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Surviving and Thriving With Conflict on the Job
By Debra Anscombe Wood, BS, RN
This course is 1 contact hour
Course must be completed by November 15, 2021
Goals and objectives: The goal of this continuing education program is to enhance nurses’, medical assistants’, laboratory professionals’, and respiratory therapists’ ability to effectively deal with conflict on the job. After studying the information presented here, you will be able to: • Identify various types of conflict • Analyze the dynamics of conflict in the workplace • Apply conflict resolution strategies to specific situations
Nurse.com educational activities are provided by OnCourse Learning. For further information and accreditation statements, please visit Nurse.com/Accreditation. The planners and authors have declared no relevant conflicts of interest that relate to this educational activity. OnCourse Learning guarantees this educational activity is free from bias. See “How to Earn Continuing Education” to learn how to earn CE credit for this module or visit http://ce.nurse.com/instructions.aspx.
What is conflict?
Conflict is a disagreement between two or more people who differ in attitudes, beliefs, values, feelings, or needs. It’s a part of every work environment, including healthcare organizations. The ingredients of conflict include:1
  • Needs: The things that are essential to someone’s or an organization’s well-being; therefore, conflict can arise when needs are not met. Not to be confused with desires (what we would like), needs are vital elements.
  • Perceptions: The interpretation of a situation, which people tend to view differently. Misperceptions can cause a breakdown in communication, leading to conflict.
  • Power: The use and definition of power can influence conflict. Conflict may arise when one person seeks to influence or exert power over another.
  • Values: Values are beliefs that a person deems important. Serious conflict can occur when people have incompatible values.
  • Feelings and emotions: People often let emotions dictate how they react in certain circumstances. Conflict can arise when people let their feelings lead the way, or if another person’s feelings are ignored or devalued. It’s important to separate emotions from the issue.
In the past, conflict in the workplace was regarded as dysfunctional, representing a breakdown in communication that would either go away by itself or be resolved with someone winning and someone losing.2 Today, conflict is no longer considered harmful or inherently bad. Instead, it’s expected in a dynamic organizational environment.

Many experts view conflict as a normal aspect of interpersonal relations in organizations and believe that when handled correctly, it can be managed and resolved to achieve beneficial outcomes. In fact, such friction can be a motivator for change and growth, a medium for airing problems, and a dynamic force for preventing stagnation. When managed from a positive perspective, conflict and the resulting resolutions can hold an organization together.2 It would be naive to assume everybody comes to the table wielding an equal balance of power. Differences in the parties’ power can affect the decision to address the conflict.3 Because sources of conflict are so diverse and their consequences so important to patient care, all healthcare professionals need to communicate and to be adept at recognizing different types of conflict and employing appropriate strategies to resolve them.3
Healthcare professionals can encounter four levels of organizational conflict: intrapersonal, interpersonal, intragroup, and intergroup.4 A healthcare professional can experience intrapersonal conflict when confronted with two or more incompatible demands.

Examples of job-related struggles include ethical dilemmas, role conflict, work overload, and uncertainty about job expectations. Intrapersonal conflict can also be related to organizational structure, supervisory style, and the position that the professional occupies within the organization.2 Interpersonal conflict occurs between two or more people when one person perceives or values a situation differently from the other.2 It is common in healthcare settings. This type of conflict can happen when there is a clash between core work values, such as determining how a job should be done, or setting different priorities or expectations because of age, experience, sex, race, and other personal attributes. Intragroup conflict is between members of a group who are arguing about responsibilities.4 Intergroup conflict occurs between two or more groups and may result from competition between departments within a single healthcare facility or from rivalry among several organizations. Most organizational conflict in healthcare organizations emerges at the interpersonal and intergroup levels. Major sources include:4
  • Individual differences about values and opinions
  • Professional differences
  • Organizational structure; changes due to restructuring
  • Interpersonal differences in perception
  • Generational or cultural differences
Additionally, in today’s healthcare environment, change — new policies and procedures, employee layoffs, and rapid growth — or even the threat of change, can contribute to conflict.
Common approaches to conflict resolution
How to earn continuing education
THIS COURSE IS 1 CONTACT HOUR
1.
Read the Continuing Education article.
2.
This continuing education course is FREE ONLINE until June 13, 2019, courtesy of Nurse.com. To take the test for FREE, go to https://www.nurse.com/ce/surviving-and-thriving-with-conflict-on-the-job. After that date, you can take the course for $12 at the same link. If you have a CE Direct login and password (generally provided by your employer), please login as you normally would at https://cedirect.continuingeducation.com and complete the course on that system.
3.
If the course you have chosen to take includes a clinical vignette, you will be asked to review the vignette and answer 3 or 4 questions. You must answer all questions correctly to proceed. If you answer a question incorrectly, we will provide a clue to the correct answer.
4.
Once you successfully complete the short test associated with the clinical vignette (if there is one), proceed to the course posttest. To earn contact hours, you must achieve a score of 75%. You may retake the test as many times as necessary to pass the test.
5.
All users must complete the evaluation process to complete the course. You will be able to view a certificate on screen and print or save it for your records.
In support of improving patient care, OnCourse Learning is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

OnCourse Learning is also an approved provider by the Florida Board of Nursing, the District of Columbia Board of Nursing, and the South Carolina Board of Nursing (provider # 50-1489). OnCourse Learning’s continuing education courses are accepted by the Georgia Board of Nursing. OnCourse Learning is approved by the California Board of Registered Nursing, provider # CEP16588.
ONLINE
You can take this test online or select from the list of courses available. Prices subject to change.
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Moving toward resolution
No matter what type of conflict you are involved in or are trying to mediate, it’s important to focus on the issues at hand; it’s critical to separate the problem from the person. Making an issue personal will only extend the conflict and prevent clear thought toward resolution.5 Whenever possible, sort through information based on the evidence. This takes the emotional aspect out of the issue, keeping it reality-based. Seek out creative resolutions, and engage in discussion with all involved parties so people feel they are a part of the process and have a stake in the outcome.

Keep in mind that conflict resolution is a negotiation; therefore, it’s an ongoing process. Approach conflict resolution with positive energy, a good attitude, and a goal, to reach the best solution.
Five common approaches to conflict resolution have been identified:6 Confront: This style approaches the conflict head-on and may invoke high emotional levels. It can be construed as not being considerate of the other person’s viewpoint. Emotions typically run high during confrontations. It is often used when each side’s goals are unclear, relationships are weak, little concern exists about formalities, or there is fear of punishment. There may be a moderate concern for tradition and self-concept.6 Compromise: This approach involves negotiation, tradeoffs, and swapping. Each person gets something, but gives up something else in the process, creating a win-lose/win-lose situation for the two sides. Everyone must cooperate when negotiating, must communicate, and there must be a balance of power.7

Compromise might be appropriate when the conflicting goals do not reach a high level of importance, and it is not worth a major argument. Time pressures might also lead to compromise. Additionally, if the two sides are powerful and strongly committed to mutually exclusive goals, a compromise might be the way to let everyone win something and give up something.4 Each party achieves a partial win.
Collaborate: Collaboration occurs when each party meets the problem head on with equal concern for both the issues and maintaining a working relationship. This approach allows everyone to win by identifying areas of agreement and differences, evaluating alternatives, and selecting solutions that have the full support and commitment of both parties. It requires emotional intelligence and high self-concept.

Collaboration is ideal when the issue is significant to the organization’s goals, to patient care, or to work relationships. Creative solutions can satisfy both sides of the disagreement. Through collaboration, the parties may be able to merge different viewpoints into something they all agree on.4 Collaboration is more time-consuming than other approaches but that can lead to a long-term resolution.
Accommodate: Accommodation occurs when one person or group is willing to yield to the other. This conciliation, or giving in, involves listening and accepting without resistance. Accommodation may be appropriate when one person admits to making a mistake; the outcome is more important to others than to you; other people’s ideas seem better; and by accommodating now, you may be in a better position to deal with issues in the future.7

Avoidance: Avoidance is one of the most commonly used conflict-management strategies when one side is uncooperative, denies that a problem exists, or withdraws from the situation, so that there’s no active resolution of the conflict. Personal needs are ignored, as is any potential contribution to the working relationship with the other person.

Avoidance can also increase stress among healthcare providers. This may happen when a less powerful person involved in a conflict responds with accommodation and avoidance to bypass possible retaliation, even at the risk of sacrificing his or her interests or the interests of others.

Avoidance is a negative conflict-management style, which leads to a lack of communication and can result in increased work stress levels.8 However, avoidance can have a place in conflict resolution; for instance, when a problem needs reflection or time for people to calm down, when additional information is needed, or if there is a desire to avoid no-win situations.7
Levels of conflict
In the workplace (or other settings), you are likely to find two types of conflict — substantive and personalized.5 Substantive conflict occurs when two people disagree about a certain issue, such as a policy or how to perform a procedure. With substantive conflict, both parties work toward a win-win outcome that usually provides an innovative resolution to the conflict. This is normally a positive conflict experience; each party walks away feeling that the outcome was worth the struggle involved in resolution.

This type of conflict can be productive, and often leads to richer, more fulfilling working relationships where people feel confident to share honest opinions and work through the details. Substantive conflict may also stimulate new thoughts and ideas and can create an exciting work environment. Keep in mind that emotions may be involved, but they are usually related to the specific issue and not to the people involved. Ambiguous policies or those policies that are not consistently enforced can lead to conflict, which can result in people not understanding what is expected of them or what the results might be. Assumptions can be incorrect and lead to conflict. Another type of conflict, one many people are all too familiar with, is known as personalized conflict. This type of conflict frequently occurs when people don’t like each other, they have no desire to work through an issue, and they elect to use almost any situation to make the other person look bad in front of others.5

Frequently, this type of conflict involves others in the form of “taking sides,” and a great deal of energy and emotion are spent on dealing with the repercussions this type of conflict generates. In personalized conflict, emotions run high and mainly involve anger and frustration. Neither party wishes to seek resolution, and the original issue (if there truly was one) is often lost in the heated exchange. New issues are generated to escalate the conflict, and normal problem-solving techniques fail because neither person is willing to address or resolve the issue.

Personalized conflict seldom has a positive ending, and usually worsens over time.5 It’s commonly known, or referred to, as a “personality conflict” between two people.
Primary types of conflict: What are the differences?
Steps to mediate and resolve a work conflict7,9,10
Supervisors and managers who need to mediate conflicts at work must remember to stay calm; intervene quickly, fairly, and appropriately to stop negative conflict; and remain positive about the ultimate resolution. A few steps to successful mediation of a conflict are outlined below.
Meet with both parties together and follow a few ground rules, such as:
Do not lose your cool
Encourage each person not to personalize the conflict
Allow only one person to talk at a time
Remain flexible
Allow each person to concisely identify the issue and exactly what the conflict is about — as each party perceives it
Use “I” statements, without adding expectations. There should be a clear statement about how the speaker views the conflict
Encourage each party to participate in active listening
Encourage both people to agree to seek a positive outcome
Keep both parties focused on the issue at hand — don’t bring up past issues
As the supervisor, make sure to have the facts straight, but allow time for each person to share details as he or she perceives them, and to indicate what resolution is sought
Let both parties know that you believe they will resolve the conflict in a positive, professional manner
Once a solution has been achieved, write it down and review it
As the supervisor, let both parties know that you won’t choose sides, but the expectation is for both parties to resolve the conflict as proactive adults
Commit to making changes
Thank everyone for participating
Set a future date for review of the resolution and for further problem solving as needed
Creating a work environment where people know they can trust their leader to fairly and quickly manage a conflict requires a calm, reasonable approach. The supervisor should not solve the conflict but rather should mediate it. Following these steps and letting each person know his or her voice will be heard can lead to successful conflict management, and to a more autonomous, productive staff.
Survive conflict with the right tools
Earn 1 credit hour with this continuing education course
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EDITOR'S NOTE: Valerie Restifo, MA, MS, RN; Marilynn Jackson, PhD, RN; and Margi J. Schultz, PhD, MSN, RN, CNE; past authors of this educational activity, have not had the opportunity to influence this version. OnCourse Learning guarantees the content of this educational activity is free from bias. Debra Anscombe Wood, BS, RN, a health writer and editor, practices in ambulatory care in Orlando, Fla.
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