Surviving and Thriving With Conflict on the Job
By Anna Ver Hage, MSN, RN, AG-ACNP, CCRN, CNRN
This course is 1 contact hour
Course must be completed by January 13, 2019
Goals and objectives: The goal of this continuing education program is to enhance nurses’, 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:
  1. Identify various types of conflict
  2. Analyze the dynamics of conflict in the workplace
  3. 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:
  • Needs. These are essential to wellbeing; therefore, conflict can arise when needs are not met. Not to be confused with desires (what we would like), needs are vital elements.
  • Perceptions. People interpret situations differently. Misperceptions can cause a breakdown in communication, leading to conflict.
  • Power. How people define, interpret and use power can greatly 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 conflicts can occur when people hold incompatible values.
  • Feelings and emotions. People often let emotions dictate how they react in a given circumstance. 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.1
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. 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.

It would be naive to assume everybody comes to the table wielding an equal balance of power. It’s been said that nursing is a “gender-structured, systematically exploited and oppressed occupational group;” therefore, it follows that conflicted people or groups would sometimes be seated unevenly at a table.2

Because sources of conflict are so diverse and their consequences so important to patient care, all healthcare professionals will need to be adept at both recognizing different types of conflict and employing appropriate strategies to resolve them.
Levels of conflict
Healthcare professionals can encounter three levels of organizational conflict — intrapersonal, interpersonal and intergroup. A healthcare professional can experience intrapersonal conflict when confronted with two or more incompatible demands. Examples of inner, 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 actual position that the professional occupies within the organization.3 Interpersonal conflict occurs between two or more people when one person perceives or values a situation differently from the other. This kind 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. 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:3 • Divergent management and staff perspectives • Competition for limited resources, such as staff, space, equipment and funds • Difficulties arising from interdependence of work activities • Differences in values and goals among work groups Additionally, in today’s healthcare environment, change — new policies and procedures, employee layoffs and rapid growth — or even the threat of change, contributes to conflict.
Primary types of conflict: What are the differences?
In the workplace (or other settings), you are likely to find two types of conflict — substantive and personalized.4 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 working environment.4 Keep in mind that emotions may be involved, but they are usually related to the specific issue and not the particular parties. The second 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.4 Frequently, this type of conflict involves others in the form of “taking sides,” and a great deal of energy and emotion is spent on dealing with the repercussions that 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 and resolve the issue.

Personalized conflict seldom has a positive ending, and usually worsens over time.4 It’s commonly known, or referred to, as a “personality conflict” between two individuals.
Moving toward resolution …
Steps to mediate and resolve a work conflict7
How to earn continuing education
THIS COURSE IS 1 CONTACT HOUR
1.
Read the Continuing Education article.
2.
Go online to https://www.nurse.com/ce/surviving-and-thriving-with-conflict-on-the-job to take the test for $12. If you are an Unlimited CE subscriber, you can take this test at no additional charge. You can sign up for an Unlimited CE membership at Nurse.com/UnlimitedCE for $49.95 per year.
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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How Healthcare Professionals Process Conflict
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 further extend the conflict and prevent clear thought toward resolution.4

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.
Common approaches to conflict resolution
Five common approaches to conflict resolution have been identified:5
  • 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.
  • Compromise. This approach involves negotiation, tradeoffs and swapping. Each person gets something, but gives something else up in the process, creating a win-lose/win-lose situation for the two sides.
  • 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. This approach requires emotional intelligence and high self-concept.
  • 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.
  • Avoidance. Avoidance is one of the most commonly used conflict-management strategies in which 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 avoid possible retaliation, even at the risk of sacrificing his or her interests or the interests of others.5 Avoidance is a negative conflict management style which leads to a lack of communication and can result in poor patient outcomes.6
Supervisors and managers who need to mediate conflicts at work must remember to stay calm; intervene quickly, fairly and appropriately in an effort to stop negative conflict; and remain positive about the ultimate resolution. A few steps to successful mediation of a conflict are outlined below.
  • Each party needs to participate in active listening.
  • Meet with both parties together and follow a few ground rules, such as:
  • Both parties should be kept focused on the issue at hand — don’t bring up past issues.
  • Each person should be encouraged not to personalize the conflict.
  • Only allow one person to talk at a time.
  • Both people need to agree to seek a positive outcome.
  • Each person should concisely identify the issue and exactly what the conflict is about — as each party perceives it.
  • As the supervisor, make sure you have the facts straight, but allow time for each person to share details as he or she perceives them.
  • As the supervisor, let both parties know that you won’t choose sides, but your expectation is for both parties to resolve the conflict as proactive adults.
  • Let both parties know that you believe they will resolve the conflict in a positive, professional manner.
  • Set a future date for review of the resolution and 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 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 more autonomous, productive staff.
1. Disbelief is often the first emotional reaction, particularly when others are
disagreeing with personal values.
2. Disconnectedness often follows the initial sense of shock,
making the individual feel confused on how to best to cope with the conflict.
4. Self-evaluation begins. This is a crucial turning point when the individual either
begins to recover a sense of balance or experiences symptoms of burnout —
withdrawal, apathy and depression. If the conflict has been intense, the
individual may have to fight a tendency to internalize negative attitudes about
him or herself.
5. Purposeful alienation — emotional space between the
individual and colleagues. The individual may take time off or seek to avoid
confrontation.
6. Once the conflict is resolved, and if it’s processed positively, the individual may
gain insight into personal shortcomings and gain experience for managing
future conflict.
3. Obsession with the conflict can develop. The individual may spend much of
the day thinking about the problem and how to deal with it.
Learn how to resolve conflict on the job
Earn 1 credit hour with this continuing education course
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EDITOR’S NOTE: Valerie Restifo, MA, MS, RN, was the original author of this educational activity but has not had the opportunity to influence this version. Marilynn Jackson, PhD, RN, was the past author of this educational activity but has not had the opportunity to influence this version. ContinuingEducation.com guarantees that the content of this educational activity is free from bias. Margi J. Schultz, PhD, MSN, RN, CNE, is the director of the nursing division at GateWay Community College in Phoenix, Ariz.
© 2018 OnCourse Learning Corp. All rights reserved
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