others. A manager may be called upon to assist two nurses in resolving a scheduling conflict or issues surrounding patient assignments. Members of healthcare teams often have disputes over the best way to treat particular cases or disagreements over how much information is necessary for patients and families to have about their illness. Yet, interpersonal conflict can serve as the impetus for needed change and can accelerate innovation in approach.
Organizational conflict arises when discord exists about policies and procedures, personnel codes of conduct, or accepted norms of behavior and patterns of communication. Some organizational conflict is related to hierarchical structure and role differentiation among employees. Nurse managers, as well as their staff, often become embattled in institution-wide conflict concerning staffing patterns and how they affect the quality of care. Complex ethical and moral dilemmas often arise when profitable services are increased and unprofitable ones are downsized or even eliminated.
A major source of organizational conflict stems from strategies that promote more participation and autonomy of direct care nurses. Increasingly, nurses are charged with balancing direct patient care with active involvement in the institutional initiatives surrounding quality patient care. A growing number of standards set by The Joint Commission (TJC) target improving communication and conflict management (Scott & Gerardi, 2011a, 2011b). Specifically, TJC requires that healthcare organizations have a code of conduct that defines acceptable and inappropriate behaviors and that leaders create and implement a process for managing intimidating and disruptive behaviors that undermine a culture of safety. Standards pertaining to medical staff also include interpersonal skills and professionalism (TJC, 2012). The Magnet Recognition Program® of the American Nurses Credentialing Center (ANCC) identifies interdisciplinary relationships as one of the Forces of Magnetism necessary for Magnet™ designation (2012). Specifically, collaborative working relationships within and among the disciplines are valued, demonstrated through mutual respect, and result in meaningful contributions in the achievement of clinical outcomes. Magnet™ hospitals must have conflict management strategies in place and use them effectively, when indicated. The following are other “forces” that are particularly germane to conflict in the practice environment:
•Organizational structure (nurses’ involvement in shared decision making)
•Management style (nursing leaders create an environment supporting participation, encourage and value feedback, and demonstrate effective communication with staff)
•Personnel policies and programs (efforts to promote nurse work/life balance)
•Image of nursing (nurses effectively influencing system-wide processes)
•Autonomy (nurses’ inclusion in governance leading to job satisfaction, personal fulfillment, and organization success)
Exercise 23-1
Recall a situation in which conflict between or among two or more people was apparent. Describe verbal and nonverbal communication and how each person responded. What was the outcome? Was the conflict resolved? Was anything left unresolved?
Stages of Conflict
Conflict proceeds through four stages: frustration, conceptualization, action, and outcomes (Thomas, 1992). The ability to resolve conflicts productively depends on understanding this process (Figure 23-1) and successfully addressing thoughts, feelings, and

Figure 23-1 Stages of conflict.
behaviors that form barriers to resolution. As one navigates through the stages of conflict, moving into a subsequent stage may lead to a return to and change in a previous stage. To illustrate, the evening shift of a cardiac step-down unit has been asked to pilot a new hand-off protocol for the next 6 weeks, which stimulates intense emotions because the unit is already inadequately staffed (frustration). Two nurses on the unit interpret this conflict as a battle for control with the nurse educator, and a third nurse thinks it is all about professional standards (conceptualization). A nurse leader/manager facilitates a discussion with the three nurses (action); she listens to the concerns and presents evidence about the potential effectiveness of the new hand-off protocol. All agree that the real conflict comes from a difference in goals or priorities (new conceptualization), which leads to less negative emotion and ends with a much clearer understanding of all the issues (diminished frustration). The nurses agree to pilot the hand-off protocol after their ideas have been incorporated into the plan (outcome).
When people or groups perceive that their goals may be blocked, frustration results. This frustration may escalate into stronger emotions, such as anger and deep resignation. For example, a nurse may perceive that a postoperative patient is noncompliant or uncooperative, when in reality the patient is afraid or has a different set of priorities at the start from those of the nurse. At the same time, the patient may view the nurse as controlling and uncaring, because the nurse repeatedly asks if the patient has used his incentive spirometer as instructed. When such frustrations occur, it is a cue to stop and clarify the nature and cause of the differences.
Conflict arises when different interpretations of a situation occur, including a different emphasis on what is important and what is not, and different thoughts about what should occur next. Everyone involved develops an idea of what the conflict is about, and this view may or may not be accurate. This may be an instant conclusion, or it may develop over time. Everyone involved has an individual interpretation of what the conflict is and why it is occurring. Most often, these interpretations are dissimilar and involve the person’s own perspective, which is based on personal values, beliefs, and culture.
Regardless of its accuracy, conceptualization forms the basis for everyone’s reactions to the frustration. The way the individuals perceive and define the conflict has a great deal of influence on the approach to resolution and subsequent outcomes. For example, within the same conflict situation, some individuals may see a conflict between a nurse manager and a direct care nurse as insubordination and become angry at the threat to the leader’s role. Others may view it as trivial complaining, voice criticism (e.g., “We’ve been over this new protocol already; why can’t you just adopt the change?”), and withdraw from the situation. Such differences in conceptualizing the issue block its resolution. Thus it is important for each person to clarify “the conflict as I see it” and “how it makes me respond” before all the people involved can define the conflict, develop a shared conceptualization, and resolve their differences. The following are question to consider:
•What is the nature of our differences?
•What are the reasons for those differences?
•Does our leader endorse ideas or behaviors that add to or diminish the conflict?
•Do I need to be mentored by someone, even if that individual is outside my own department or work area, to successfully resolve this conflict?
A behavioral response to a conflict follows the conceptualization. This may include seeking clarification about how another person views the conflict, collecting additional information that informs the issue, or engaging in dialog about the issue. As actions are taken to resolve the conflict, the way that some or all parties conceptualize the conflict may change. Successful resolution frequently stems from identifying a common goal that unites (e.g., quality patient care, good working relations). It is important to understand that people are always taking some action regarding the conflict, even if that action is avoiding dealing with it, deliberately delaying action, or choosing to do nothing. The longer ineffective actions continue, though, the more likely people will experience frustration, resistance, or even hostility. The more the actions appropriately match the nature of the conflict, the more likely the conflict will be resolved with desirable results.
Tangible and intangible consequences result from the actions taken and have significant implications for the work setting. Consequences include (1) the conflict being resolved with a revised approach, (2) stagnation of any current movement, or (3) no future movement.
Constructive conflict results in successful resolution, leading to the following outcomes:
•Growth occurs.
•Problems are resolved.
•Groups are unified.
•Productivity is increased.
•Commitment is increased.
Unsatisfactory resolution is typically destructive and results in the following:
•Negativity, resistance, and increased frustration inhibit movement.
•Resolutions diminish or are absent.
•Groups divide, and relationships weaken.
•Productivity decreases.
•Satisfaction decreases.
Assessing the degree of conflict resolution is useful for improving individual and group skills in resolutions. Two general outcomes are considered when assessing the degree to which a conflict has been resolved: (1) the degree to which important goals were achieved and (2) the nature of the subsequent relationships among those involved (Box 23-1).
Box 23-1 Assessing the Degree of Conflict Resolution
I. Quality of decisions
A. How creative are resulting plans?
B. How practical and realistic are they?
C. How well were intended goals achieved?
D. What surprising results were achieved?
II. Quality of relationships
A. How much understanding has been created?
B. How willing are people to work together?
C. How much mutual respect, empathy, concern, and cooperation have been generated?
Modified from Hurst, J., & Kinney, M. (1989). Empowering self and others. Toledo, OH: University of Toledo.
Categories of Conflict
Categorizing a conflict can further define an appropriate course of action for resolution. Conflicts arise from discrepancies in four areas: facts, goals, approaches, and values. Sources of fact-based conflicts are external written sources and include job descriptions, hospital policies, standard of nursing practice, and TJC mandates. Objective data can be provided to resolve a disagreement generated by discrepancies in information. Goal conflicts often arise from competing priorities (e.g., desire to empower employees vs. control through micromanagement); frequently, a common goal (e.g., quality patient care) can be identified and used to frame conflict resolution. Even when all agree on a common goal, different ideas about the best approach to achieve that goal may produce conflict. For example, if the unit goal is to reduce costs by 10%, one leader may target overtime hours and another may eliminate the budget for continuing education. Values, opinions, and beliefs are much more personal, thus generating disagreements that can be threatening and adversarial. Because values are subjective, value-based conflicts often remain unresolved. Therefore a need to find a way for competing values to coexist is necessary for conflict management.
Modes of Conflict Resolution
Understanding the way healthcare providers respond to conflict is an essential first step in identifying effective strategies to help nurses constructively handle conflicts in the practice environment. Five distinct approaches can be used in conflict resolution: avoiding, accommodating, competing, compromising, and collaborating (Thomas & Kilmann, 1974, 2002). These approaches can be viewed within two dimensions: assertiveness (satisfying one’s own concerns) and cooperativeness (satisfying the concerns of others). Most people tend to employ a combined set of actions that are appropriately assertive and cooperative, depending on the nature of the conflict situation (Thomas, 1992). See the conflict self-assessment in Box 23-2.
Exercise 23-2
Self-assessment of preferred conflict-handling modes is important. As you read and answer the 30-item conflict survey in Box 23-2, think of how you respond to conflict in professional situations. After completing the survey, tally, total, and reflect on your scores for each of the five approaches. Consider the following questions:
•Which approach do you prefer? Which do you use least?
•What determines if you respond in a particular manner?
•Considering the reoccurring types of conflicts you have, what are the strengths and weaknesses of your preferred conflict-handling styles?
•Have others offered you feedback about your approach to conflict?
As you read the rest of this section, use this pattern of scores and your reflections to examine the appropriate uses of each approach, assess your use of each approach more extensively, and commit to new behaviors to increase your future effectiveness.
Avoiding, or withdrawing, is very unassertive and uncooperative because people who avoid neither pursue their own needs, goals, or concerns immediately nor assist others to pursue theirs. Avoidance as a conflict-management style only ensures that conflict is postponed, and conflict has a tendency to escalate in intensity when ignored. That is not to say that all conflict must be addressed immediately; some issues require considerable reflection, and action should be delayed. The positive side of withdrawing may be postponing an issue until a better time or simply walking away from a “no-win” situation (Box 23-3). The self-assessment in Box 23-4 will help you recognize your own avoidance behaviors and use them more effectively.
When accommodating, people neglect their own needs, goals, and concerns (unassertive) while trying to satisfy those of others (cooperative). This approach has an element of being self-sacrificing and simply obeying orders or serving other people. For example, a co-worker requests you cover her weekends during her children’s holiday break. You had hoped to visit friends from college, but you know how important it is for her to have more time with her family, so you agree. Box 23-5 lists some appropriate uses of accommodation.
Individuals who frequently use accommodating may feel disappointment and resentment because they “get nothing in return.” This is a built-in by-product
Box 23-2 Conflict Self-Assessment
Directions: Read each of the following statements. Assess yourself in terms of how often you tend to act similarly during conflict at work. Place the number of the most appropriate response in the blank in front of each statement. Put 1 if the behavior is never typical of how you act during a conflict, 2 if it is seldom typical, 3 if it is occasionally typical, 4 if it is frequently typical, or 5 if it is very typical of how you act during conflict.
________1.Create new possibilities to address all important concerns.
________2.Persuade others to see it and/or do it my way.
________3.Work out some sort of give-and-take agreement.
________4.Let other people have their way.
________5.Wait and let the conflict take care of itself.
________6.Find ways that everyone can win.
________7.Use whatever power I have to get what I want.
________8.Find an agreeable compromise among people involved.
________9.Give in so others get what they think is important.
________10.Withdraw from the situation.
________11.Cooperate assertively until everyone’s needs are met.
________12.Compete until I either win or lose.
________13.Engage in “give a little and get a little” bargaining.
________14.Let others’ needs be met more than my own needs.
________15.Avoid taking any action for as long as I can.
________16.Partner with others to find the most inclusive solution.
________17.Put my foot down assertively for a quick solution.
________18.Negotiate for what all sides value and can live without.
________19.Agree to what others want to create harmony.
________20.Keep as far away from others involved as possible.
________21.Stick with it to get everyone’s highest priorities.
________22.Argue and debate over the best way.
________23.Create some middle position everyone agrees to.
________24.Put my priorities below those of other people.
________25.Hope the issue does not come up.
________26.Collaborate with others to achieve our goals together.
________27.Compete with others for scarce resources.
________28.Emphasize compromise and trade-offs.
________29.Cool things down by letting others do it their way.
________30.Change the subject to avoid the fighting.
Conflict Self-Assessment Scoring
Look at the numbers you placed in the blanks on the conflict assessment. Write the number you placed in each blank on the appropriate line below. Add up your total for each column, and enter that total on the appropriate line. The greater your total is for each approach, the more often you tend to use that approach when conflict occurs at work. The lower the score is, the less often you tend to use that approach when conflict occurs at work.
1. ________
2. ________
3. ________
4. ________
5. ________
6. ________
7. ________
8. ________
9. ________
10. ________
11. ________
12. ________
13. ________
14. ________
15. ________
16. ________
17. ________
18. ________
19. ________
20. ________
21. ________
22. ________
23. ________
24. ________
25. ________
26. ________
27. ________
28. ________
29. ________
30. ________
Total ________
Total ________
Total ________
Total ________
Total ________
Throughout the rest of this section, there are descriptions of each approach and related self-assessment and commitment-to-action activities. Use these totals to stimulate your thinking about how you do and could handle conflict at work. Most important, consider if your pattern of frequency tends to be consistent, or inconsistent, with the types of conflicts you face. That is, does your way of dealing with conflict tend to match the situations in which that approach is most useful?
From Hurst, J.B. (1993). Conflict self-assessment. Toledo, OH: Human Resource Development Center, University of Toledo.
Box 23-3 Appropriate Uses for the Avoiding Approach
1. When facing trivial and/or temporary issues, or when other far more important issues are pressing
2. When there is no chance to obtain what one wants or needs, or when others could resolve the conflict more efficiently and effectively
3. When the potential negative results of initiating and acting on a conflict are much greater than the benefits of its resolution
4. When people need to “cool down,” distance themselves, or gather more information
Box 23-4 Avoidance: Self-Assessment and Commitment to Action
If You Tend to Use Avoidance Often, Ask Yourself the Following Questions:
1. Do people have difficulty getting my input into and understanding my view?
2. Do I block cooperative efforts to resolve issues?
3. Am I distancing myself from significant others?
4. Are important issues being left unidentified and unresolved?
If You Seldom Use Avoidance, Ask Yourself the Following Questions:
1. Do I find myself overwhelmed by a large number of conflicts and a need to say “no”?
2. Do I assert myself even when things do not matter that much? Do others view me as an aggressor?
3. Do I lack a clear view of what my priorities are?
4. Do I stir up conflicts and fights?
Commitment to Action
What two new behaviors would increase your effective use of avoidance?
of the overuse of this approach. The self-assessment in Box 23-6 asks you to examine your current use of accommodation and challenges you to think of new ways to use it more effectively.
When competing, people pursue their own needs and goals at the expense of others. Sometimes people use whatever power, creativeness, or strategies that are available to “win.” Competing may also take the form of standing up for your rights or defending important
Box 23-5 Appropriate Uses of Accommodation
1. When other people’s ideas and solutions appear to be better, or when you have made a mistake
2. When the issue is far more important to the other(s) person than it is to you
3. When you see that accommodating now “builds up some important credits” for later issues
4. When you are outmatched and/or losing anyway; when continued competition would only damage the relationships and productivity of the group and jeopardize accomplishing major purpose(s)
5. When preserving harmonious relationships and avoiding defensiveness and hostility are very important
6. When letting others learn from their mistakes and/or increased responsibility is possible without severe damage
Box 23-6 Accommodation: Self-Assessment and Commitment to Action
If You Use Accommodation Often, Ask Yourself the Following Questions:
1. Do I feel that my needs, goals, concerns, and ideas are not being attended to by others?
2. Am I depriving myself of influence, recognition, and respect?
3. When I am in charge, is “discipline” lax?
4. Do I think people are using me?
If You Seldom Use Accommodation, Ask Yourself the Following Questions:
1. Am I building goodwill with others during conflict?
2. Do I admit when I have made a mistake?
3. Do I know when to give in, or do I assert myself at all costs?
4. Am I viewed as unreasonable or insensitive?
Commitment to Action
What two new behaviors would increase your effective use of accommodation?
principles, as when opposition to mandatory overtime is voiced (Box 23-7).
People whose primary mode of addressing conflict is through competition often react by feeling threatened, acting defensively or aggressively, or even resorting to cruelty in the form of cutting remarks, deliberate gossip, or hurtful innuendo. Competition within work groups can generate ill will, favor a
Box 23-7 Appropriate Uses of Competing
1. When quick, decisive action is necessary
2. When important, unpopular action needs to be taken, or when trade-offs may result in long-range, continued conflict
3. When an individual or group is right about issues that are vital to group welfare
4. When others have taken advantage of an individual’s or group’s noncompetitive behavior and now are mobilized to compete about an important topic
Box 23-8 Competing: Self-Assessment and Commitment to Action
If You Use Competing Often, Ask Yourself the Following Questions:
1. Am I surrounded by people who agree with me all the time and who avoid confronting me?
2. Are others afraid to share themselves and their needs for growth with me?
3. Am I out to win at all costs? If so, what are the costs and benefits of competing?
4. What are people saying about me when I am not around?
If You Seldom Compete, Ask Yourself the Following Questions:
1. How often do I avoid taking a strong stand and then feel a sense of powerlessness?
2. Do I avoid taking a stand so that I can escape risk?
3. Am I fearful and unassertive to the point that important decisions are delayed and people suffer?
Commitment to Action
What two new behaviors would increase your effective use of competition?
win-lose stance, and commit people to a stalemate. Such behaviors force people into a corner from which there is no easy or graceful exit. Use Box 23-8 to help you learn to use competing more effectively.
Compromising involves both assertiveness and cooperation on the part of everyone and requires maturity and confidence. Negotiating is a learned skill that is developed over time. A give-and-take relationship results in conflict resolution, with the result that each person can meet his or her most important priorities as much of the time as possible. Compromise is very often the exchange of concessions as it creates a middle ground. This is the preferred means of conflict resolution during union negotiations, in which each side is appeased to some degree. In this mode, nobody gets everything he or she thinks he or she needs, but a sense of energy exists that is necessary to build important relationships and teams.
Negotiation and compromise are valued approaches. They are chosen when less accommodating or avoiding is appropriate (Box 23-9). Compromising is a blend of both assertive and cooperative behaviors, although it calls for less finely honed skills for each behavior than does collaborating. Negotiating is more like trading (e.g., “You can have this if I can have that,” as in “I will chair the unit council taskforce on improving morale if you send me to the hospital’s leadership training classes next week so I can have the skills I need to be effective.”). Compromise is one of the most effective behaviors used by nurse leaders because it supports a balance of power between themselves and others in the work setting. The self-assessment in Box 23-10 will help you become more aware of your own use of negotiation and compromise and improve it.
Collaborating, although the most time-consuming approach is the most creative stance. It is both assertive and cooperative because people work creatively and openly to find the solution that most fully satisfies all important concerns and goals to be achieved. Collaboration involves analyzing situations and defining the conflict at a higher level where shared goals are identified and commitment to working together is generated (Box 23-11). When
Box 23-9 Appropriate Uses of Compromise
1. When two powerful sides are committed strongly to perceived mutually exclusive goals
2. When temporary solutions to complex issues need to be implemented
3. When conflicting goals are “moderately important” and not worth a major confrontation
4. When time pressures people to expedite a workable solution
5. When collaborating and competing fail
Box 23-10 Negotiation/Compromise Self-Assessment and Commitment to Action
If You Tend to Use Negotiation Often, Ask Yourself the Following Questions:
1. Do I ignore large, important issues while trying to work out creative, practical compromises?
2. Is there a “gamesmanship” in my negotiations?
3. Am I sincerely committed to compromise or negotiated solutions?
If You Seldom Use Negotiation, Ask Yourself the Following Questions:
1. Do I find it difficult to make concessions?
2. Am I often engaged in strong disagreements, or do I withdraw when I see no way to get out?
3. Do I feel embarrassed, sensitive, self-conscious, or pressured to negotiate, compromise, and bargain?
Commitment to Action
What two new behaviors would increase your compromising effectiveness?
Box 23-11 Appropriate Uses for Collaboration
1. When seeking creative, integrative solutions in which both sides’ goals and needs are important, thus developing group commitment and a consensual decision
2. When learning and growing through cooperative problem solving, resulting in greater understanding and empathy
3. When identifying, sharing, and merging vastly different viewpoints
4. When being honest about and working through difficult emotional issues that interfere with morale, productivity, and growth
nurses use cooperative conflict-management approaches, decision making becomes a collective process in which action plans are mutually understood and implemented. An organizational culture that supports collaborative behavior among nurses and physicians is needed to merge the unique strengths of both professions into opportunities to improve patient outcomes (Nair, Fitzpatrick, McNulty, Click, & Glembocki, 2012). For example, when nurses and physicians work together, they can collaborate by asking, “What is the best thing we can do for the patient and family right now?” and “How does each of us fit into the plan of care to meet their needs?” This requires discussion about the plan, how it will be accomplished, and who will make what contributions toward its achievement and proposed outcomes. Use the self-assessment in Box 23-12 to determine your own use of collaboration.
At the onset of conflict, involved collaborating individuals can carefully analyze situations to identify the nature and reasons for conflict and choose an appropriate approach. For example, a conflict arises when a direct care nurse and a charge nurse on a psychiatric unit disagree about how to handle a patient’s complaints about the direct care nurse’s delay in responding to the patient’s requests. At the point that they reach agreement that it is the direct care nurse’s responsibility and decision to make, collaboration has occurred. The charge nurse might say, “I didn’t realize your plan of care was to respond
Box 23-12 Collaboration Self-Assessment and Commitment to Action
If You Tend to Collaborate Often, Ask Yourself the Following Questions:
1. Do I spend valuable group time and energy on issues that do not warrant or deserve it?
2. Do I postpone needed action to get consensus and avoid making key decisions?
3. When I initiate collaboration, do others respond in a genuine way, or are there hidden agendas, unspoken hostility, and/or manipulation in the group?
If You Seldom Collaborate, Ask Yourself the Following Questions:
1. Do I ignore opportunities to cooperate, take risks, and creatively confront conflict?
2. Do I tend to be pessimistic, distrusting, withdrawing, and/or competitive?
3. Am I involving others in important decisions, eliciting commitment, and empowering them?
Commitment to Action
What two new behaviors would increase your collaboration effectiveness?
to the patient at predetermined intervals or that you told the patient that you would check on her every 30 minutes. I can now inform the patient that I know about and support your approach.” Or the direct care nurse and the charge nurse might talk and subsequently agree that the direct care nurse is too emotionally involved with the patient’s problems and that it may be time for her to withdraw from providing the care and enlist the support of another nurse, even temporarily. Discussion can result in collaboration aimed at allowing the direct care nurse to withdraw appropriately. Another, less desirable choice could be to compete and let the winner’s position stand (e.g., “I’m in charge; I’m going to assign another nurse to this patient to preserve our patient satisfaction scores” or “I know what is best for this patient; I took care of her during her past two admissions”).
Differences of Conflict-Handling Styles Among Nurses
The way in which conflict-management styles are used in health care has changed very little in the past 20 years. Previous studies suggest that avoidance and accommodation remain the predominant choices for direct care nurses and that the prevalent style for nurse managers is compromise, despite the emphasis placed on collaboration as an effective strategy for conflict management (Mahon & Nicotera, 2011). Nursing students and new graduates may be unprepared to handle conflict in the practice environment; Hasson, McKenna, and Keeney (2013) reported a number of barriers novice nurses faced when delegating tasks such as fear of causing conflict. This highlights the need to develop delegation strategies including conflict-handling skills to adapt to the evolving professional role. The prevalent conflict-management style for nursing students is avoidance and accommodation (Pines et al., 2011). Nurses who successfully managed disruptive workplace conflict reported a deliberate approach that included delaying confrontation, approaching the colleague calmly, and acknowledging the colleague’s point of view (Lux, Hutcheson, & Peden, 2012). Nurses working in specialty areas may adapt communication and conflict management strategies to respond to diverse patient populations and the unique mix of interprofessional colleagues. For example, in primary care settings, conflicts regarding scope of practice issues, role confusion, and disagreements over accountability for care are amplified (Brown, Lewis, Ellis, Stewart, Freeman, & Kasperski, 2011). See the Research Perspective, which describes conflicts and communication gaps common in intensive care units and in palliative care situations.


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