Nurse leaders must model standards of behavior.
When Ann O’Sullivan, MSN, RN, CNE, NE-BC, ANEF, provides conflict management training for nurses, she discovers that even the most educated nurses can have trouble with effective communication. “We teach nurses how to chart, start I.V.s, and do assessments,” she said, but not necessarily how to communicate. Combine that with the fast-paced, high-stress environment of nursing (which gets even more intense in times of crisis), and incivility and conflict can occur.
And although nurses can improve their interpersonal skills, it’s up to nurse leaders to set the tone with proven methods to promote conflict management in the workplace, O’Sullivan said.
Better communication for better care
Along with increased stress for nurses, breakdowns in communication and collaboration can potentially lead to patient care errors. “A nurse leader can identify and address these potential breakdowns by fostering a team collaboration environment,” said Mary L. Johansen, PhD, RN, NE-BC, FAAN, a clinical associate professor at Rutgers University School of Nursing who has published several articles on conflict management for nurse managers. The first step is to increase the team’s awareness of each member’s unique knowledge and skills. This in turn will lead to improvement in decision making and feelings of mutual respect and trust.
One of the basic tenets of conflict management is that conflict itself isn’t necessarily a bad thing, said O’Sullivan, who is an adjunct professor at Illinois College and an American Nurses Association-Illinois member. Conflict is just differences, and we need different opinions and strategies to deal with workplace issues. Rather than trying to resolve conflict, nurse leaders should manage it in a way that recognizes the shared goal of the healthcare team—doing what’s best for the patient.
Johansen offers four recommendations for effective conflict management, which she identified in her article “Keeping the peace: Conflict management strategies for nurse managers” in Nursing Management.
• Engage in dialogue. When a conflict arises, debrief with staff to provide reflective learning and remove frustration. This can lead to trust, openness, and effective conflict management in the future.
• Engage in coaching. Nurse managers frequently learn about conflict between nurses after it happens. Educating staff on ways to resolve disputes and disagreements can lead to a healthy work environment.
• Identify potential conflicts. Develop procedures and processes to identify potential common conflicts and transform them into opportunities for growth and learning.
• Provide education and training. Empower nurses with conflict management strategies to resolve conflict early and influence the work environment in which they deliver patient care.
These approaches may sound simple, but they require time and effort. Nurses may be surprised at the power of approaching colleagues directly, voicing optimism about outcomes, and taking responsibility for their part in conflict, said O’Sullivan, who is a co-presenter of “Navigate and negotiate conflict,” an ANA webinar designed in collaboration with Capella University.
Incivility frequently is a symptom of a bigger issue.
“Many people don’t know how to communicate assertively to get their needs met,” O’Sullivan said. And when they don’t get what they need, they may become disrespectful, yell, or choose not to engage, keeping their frustrations inside.
She emphasizes that the first rule of conflict management is knowing that people can change only their own behavior. O’Sullivan advises nurses to look at their own behavior and thinking and ask themselves, “What role am I playing in this conflict?”
Johansen, a New Jersey State Nurses Association member, offers nurse managers these strategies:
• Learn how to recognize conflict early and address it right away.
• Pay attention to body language and be cognizant of staff moods.
• Remain calm. While actively listening, focus your attention on the speaker. Try to understand, interpret, and evaluate what’s being said.
After hearing from all sides, clearly define the problem before seeking a solution that’s acceptable to all parties.
Modeling positive conflict engagement should lead to staff members feeling capable of solving interpersonal conflicts on their own. However, nurse managers should be open to hearing conflict issues and addressing them when needed, Johansen said.
Research suggests that nurses in inpatient acute-care environments tend to avoid conflict rather than risk a confrontation. Breaking out of the avoidance conflict management style can be challenging, Johansen said. Nurse managers should provide opportunities for education and act as role models to help nursing staff understand that when working toward conflict resolution—whether with nursing colleagues, physicians, other healthcare professionals, or patients—remaining calm and positive and staying focused on the situation at hand is important. Some suggestions include:
• Separate your feelings for the person involved in the conflict from the issue.
• Come prepared with proposed solutions that focus on the problem and not the person.
• Keep an open mind and reach out to the person involved and speak with them in private.
In other instances, nurses may choose not to speak up at all when it’s important. Fear of retaliation can make nurses reluctant to report colleagues’ errors or poor behavior. Or they may have seen that even when issues are reported, they aren’t addressed. “If I get up the nerve to tell my director that someone isn’t following procedure,” O’Sullivan said, “but nothing is done about it, why would I speak up again?”
Setting the standard
“If incivility is allowed in the organization or on the unit, and there are no standards of behavior about how to communicate with respect, then it’s very hard to hold people accountable,” O’Sullivan said. Leaders will find it difficult to address behavior or educate staff if standards of behavior, along with consequences for not following those standards, aren’t clearly outlined. O’Sullivan believes such standards should be part of every job description and recommends using the ANA Nursing Scope and Standards of Practice for guidance.
Johansen emphasized that in a healthy work environment, a just culture is required for positive communication to thrive. “Nurses and nursing students need to be aware of what a just culture is—it’s a blameless culture, where members of the healthcare team are empowered to address conflict directly.”
People can disagree, but they must learn to do it respectfully and professionally, Johansen said. “You have to resolve the conflict so that it doesn’t affect the patient’s care.”
— Elizabeth Moore is a writer at ANA.