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9 conflict management tips to help you keep the peace
From issues with patients and families to the occasional disagreement with fellow nurses and physicians, conflict can be a common component of a nurse’s work life, according to healthcare experts.
“If we think about how diverse we are, it’s inevitable that we’re going to have disagreement about what ought to be done,” said Cynthia H. Rushton, PhD, RN, FAAN, Anne and George L. Bunting professor of clinical ethics and nursing at Johns Hopkins University. Generally speaking, the literature suggests there are two primary ways in which nurses tend to deal with conflict — avoid it or dominate it, said Mary L. Johansen, PhD, RN, NE-BC, clinical associate professor, Rutgers School of Nursing in Newark. Nurses who avoid conflict often try not to deal with other nurses, physicians or even patients who are unpleasant or difficult. Both patients and nurses pay in such situations through less optimal outcomes and high stress, Johansen said. “Nurses that use the dominating approach — they get what they want for their patient,” she said. “Those patients, generally speaking, have better outcomes. And the nurses who are dominating also have less stress.” Other approaches for handling interpersonal conflict include obliging, avoiding, compromising and integrating styles. But there are a variety of ways to manage conflict to ensure a healthy workplace and the best possible patient outcomes. Our experts weighed in on this topic and offered the following tips:
Like an illness or injury, conflict, seems to get worse if ignored, according to Dan Bjerknes, vice president of hospital operations, at CHI St. Alexius Health Williston (N.D.). Bjerknes, holds a master’s degree in counseling and worked for a decade in human resources and four years as a conflict management consultant. “Having awareness that there is a conflict and that something needs to be done is a first step,” he wrote in an email to Nurse.com. “Our work is relational and involves people. Our patients can feel and sense if there is discord on a unit or within in a team when that nurse comes to their room or interacts with them or family member. Managing conflict both on an intrapersonal and interpersonal level is crucial to ensuring that our patients get our full attention and focus.”
When conflict arises, it tends to ignite the most primitive parts of the human brain because people see it as a threat, Rushton said. “The first thing we have to do is calm our nervous system,” she said. “A very simple thing is to just take a few really deep breaths. What that does is it helps to bring our parasympathetic nervous system online. That will help us calm our nervous system, so that we can review the situation clearly and we can then respond, rather than react.”
1. Be proactive.
Pay attention to body language and be cognizant of the moods of the staff, Johansen said. Patients, their families and friends, coming into an acute care facility are already at an elevated level of stress, she said. Be aware of indications that someone might be primed for conflict, such as grimacing, not speaking in full sentences, tapping his or her feet or pacing. In addition, be cognizant of higher than usual stressors among the staff. Are there terrible weather conditions preventing some employees from getting to or from work? In the case of bad weather, nurse leaders might prepare by anticipating staffing issues and making sure to have additional resources in place. Or has there been a major trauma case at the facility or a violent event in the news that might be impacting their moods? If there’s a conflict brewing between staff members, a nurse leader might try to have a conversation with the individuals involved to address and diffuse a disagreement before it escalates, Johansen said.
3. Breathe
2. Don’t ignore it.
4. Pause
EDITOR'S NOTE: Lisette Hilton is a freelance writer.
Pausing helps you to gather your thoughts. Questions to sort through mentally during the pause, according to Rushton, might include: What are the facts in this situation? What assumptions am I making? What’s really at stake and why does it matter? What is my intention in addressing that issue? “Sometimes we want to lash out at the other person — to prove ourselves right or get what we want. And that doesn’t usually help,” Rushton said.
5. Consider what will best serve the cause.
There isn’t one best way to resolve a conflict. It’s situation dependent. Sometimes, for example, leaving a situation alone makes it worse — sometimes, it makes it better. Nurses should avoid accommodating when compromise or collaboration might be better. Accommodation often means putting up with something a nurse might not think is right or compromises his or her integrity, causing inner-conflict that can fester, Rushton said.
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People tend to tiptoe around crucial points because they don’t want to upset another person. “Instead of trying to control someone’s reaction, prepare for it,“ Bjerknes wrote. “Emotion very well could be a part of the conversation. Addressing conflict, talking about behavior you want to change, etc. will more than likely lead to someone being defensive, frustrated or upset. Consider how you will best respond to these reactions. “Go into the conversation with the purpose of talking about what bothers you, what changes you would like to see, and give the other person the opportunity to express how he or she feels. This gives you control over everything you can control and gives the other person the right to react however he or she needs to react.”
Responding to conflict is an art. Reacting negatively to a situation can intensify the conflict, Rushton said. Start by expressing gratitude for a person’s willingness to work toward resolution, she said. “It’s really important to create space for the other person to speak and to allow them to get their point of view out without interrupting them and to make sure you’re accurately hearing the other person’s perspective, Rushton said. Active listening is key, according to Johansen. Focus your attention on the speaker, and try to understand, interpret and evaluate what’s being said. Introduce the topic, then learn the other person’s story. “Until someone feels heard and understood, it is very difficult to move a conversation in a productive manner,” Bjerknes wrote. “Express your views and feelings. Say what is important to you about the problem/issue. Don’t present your story as ‘the truth.’ That’s not to say that there is no truth in the situation or that all opinions are equally valid. It simply distinguishes fact from opinion.” A helpful tip for making sure you’re comprehending another person’s point of view is to ask: “Here’s what I hear you saying. Is that correct?” Rushton suggested. It’s important to define the problem, Johansen said, and understand the issues that will facilitate resolution.
7. Respond
6. Be (respectfully) direct
8. Remain calm.
Keep responses under control and emotions in check. Don’t react to volatile comments. Your calmness will help set the tone for the parties involved, according to Johansen.
9. Realize conflict isn’t always bad
In some cases, conflict gives nurses and others the opportunity to raise concerns and address issues, Rushton said. “Conflict is often framed as a bad thing, and one thing that would really serve nurses is to normalize it. It’s going to happen. It’s not because we’re bad people,” Rushton said. “It’s because we come from different perspectives and bring different perspectives, so it’s a way to embrace diversity.”
What's next?
Sometimes, conflict resolution has to go the next step to be resolved. That next step might be a hospital’s resources for managing conflict or third party mediation. But, sometimes, people in conflict have to agree to disagree, Rushton said. Both parties have to walk away with the feeling that it’s a win-win. If one feels he or she has lost, the probability of that person continuing to engage in conflict is higher, according to Johansen. Often that’s achieved by simply giving both people a voice, showing respect for what both have to say and valuing their concerns, Johansen said. “Work toward mutual understanding,” Bjerknes writes. “Given what you have learned, what would improve the situation? Are there common purposes behind each of the needs? Can you brainstorm creative ways to satisfy both of your needs?”
Cynthia H. Rushton,
RN
Mary L. Johansen, RN
Dan Bjerknes

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By Lisette Hilton
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