19Jones Leadership(F)-ch 19 328 1/14/07 3:51 PM Page 328 Skills for Being an Effective Manager Sullivan, E., & Decker, P (2001) Effective leadership and management in nursing (5th ed.) Upper Saddle River, NJ: Prentice Hall Tappen, R (2001) Nursing leadership and management: Concepts and practice (4th ed.) Philadelphia: F.A Davis Watson, Y (1988) Human science and human theory of care: Theory of nursing New York: National League for Nursing Watson, Y (1985) Nursing: The philosophy and science of caring Boulder, CO: Colorado Associated University Press BIBLIOGRAPHY Andrews, M., & Boyle, J (1999) Transcultural concepts in nursing care (3rd ed.) Philadelphia: J.B Lippincott Health Resources and Services Administration, Bureau of Health Professions (2000) A national agenda for nursing workforce racial/ethnic diversity, Washington, DC: Author Huff, R.M (1999) Promoting health in multicultural populations: A handbook for practitioners, Thousand Oaks, CA: Sage Kelley, M.L., & Fitzsimons, V.M (1999) Understanding cultural diversity: Culture, curriculum, and community in nursing Boston: Jones & Bartlett/NLN Leininger, M (1994) Transcultural nursing education: a worldwide imperative Nursing Health Care, 15(5), 254–257 Munro, B.H (2003) Caring for the Hispanic populations: The state of the science Journal of Transcultural Nursing, 14, 174–176 Purnell, L.D., & Paulanka, B.J (1998) Transcultural health care: A culturally competent approach Philadelphia: F.A Davis Rundle, A.K., Carvalho, M., & Robinson, M (1999) Honoring patient preferences: A guide to complying with multicultural patient requirements San Francisco: Jossey-Bass Snyder, M., & Lindquist, R (2002) Complementary/alternative therapies in nursing (4th ed.) New York: Springer Tate, D.M (2003) Cultural awareness: Bridging the gap between caregivers and Hispanic patients Journal of Continuing Education in Nursing, 34, 213–217 Villaire, M (1994) Toni Tripp-Reimer: Crossing over the boundaries Critical Care Nurse, 14(3), 134–141 20Jones Leadership(F)-ch 20 1/14/07 3:52 PM Page 329 chapter 20 Constructive Conflict Management SUSAN SPORTSMAN, RN, PHD CHAPTER MOTIVATION “Conflict happens.” Wilmot and Hocker CHAPTER MOTIVES ■ ■ ■ ■ ■ Discuss the concept of conflict in health-care organizations Make a complete and accurate assessment of a conflict situation, using the Parties, Events, Power, Regulation of Conflict, and Style of Conflict (PEPRS) framework Choose appropriate management strategies to deal with conflict Develop a negotiation plan designed to resolve conflict constructively Consider the effect of collective bargaining in managing conflict in health care 329 20Jones Leadership(F)-ch 20 330 W 1/14/07 3:52 PM Page 330 Skills for Being an Effective Manager hen two or more people interact, there is the potential for conflict The way conflict is managed has a major impact on its outcome The stereotypical response to a conflict is to prepare to “win.” However, “beating your opponent” may not be possible, or it may not provide the most positive outcome to the conflict In fact, depending on the circumstances, the methods chosen to resolve the conflict may have harmful consequences Since 2000, patient safety and the work environment have received major emphasis in health care Nearly three in four errors in health care are caused by human factors associated with interpersonal interactions (Maxfield, et al., 2005) A recently released study, “Silence Kills,” a joint project of the American Association of Critical Care Nurses (AACN) and VitalSmarts, highlsights specific “difficult to discuss” issues, which may contribute to avoidable errors and other chronic communication problems in health care (Maxfield, et.al, 2005) Accompanying this report are new AACN Standards to establish and sustain a healthy work environment The first of these standards is: “Nurses must be as proficient in communication skills as they are in clinical skills” (AACN, 2005) One of the communication skills that improves the work environment is the ability to manage conflict constructively This chapter explores the concept of conflict in health care and considers ways to deal constructively with interpersonal and professional conflicts to reach a positive outcome The chapter also considers strategies to assess conflict situations as well as to use negotiation in constructive conflict management A topic such as conflict management cannot be learned in a vacuum; it is discussed best by using everyday examples Consider the following three conflict scenarios, which will be used throughout the chapter to illustrate specific points under discussion A The nurse manager and the physician: A nurse manager and a physician are having a conflict over a protocol for teaching newly diagnosed diabetic patients The nurse manager has developed a protocol for teaching foot care based on recently released nursing research The physician is not convinced that this approach is effective and wants to use a protocol that has been endorsed by the hospital for a number of years B The nursing director of ICU and the director of respiratory care: The nursing director of an intensive care unit (ICU) and the director of respiratory care in a 500bed tertiary hospital, both of whom report to the vice president of patient care services (VPPCS), have an ongoing conflict over financial resources available for nursing and respiratory care staff Both disciplines believe they are short-staffed The VPPCS is a registered nurse, active in professional nursing activities, and many believe she is partial to nurses under her supervision The conflict has escalated because there is a rumored plan to revise the administrative organization from a traditional discipline-specific departmental structure to an interdisciplinary model C A pediatric surgical service: The nurse manager of a pediatric surgical service and the night charge nurse on the unit are having a conflict about timing for surgery preparation The nurse manager has asked that all children scheduled for surgery on any given day be ready for their preoperative medication when the day shift arrives The nurse manager’s rationale is that the surgeries are minor elective surgeries, and there is little lag time between each surgery If the day shift staff has to preoperative preparation, in addition to giving preoperative medication, patients scheduled for surgeries later in the morning may not be ready when the operating room (OR) staff arrives to transport the children to the OR As a result, the surgical schedule is disrupted The night charge nurse contends that waking children up early enough for the night staff to complete all the preparation for all children going to surgery that day means that some of the children will be awakened earlier than necessary Not only will the children not get sufficient sleep but the resulting wait may increase the anxiety for the children and their families Dimensions of Conflict In order to use conflict constructively, it is critical first to understand the concept of conflict Traditionally, conflict has been viewed negatively as a power struggle, with the intent to neutralize, injure, or eliminate rivals Several assumptions drive the perception of conflict as negative: 20Jones Leadership(F)-ch 20 1/14/07 3:52 PM Page 331 Constructive Conflict Management ■ ■ ■ ■ ■ Harmony is normal and conflict is abnormal Conflict occurs because of personal problems Conflict should never be forced, because anger, the predominant emotion, will escalate the conflict Management of conflict should be polite and orderly There is only one right way to resolve differences (Wilmot & Hocker, 2001, pp 11–13) In the 1960s, however, scholars began to suggest that properly managed conflict could facilitate organizational and/or personal growth (Valentine, 1995) When conflict is viewed from a positive perspective, there are a number of benefits to be gained Assumptions underlying a positive perception of conflict include: ■ ■ ■ ■ Conflict is inevitable; learning to manage it effectively is necessary Conflict brings problems to the surface Conflict helps people discuss their goals Managing conflict can help to resolve resentments and increase understanding (Wilmot & Hocker, 2001, pp 15–16) Many different types of conflicts arise in organizations Conflicts often instigate positive change in organizations, but the parties involved must learn to manage them constructively Understanding what conflict is and its potential outcome is a prerequisite to creating growth-producing experiences CONFLICT DEFINED Conflict can be defined as an expressed struggle between at least two interdependent parties who perceive that incompatible goals, scarce resources, or interference from others are preventing them from achieving their goals (Wilmot & Hocker, 2001, p 41) The words highlighted emphasize the key ingredients of a conflict Identifying these ingredients in a particular situation is the first step in addressing the conflict situation The conflict in situation A easily illustrates this definition The difference of opinion in this situation rises to the level of expressed struggle when the nurse manager and the physician cannot agree how to move forward in teaching foot care The difference in opinion impedes progress because of the interdependence of the manager and the physician 331 The physician depends upon nurses to provide education for her diabetic patients; the nurses are dependent upon the physician to admit patients to their unit Although both share the goal of ensuring that patients are competent to deal with the effects of their disease, the methods to reach the goal are in conflict CONFLICTS CATEGORIZED BY UNDERLYING ISSUES Applying the definition of a conflict in a particular situation is only the first step in understanding a conflict Constructive conflict management also requires an understanding of the underlying issues Classifying issues according to categories helps to explain the subtleties of the conflict Categories of issues underlying conflict typically include: relationship, value, data, interest, and structural Relationship conflicts occur when those in a relationship hold different views, beliefs, or values that negatively affect the functioning of the relationship because of poor communication, strong negative emotions, and/or misperceptions Conflicts that arise because of opposing values that have an impact beyond a single relationship are often referred to as value conflicts Data conflicts result when parties not have sufficient information to make a decision or when the data required for decision making are interpreted differently by the various parties Data conflicts may also occur when participants disagree about the relevance or interpretation of the data Interest conflicts result from perceived incompatible needs External forces, such as limited physical resources, time, geographical constraints, or organizational changes, often result in structural conflicts (Wilmot & Hocker, 2001) The conflict between the nursing director of the ICU and the director of respiratory care services (situation B) illustrates several categories of conflict The directors are in conflict because both need additional staff to care for patients with increasingly complex conditions This conflict could be considered an interest conflict, because there is competition over perceived incompatible needs The reorganization at the director level aimed at consolidating the number of departments into fewer interdisciplinary teams represents a situation in which one of the directors may lose power if her 20Jones Leadership(F)-ch 20 332 1/14/07 3:52 PM Page 332 Skills for Being an Effective Manager position is eliminated This results in a potential structural conflict, which could escalate the conflict over resources In addition, the relationship the directors have with their supervisor may also contribute to the conflict For example, if the director of respiratory care believes that the vice president will favor the nursing director of the ICU because they are both nurses, this perception may escalate the conflict TYPES OF ORGANIZATIONAL CONFLICT In addition to classifying conflicts by the underlying interest, other frameworks have been used to categorize conflicts within organizations For example, Rowland and Rowland (1997, p 381) identify seven Practice Proof 20-1 Article: Seago, J., & Ash, M (2002) Registered nurse unions and patient outcomes JONA, 2(3), 143–151 Organizational characteristics in hospitals have been shown to influence patient outcomes; however, the association between RN unions and patient outcomes is unclear This study examined the relationship between the presence of a bargaining unit for RNs and the acute myocardial infarction (MI) mortality rate for acute care hospitals in California In California, 35% of hospitals had unions The signficant finding in the study is that California hospitals with RN unions had a 5.7% lower mortality rates for acute MIs after accounting for patient age, gender, type of MI, other chronic diseases, and several organizational characteristics A causal relationship between RN unions and patient outcomes could not be determined QUESTIONS: In the review of the literature, Seago and Ash (2002) discuss various organizational characteristics that are known to influence patient outcomes What were some of these variables? The authors discussed some limitations to the study What were they and how did the authors address these limitations? Do you see additional limitations to this study? What are the implications of the results for practice in hospitals that have RN unions? What are the implications of the results for practice in hospitals that not have RN unions? What additional research questions the results of this study suggest? types of organizational-specific conflicts that occur when there is disagreement over work issues: goal, affective, cognitive, vertical, horizontal, line/staff, and role conflicts At first glance, some of these categories may seem to be interpersonal; in fact, they are organizational The individuals involved represent organizational units or levels that are in conflict over resources, authority, or power Goal conflict occurs when preferred goals are incompatible, such as in the situation between the director of respiratory care and the nursing director of the ICU (situation B) Both of the directors want to hire new staff to work in the ICU and are competing for the limited available funding to so Affective conflict occurs when feelings or emotions are incompatible The feelings of injustice that the director of respiratory care may harbor from reporting to a nurse illustrate an affective conflict Cognitive conflict occurs when ideas or opinions are believed to be incompatible For example, the conflict between the physician and the nurse manager over the proposed teaching protocol (situation A) illustrates cognitive conflict Vertical conflict occurs between levels of authority when superiors try to exert their authority over subordinates The conflict between the pediatric surgical service nurse manager and the night charge nurse (situation C) illustrates such a conflict Horizontal conflict takes place between those in the same hierarchical level The conflict between the nursing director of the ICU and the director of respiratory care represents horizontal conflict Role conflict occurs when there is inconsistency or misunderstanding about the way a job should be performed Line-staff conflict occurs when line managers believe that staff members use their technical knowledge to intrude on the line manager’s area of legitimate authority This sort of conflict often erupts in the hospital setting, for example, when the quality management staff dictates changes in practice without the supervisor’s commitment to the process An awareness of the various categories of conflict assists in a complete assessment of the circumstances As will be discussed later in the chapter, these categories suggest what direction the assessment should take The ability to assess factors influencing the conflict at its beginning and through the resolution process is crucial to constructive conflict management ... resources available for nursing and respiratory care staff Both disciplines believe they are short-staffed The VPPCS is a registered nurse, active in professional nursing activities, and many believe... within organizations For example, Rowland and Rowland (1997, p 381) identify seven Practice Proof 20-1 Article: Seago, J., & Ash, M (2002) Registered nurse unions and patient outcomes JONA, 2(3),... (Maxfield, et.al, 2005) Accompanying this report are new AACN Standards to establish and sustain a healthy work environment The first of these standards is: “Nurses must be as proficient in communication