7.7 Conflict Resolution
Conflicts are inevitable when working on a team composed of members with different personalities, roles, and responsibilities. It is essential for all nurses to develop conflict resolution skills.
Common Sources of Interpersonal Conflict
Common sources of interpersonal conflict in health care settings are passive-aggressiveness, horizontal aggression, defensiveness, peer informer behavior, and victimization behaviors.[1]
Passive-Aggressiveness
Passive-aggressiveness is a behavior that shows disconnection between what a person says and does. Many times, a passive-aggressive person will agree with another person’s request, but later express feelings of frustration or anger to others and not comply with the request.
As an example, a charge nurse informs the team of RNs in a team meeting that a new policy requires bedside rounding. A nurse responds enthusiastically during the meeting but then complains to others about the policy and refuses to do it. The best method of managing passive-aggressive behavior is to confront it calmly and directly. For this example, it would be helpful for the charge nurse to say, “I was disappointed to hear you are upset about the new bedside rounding policy because you didn’t express any concerns directly to me. It is important for you to directly communicate concerns to me so we can discuss them and make a plan for going forward.”[2]
Horizontal Aggression
You may have heard the saying, “Nurses eat their young.” Unfortunately, there has been a history of some experienced nurses refusing to help new nurses with statements such as, “I had to learn that the hard way – nobody helped me when I started.” Horizontal aggression refers to hostile behavior among one’s peers. It is not acceptable and should be directly confronted in a constructive manner or it will get worse.
A suggested approach to a peer displaying horizontal aggression is to respond calmly and sincerely, “I value your expertise and experience and am looking for your help and support.” If the negative behavior continues after an attempt to address the individual directly, the nurse supervisor should be notified according to the agency’s chain of command.[3]
Defensiveness
It can be difficult to receive negative feedback. Some people respond by becoming defensive. Defensiveness puts the blame for one’s shortcomings on another person to make oneself appear better.
As an example, a charge nurse addresses a nurse about not turning on the bed alarm after repositioning a client and leaving the room. The nurse responds defensively by inaccurately blaming others, stating, “The nursing assistants are always sloppy with their responsibilities.” It is helpful to confront defensiveness by restating the facts in a calm manner and redirecting the conversation to the problem, its resolution, and the risk of jeopardizing patient safety. For example, the charge nurse could reply, “In this situation, I saw you leave the room after repositioning the patient and when I went into the room to answer the patient’s call light, the bed alarm was off. It is important to prevent falls for this patient by having the bed alarm on at all times when they are in bed. Do you have any questions about how to use the bed alarm? (Wait for an answer.) Quality patient care depends on our team working effectively together.”[4]
Peer Informer Behavior
Peer informer behavior is similar to gossip. Peer informers relay information about fellow team members to the nurse leader, and this information often lacks objective evidence. It is often best to respond to the informer by asking them to speak to their team member directly about their concerns unless it is an urgent matter that must be dealt with immediately. However, keep in mind that if concerns are shared about a staff member by more than one team member, it may be a pattern of behavior and the nurse leader should follow up with that staff member.[5]
As an example, a nurse approaches the charge nurse and says, “Everyone is concerned about how much time Nancy is spending in the room with her patients. She gets behind in her work and the rest of us have to make up for it.” The charge nurse could reply, “Have you addressed your concerns directly with Nancy?” If the nurse replies, “No,” then the charge nurse could state, “Please talk to Nancy directly with your concerns first.” However, if another nurse shares a similar concern with the charge nurse, then the charge nurse should address this pattern of behavior with Nancy and obtain her perspective.
Victimization
Victimization occurs when a team member feels they are being singled out unfairly or held to higher expectations than their peers. Comments may include, “Why am I getting called out on this when other people are doing this and aren’t getting in trouble?” or “I was never told this; why I’m I always the last to know?” Team members who feel victimized should be reminded by the nurse leader they are held to the same standards as the other members. However, keep in mind that sharing information about other staff members’ performance breaches confidentiality, so do not include another employees’ performance information in conversations but instead focus on policies and procedures that apply to everyone.[6]
Conflict Management
Individuals manage conflict differently. During conflict, a person’s behavior is typically driven by their commitment to their goals or their commitment to relationships:[7]
- Commitment to goals: The extent to which an individual attempts to satisfy their personal concerns or goals.
- Commitment to relationships: The extent to which an individual attempts to satisfy the concerns of another party or maintain the relationship with the other party.
Most people use different methods to resolve conflict depending on the situation and what strategy best applies. One approach is not necessarily better than another, and all approaches can be learned and used effectively with practice. However, to effectively manage conflict, it is important to first analyze the situation and then respond accordingly.
A long-standing conflict resolution model created by Thomas and Killmann describes five approaches to dealing with conflict: avoiding, competing, accommodating, compromising, and collaborating. Each of these steps is further described in the following sections.[8]
Avoidance Approach
An avoidance approach to conflict resolution demonstrates a low commitment to both goals and relationships. This is the most common method of dealing with conflict, especially by people who view conflict negatively. See Table 7.7a for types of avoidance, potential results, and situations when this strategy may be appropriate.[9]
Table 7.7a Avoidance Approach[10]
| Types of Avoidance Approaches | Potential Results | Appropriate Use |
|---|---|---|
|
|
|
Application to Nursing
In a clinical setting, there may be times when it is appropriate to avoid confrontation. For example, on a particularly busy day in the emergency department, a patient in a life-threatening condition was recently received. The attending physician barks orders to the nurse in a disrespectful manner. The nurse avoids addressing the conflict until after the patient has been stabilized and then shares her concerns. However, if the physician continues to bark orders to nursing staff in nonemergency situations, avoidance is no longer appropriate, and the conflict must be addressed to establish a positive and respectful working environment.[11]
Competitive Approach
A competitive approach to conflict management demonstrates a high commitment to goals and a low commitment to relationships. Individuals who use the competitive approach pursue their goals at other individuals’ expense and will use whatever power is necessary to win. A competitive approach may also be displayed when an individual defends an action, belief, interest, or value they believe to be correct. Competitive approaches may also be supported by infrastructure (agency promotion procedures, courts of law, legislature, etc.).[12] See Table 7.7b for types of competitive approaches, potential results, and appropriate uses.
Table 7.7b Competitive Approach[13]
| Types of Competitive Approaches | Potential Results | Appropriate Use |
|---|---|---|
|
|
|
Application to Nursing
A competitive approach to conflict resolution may be appropriate in a clinical setting if a nurse leader realizes a nurse has made an error while preparing to administer IV medication to a patient. The nurse leader may stop the nurse from inaccurately administering the medication and take over completing the procedure. In this case, the goal of patient safety outweighs the commitment to the relationship with that nurse. However, after patient safety is maintained, it would be inappropriate to continue the competitive approach when debriefing the nurse about a simple human error. Debriefing should focus on educating the nurse about policy and procedures to improve their performance. However, if it is determined the nurse was acting recklessly and disciplinary measures must be instituted by a manager, then the competitive approach may be appropriate.[14] This approach to responding to errors is often referred to as “Just Culture.”
Read more about Just Culture in the “Legal Implications” chapter.
Accommodating Approach
An accommodating approach to conflict management demonstrates a low commitment to goals and high commitment to relationships. This approach is the opposite of the competitive approach. It occurs when a person ignores or overrides their own concerns to satisfy the concerns of the other party. An accommodating approach is often used to establish reciprocal adaptations or adjustments, but when the other party does not reciprocate, conflict can result. Accommodators typically do not ask for anything in return but can become resentful when a reciprocal relationship isn’t established. If resentment grows, individuals relying on the accommodating approach may shift to a competitive approach from a feeling of “being used” that can lead to conflict.[15] See Table 7.7c for types of the accommodating approach, potential results, and appropriate uses.
Table 7.7c Accommodating Approach[16]
| Types of Accommodating Approaches |
Potential Results | Appropriate Use |
|---|---|---|
|
|
|
Application to Nursing
It may be appropriate to use an accommodating approach when one of the nurses on your team has a challenging patient who is taking up a lot of time and effort. By being situationally aware and noticing the nurse has been involved in that patient’s room for a long period of time, you offer to provide task assistance in an effort to provide mutual support. You are aware this will increase your workload for a short period of time, but it will assist your colleague and promote a strong team. However, the accommodating approach is no longer appropriate if the nurse continues to expect you to cover their tasks after the situation has been resolved.[17]
Compromising Approach
A compromising approach to conflict resolution strikes a balance between commitment to goals and commitment to relationships. The objective of a compromising approach is a quick solution that will work for both parties. It typically involves both parties giving up something in return for something, thereby “meeting in the middle.”[18] See Table 7.7d for types of compromising approaches, potential results, and appropriate uses.
Table 7.7d Compromising Approach
| Types of Compromising Approaches |
Potential Results | Appropriate Use |
|---|---|---|
|
|
|
Application to Nursing
Compromise is an appropriate approach to conflict in many clinical settings. For example, you are working with another nurse who rarely assists other team members. The nurse asks you for assistance with a blood draw for a patient. You hesitate because you are searching for a lunch tray that has not yet been delivered for a patient with diabetes. You ask your colleague to obtain the patient’s lunch tray while you complete their request for assistance with a blood draw. However, it would be inappropriate to refuse to assist the nurse based on their reputation because this could impact safe, effective care for the patient.[19]
Collaborative Approach
The collaborative approach to conflict resolution demonstrates a high commitment to goals as well as a high commitment to relationships. The collaborative approach attempts to meet the concerns and priorities of all parties, but trust and willingness for risk are required for this approach to be effective.[20] See Table 7.7e for types of collaborative approaches, potential results, and appropriate uses.
Table 7.7e Collaborative Approach[21]
| Type of Collaborative Approaches |
Potential Results | Appropriate Use |
|---|---|---|
|
|
|
Application to Nursing
An example of appropriately using the collaborative approach in conflict management in a clinical setting is when discussing vacation time off with team members during a team meeting. During a team meeting, time is available to discuss and focus on what is important and a priority for each member of the team. However, the collaborative approach to conflict management would be inappropriate when discussing the implementation of a new agency policy if the team has little influence in making adjustments.[22]
All approaches to conflict can be appropriate for specific situations, but they can also be inappropriate or overused. When conflict occurs, take time to consider which approach is most beneficial for the situation. Keep in mind that using wrong approaches can escalate conflict, damage relationships, and reduce your ability to effectively meet team goals. Correct conflict management approaches build trust in relationships, accomplish goals, and deescalate conflict.[23]
Everyone has the capacity to use any of these approaches for managing conflict and can shift from their natural style as needed. We tend to react with our most dominant natural style when under stress, but other approaches can be learned and applied with practice and self-awareness. When dealing with others who have not developed their capacity to shift from their natural style of conflict management, it is important to consider their underlying needs. By understanding individuals’ needs existing beneath the surface of the conflict, you can work with the other person toward achieving a common goal.[24]
Addressing Individual Needs and Approaches
There are times when other individuals take an approach that is not helpful to resolving the conflict. It is important to remember the only person you can control during a conflict is yourself. Be flexible with your approach according to the situation and the team members with whom you are working. If someone is taking an approach that is not beneficial to resolving conflict, it can be helpful to try to understand the needs that underlie their decision to take that approach.[25]
Here are some examples of needs underlying their approaches to conflict and suggested ways to address them:[26]
- People using the avoidance approach may need to feel physically and emotionally safe. Take the time to reassure them that their needs will be heard.
- People taking the competitive approach often feel the need for something to be accomplished to meet their goals. It may be helpful to say, “We will work out a solution, but it may take some time to get there.”
- People using the accommodating approach may need to know that no matter what happens during the conversation, your relationship will remain intact. It may be helpful to say, “This decision will not affect our relationship or how we work together.”
- People using the compromising approach may need to know that they will get something in return. It may be helpful to say, “We will do Action A first, and then we will do Action B for you.” However, be sure to be true to your word.
- People using the collaborative approach may need to know what you want before they are comfortable sharing their needs. It may be helpful to say, “I need this, this, and this…What do you need?”
View this information about the Thomas-Kilmann Conflict Mode Instrument.
Take free online Conflict Quizzes and Assessments to identify your preferred conflict management styles.
Escalating and De-Escalating Conflict
An approach taken to manage conflict can escalate (increase) or de-escalate (decrease) the conflict. Conflict on a team can take a life of its own and escalate beyond reason if not managed appropriately by nurse leaders. When conflict is not managed appropriately, negative consequences within the team often occur, and patient safety can be compromised. Increased rates of absenteeism and turnover may also occur.[27]
Conflict tends to escalate under the following conditions:[28]
- There is an increase in emotions like anger, frustration, etc.
- An individual feels that they are being threatened (i.e., the fight-or-flight response is triggered).
- Other people get involved and choose sides.
- The individuals were not friendly prior to the conflict.
- The individuals desire to engage in conflict.
However, conflict can be de-escalated under the following conditions:[29]
- Attention is focused on solving the problem.
- There is a decrease in emotion and perceived threat.
- The individuals were friendly prior to the conflict.
- The individuals desire to reduce conflict.
Read an example of escalating conflict in the following box.
Example of Escalating Conflict[30]
A conflict begins between two team members who snapped at each other while performing their roles caring for a patient experiencing a medical emergency.
- The parties become aware of the conflict but attempt to deal with it sensibly. Often, they will attribute the problem to “a misunderstanding” and indicate “we can work it out.”
- If an appropriate conflict management approach is not used, the parties begin to slide from cooperation to competition. (“I’ll bend – but only if they bend first.”) They begin to view the conflict as resulting from deliberate action on the part of the other. (“Didn’t they know this was going to happen?”) Positions begin to harden and defensiveness sets in, creating adversarial encounters. Parties begin to strengthen their positions and look to others on the team for support. (“Don’t you feel I’m being reasonable?” or “Did you know what that idiot did to me?”)
- As communication deteriorates, parties rely on assumptions about the other individual and attribute negative motives to them. (“I bet they did that on purpose.”) Groupthink can take over the subgroups as each individual seeks others to take on their side. (“We have to appear strong and make a united front.”)
- Parties believe that cooperation cannot resolve the problem because of the assumed negative actions of the other. (“I’ve tried everything to get them to see reason,” “It’s time to get tough,” or “I’m going to put a stop to this.”)
- Parties begin to feel righteous and blame the other for the entire problem. Generalizing and stereotyping begin. (“I know what those kinds of people are like. . . We can’t let them get away with this.”) Parties begin to be judgmental and moralistic and believe they are defending what is “right.” (“It’s the principle of the matter” or “What will others say if we give in to this?”)
- Severe confrontation is anticipated and planned, thus making it inevitable. The parties view this confrontation as acceptable. The objective of the conflict becomes to hurt the other more than being hurt, and the dispute is beyond rational analysis. (“I’m going to make you pay even if we both go down over this,” “There is no turning back now,” or “They won’t make a fool out of me.”)
There are positive steps to take to de-escalate conflict with another individual before it takes on a life of its own. See Figure 7.9[31] for steps to de-escalate conflict and implement change.
Conflict Management Tips
Nurses must develop their own tool kit to manage conflict in a productive, positive way. See Table 7.7f for tips on managing conflict constructively.[32]
Table 7.7f Conflict Management Tips[33]
| Tip | Description |
|---|---|
| Be Consistent | Convey to the team that expectations are consistent and implemented fairly across the team. Set expectations and make sure the team knows those expectations via department meetings and visuals. Follow up to ensure expectations are met. This sets a clear picture of what is required. |
| Be Team-Focused | Address poor performance and negative attitudes. Teamwork and team dynamics impact patient safety and staff retention. Coach team members as staff on a regular basis. |
| Convey Trust and Integrity | Trustworthiness and integrity are powerful when managing conflict. Team members are more likely to handle difficult situations constructively if they know they are supported by an approachable and supportive team leader. Stay focused on the individual and remind them that you value them and want them to feel heard. It may be helpful to include a statement such as, “As health care members, we are held accountable for positive behaviors with team members.” |
| Lead with Truth | If you need to have a difficult conversation, lead with the tough message and be clear. For example, try saying, “There’s something difficult I need to talk with you about. I’m concerned about the feedback I’ve been receiving from patients.” Even in conveying a tough message, you can build trust by showing the employee that you’ll be honest with them and share feedback openly.
Don’t leave the team member guessing about the problem or what they need to do to improve. Clearly state the performance gap, your expectations, the reason it matters, and the time line for improvement, including when you’ll round back to determine improvement and give a progress update. Provide support and available resources to help them make the needed change. |
| Anticipate Reactions | Knowing how a team member will respond when conflicts arise can be a challenge. Common negative reactions to conflicts are defensiveness, deflection, and denial. Defensive comments may include, “No one’s ever brought this to me before.” You can reply, “I’m invested in you and want to see you succeed. I owe it to you and our department to be transparent with you and share these concerns.” Deflection can take the form of an employee asking you why a coworker didn’t directly bring up the concern. Often, it’s because others are too intimidated by the individual or situation to speak up. Your reply can be, “Accountability between colleagues is always encouraged, but as your leader, I owe it to you to share this feedback. Do you feel your colleagues perceive you as approachable and open to feedback?” Denial may include the employee refuting that the incident of concern ever happened. You can calmly remind the employee that we own others’ perceptions of our behaviors and you want to help them understand where some actions may be giving people the wrong impression. |
| Use Available Resources | Engage in professional development for managing conflicts when they arise. Share knowledge and experiences with other nurse leaders to build networks, partner with other teams within the organization, and use the human resources department when needed. |
- Elizabeth, A. (2019). Managing interpersonal conflict: Steps for success. Nursing Management, 50(6), 22-28. https://journals.lww.com/nursingmanagement/Fulltext/2019/06000/Managing_interpersonal_conflict__Steps_for_success.7.aspx ↵
- Elizabeth, A. (2019). Managing interpersonal conflict: Steps for success. Nursing Management, 50(6), 22-28. https://journals.lww.com/nursingmanagement/Fulltext/2019/06000/Managing_interpersonal_conflict__Steps_for_success.7.aspx ↵
- Elizabeth, A. (2019). Managing interpersonal conflict: Steps for success. Nursing Management, 50(6), 22-28. https://journals.lww.com/nursingmanagement/Fulltext/2019/06000/Managing_interpersonal_conflict__Steps_for_success.7.aspx ↵
- Elizabeth, A. (2019). Managing interpersonal conflict: Steps for success. Nursing Management, 50(6), 22-28. https://journals.lww.com/nursingmanagement/Fulltext/2019/06000/Managing_interpersonal_conflict__Steps_for_success.7.aspx ↵
- Elizabeth, A. (2019). Managing interpersonal conflict: Steps for success. Nursing Management, 50(6), 22-28. https://journals.lww.com/nursingmanagement/Fulltext/2019/06000/Managing_interpersonal_conflict__Steps_for_success.7.aspx ↵
- Elizabeth, A. (2019). Managing interpersonal conflict: Steps for success. Nursing Management, 50(6), 22-28. https://journals.lww.com/nursingmanagement/Fulltext/2019/06000/Managing_interpersonal_conflict__Steps_for_success.7.aspx ↵
- Leadership and Influencing Change in Nursing by Joan Wagner is licensed under CC BY 4.0 ↵
- Leadership and Influencing Change in Nursing by Joan Wagner is licensed under CC BY 4.0 ↵
- Leadership and Influencing Change in Nursing by Joan Wagner is licensed under CC BY 4.0 ↵
- Leadership and Influencing Change in Nursing by Joan Wagner is licensed under CC BY 4.0 ↵
- Leadership and Influencing Change in Nursing by Joan Wagner is licensed under CC BY 4.0 ↵
- Leadership and Influencing Change in Nursing by Joan Wagner is licensed under CC BY 4.0 ↵
- Leadership and Influencing Change in Nursing by Joan Wagner is licensed under CC BY 4.0 ↵
- Leadership and Influencing Change in Nursing by Joan Wagner is licensed under CC BY 4.0 ↵
- Leadership and Influencing Change in Nursing by Joan Wagner is licensed under CC BY 4.0 ↵
- Leadership and Influencing Change in Nursing by Joan Wagner is licensed under CC BY 4.0 ↵
- Leadership and Influencing Change in Nursing by Joan Wagner is licensed under CC BY 4.0 ↵
- Leadership and Influencing Change in Nursing by Joan Wagner is licensed under CC BY 4.0 ↵
- Leadership and Influencing Change in Nursing by Joan Wagner is licensed under CC BY 4.0 ↵
- Leadership and Influencing Change in Nursing by Joan Wagner is licensed under CC BY 4.0 ↵
- Leadership and Influencing Change in Nursing by Joan Wagner is licensed under CC BY 4.0 ↵
- Leadership and Influencing Change in Nursing by Joan Wagner is licensed under CC BY 4.0 ↵
- Leadership and Influencing Change in Nursing by Joan Wagner is licensed under CC BY 4.0 ↵
- Leadership and Influencing Change in Nursing by Joan Wagner is licensed under CC BY 4.0 ↵
- Leadership and Influencing Change in Nursing by Joan Wagner is licensed under CC BY 4.0 ↵
- Leadership and Influencing Change in Nursing by Joan Wagner is licensed under CC BY 4.0 ↵
- Children, Youth, Families & Communities & Michigan State University Extension. (2009). Module 3 | Part 6 - Managing conflict: Escalating and de-escalating. Michigan State University Board of Trustees. https://www.canr.msu.edu/uploads/236/64484/MOD_3_MANAGING_CONFLICT_ESCALATING_AND_DE-ESCALATING.pdf ↵
- Children, Youth, Families & Communities & Michigan State University Extension. (2009). Module 3 | Part 6 - Managing conflict: Escalating and de-escalating. Michigan State University Board of Trustees. https://www.canr.msu.edu/uploads/236/64484/MOD_3_MANAGING_CONFLICT_ESCALATING_AND_DE-ESCALATING.pdf ↵
- Children, Youth, Families & Communities & Michigan State University Extension. (2009). Module 3 | Part 6 - Managing conflict: Escalating and de-escalating. Michigan State University Board of Trustees. https://www.canr.msu.edu/uploads/236/64484/MOD_3_MANAGING_CONFLICT_ESCALATING_AND_DE-ESCALATING.pdf ↵
- The Center for Congregational Health. (2011, October 3). Levels of conflict by Speed Leas. https://cntr4conghealth.wordpress.com/2011/09/01/levels-of-conflict-by-speed-leas/ ↵
- Dispute Resolution Office, Ministry of Justice (Government of Saskatchewan), designed by JVDW Designs, is licensed under a CC BY 4.0 International License. ↵
- Elizabeth, A. (2019). Managing interpersonal conflict: Steps for success. Nursing Management, 50(6), 22-28. https://journals.lww.com/nursingmanagement/Fulltext/2019/06000/Managing_interpersonal_conflict__Steps_for_success.7.aspx ↵
- Elizabeth, A. (2019). Managing interpersonal conflict: Steps for success. Nursing Management, 50(6), 22-28. https://journals.lww.com/nursingmanagement/Fulltext/2019/06000/Managing_interpersonal_conflict__Steps_for_success.7.aspx ↵