JOURNAL OF MILITARY PHARMACO MEDICINE N03 2022 184 A SURVEY OF CONFLICTS AT WORK AND THEIR IMPACT ON NURSES Nguyen Hoang Long1, Pham Tien Dung2 Summary Objectives To describe the conflicts between nur[.]
JOURNAL OF MILITARY PHARMACO - MEDICINE N03 - 2022 A SURVEY OF CONFLICTS AT WORK AND THEIR IMPACT ON NURSES Nguyen Hoang Long1, Pham Tien Dung2 Summary Objectives: To describe the conflicts between nurses and other hospital personnel, and examine nurses’ perceived impacts of those conflicts on their work performance and health Subjects and methods: In this cross-sectional survey, a convenience sample of 202 nurses (of the 288 invited individuals) provided consent to participate in the study Data were collected from March to June 2021 using self-administered questionnaires Participants were asked to rate the frequency and impact of conflicts with other nurses, direct supervisors, physicians, other healthcare staff (e.g., dieticians, physical therapists, pharmacists), and non-healthcare staff Results: Nurses reported a high prevalence of conflicts with other nurses (89.6%), direct supervisors (65.9%), physicians (77.7%), other healthcare staff (63.4%), and non-healthcare staff (61.4%) The impact of nurses’ conflicts with direct supervisors was rated the highest (1.46 ± 1.09), followed by conflicts with physicians (1.37 ± 1.08), nonhealthcare staff (1.35 ± 1.00), other nurses (1.34 ± 1.21), and other healthcare staff (1.22 ± 1.03) Conclusion: Both intra- and inter-professional conflicts of nurses should be addressed properly Special attention should be paid to nursenurse manager, nurse-physician, and nurse-nurse conflicts * Keywords: Conflict management; Healthcare personnel; Inter-professional conflicts; Workplace conflict; Nurses’ conflicts College of Health Sciences, VinUniversity Department of Nursing, National Hospital of Dermatology and Venereology, Dong Da District Corresponding author: Nguyen Hoang Long (long.51@hotmail.com) Date received: 23/3/2022 Date accepted: 21/4/2022 184 JOURNAL OF MILITARY PHARMACO - MEDICINE N03 - 2022 INTRODUCTION In hospitals, healthcare professionals with different backgrounds, schools of thought, and fields of specialty work together for the common goal of ensuring safe and quality services Work is often demanding and stressful, with overlapping roles and responsibilities [1] It has been reported that most healthcare professionals observe or experience conflicts on a weekly basis [2] Various negative outcomes of conflicts in the healthcare sector have been discussed, such as decreased team performance, reduced trust, poor mental health, and drained personal resources [3] A recent study found that four in every ten conflicts that occur in hospitals might have potential adverse outcomes for patient care [2] Nurses’ functions require a wide range of interactions among themselves, as well as with other healthcare personnel This makes workplace conflicts a significant issue among nurses [4] Dewetty and Osborne [5] indicated that over 53% of nurses who participated in their survey reported frequent workplace conflicts Researchers have examined both quantitatively and qualitatively the types of conflicts, conflict management styles, and consequences of conflicts among staff nurses, nurse managers, and nursing students The findings suggest that nurses face various types of intra- and inter-professional, and tend to use less preferred management styles (e.g., avoiding or forcing) to solve these conflicts [4] Inter-professional conflicts are believed to hinder nursing quality, and timely and patient-centered care [2] Nurses, like other healthcare professionals, also suffer from stress, fear, irritability, low self-esteem and confidence, stomachache, headache, withdrawal, and isolation as a result of workplace conflicts [3] Therefore, finding ways to improve conflict management is important to promote the quality of patient care, a healthy work environment, and nurses’ health [3, 4, 6] However, to date, the association between the occurrence of conflicts and their impact on nurses remains unclear Obviously, the trouble caused by different types of conflicts is not the same, and conflicts with more impact should be managed properly This study aimed: To describe the conflicts between nurses and other hospital 185 JOURNAL OF MILITARY PHARMACO - MEDICINE N03 - 2022 personnel, and examine the relationship work between these conflicts and nurses’ work performance and personal health asked to rate the frequency of conflicts The findings are expected to help identify conflicts that may require supervisors more attention than others (e.g., dieticians, physical therapists, position were with other nurses (1 item), direct (1 item), pharmacists) SUBJECTS AND METHODS Participants (1 item), other (1 physicians healthcare item), and staff non- healthcare staff of the hospital (1 item) Subjects The frequency ranged from never (0), Participants were nurses attending sometimes (1) to frequently (2), and professional development programs at very the Faculty of Nursing, Thai Nguyen participant declared conflicts with University of Medicine and Pharmacy others, he/she was asked to evaluate Data were collected between March and June 2021 The participants were recruited using a convenient sampling method All students who took courses in the second semester of the academic year 2020 - 2021 were invited Among the 288 students, 202 students (70%) gave consent and completed the survey frequently (3) Once the the impact of such conflicts on his/her work performance (1 item) and personal health (1 item) The rating scale consisted of four levels: no (0), a little (1), much (2), and very much (3) The total impact-of-conflict score with each type of personnel is a sum of its relevant impact-on-work performance and impact-on-personal health scores The sample characteristics of occurrences of Methods participants This was a cross-sectional study conflicts are depicted using descriptive Self-administered statistics The study was approved by questionnaires and The the ethical review committee of Thai demographic questionnaire obtained Nguyen National Hospital (decision participants’ basic information, such number 234/HDDD-BVTWTN, dated as age, gender, work experience, and on March 25th, 2021) were 186 used to collect data JOURNAL OF MILITARY PHARMACO - MEDICINE N03 - 2022 RESULTS Table 1: Characteristics of participants (n = 202) Characteristics Frequency Percentage (%) ± SD (min - max) Age (years) 34.63 ± 4.77 (23 - 53) Work experience (years) 11.07 ± 4.40 (1 - 32) Gender Male 35 17.3 Female 167 82.7 2-year vocational degree 46 22.8 3-year college degree and higher 156 77.2 Staff nurse 183 90.6 Nurse administrator 19 9.4 Inpatient 141 68.8 Outpatient 18 8.9 Non- or para-clinical department 34 16.8 Community clinic 4.5 Professional Education Work position Department The mean age of the participants was 34.6 ± 4.8 years, and their work experience ranged from to 32 years Most of the participants were women (82.7%) Nurses with administrative positions accounted for 9.4% of the participants Remarkably, nearly seven out of ten participants (68.8%) were working in inpatient wards 187 JOURNAL OF MILITARY PHARMACO - MEDICINE N03 - 2022 Table 2: Nurses’ conflict with colleagues at work (n = 202) Frequency of conflict Frequency Percentage (%) With other nurses ± SD 0.92 ± 0.37 Very frequently 0.5 Frequently 1.5 Sometimes 177 87.6 Never 21 10.4 With direct supervisors 0.67 ± 0.49 Very frequently 0.0 Frequently 1.0 Sometimes 131 64.9 Never 69 34.1 With physicians 0.82 ± 0.49 Very frequently 0.0 Frequently 4.5 Sometimes 148 73.2 Never 45 22.3 With other healthcare staff 0.65 ± 0.52 Very frequently 0.0 Frequently 2.0 Sometimes 124 61.4 Never 74 36.6 With non-healthcare staff 0.64 ± 0.53 Very frequently 0.0 Frequently 2.5 Sometimes 119 58.9 Never 78 38.6 Most of the nurses reported frequent conflicts with others, for example, with nurses (89.6%), direct supervisors (65.9%), and non-healthcare staff (61.4%) 188 JOURNAL OF MILITARY PHARMACO - MEDICINE N03 - 2022 The mean score for conflict with other nurses was the highest (0.92 ± 0.37), followed by conflict with physicians (0.82 ± 0.49) Table 3: Impact of conflicts on nurses Types and impact of conflict ± SD Min - max With other nurses (n = 181) 1.34 ± 1.21 0-6 Work performance 0.86 ± 0.74 0-3 Personal health 0.48 ± 0.65 0-3 With direct supervisors (n = 133) 1.46 ± 1.09 0-4 Work performance 0.90 ± 0.62 0-2 Personal health 0.56 ± 0.63 0-2 With physicians (n = 157) 1.37 ± 1.08 0-4 Work performance 0.89 ± 0.64 0-3 Personal health 0.48 ± 0.58 0-2 With other healthcare staff (n = 128) 1.22 ± 1.03 0-4 Work performance 0.74 ± 0.57 0-2 Personal health 0.48 ± 0.59 0-2 With non-healthcare staff (n = 124) 1.35 ± 1.00 0-4 Work performance 0.85 ± 0.59 0-2 Personal health 0.50 ± 0.58 0-2 The impact score for each category of personnel was calculated from the responses of participants who reported having conflicts with that group For example, 21 nurses reported no conflict with other nurses (Table 2) The impact score of conflicts with other nurses was then calculated from the information obtained from the remaining 181 respondents (1.34 ± 1.21) The impact score of conflict with direct supervisors ranked the highest (1.46 ± 1.09) The lowest impact score was reported for conflicts with other healthcare staff (1.22 ± 1.03) In general, the scores on the impact of conflict on work performance were higher than those for personal health in all groups 189 JOURNAL OF MILITARY PHARMACO - MEDICINE N03 - 2022 DISCUSSION The current study found that nearly nine out of every ten nurses (89.6%) reported conflicts with other nurses Conflicts with nurse supervisors were also highly prevalent (65.9%) Nurses’ conflicts can occur among peers or across generations [6] Interestingly, although toxic behavior, such as bullying, verbal violence, and aggression, is common in conflict situations, it tends to occur in private [6], and less experienced nurses are at a higher risk of being victims of such manners [7] This reality contradicts the fact that a supportive and friendly environment, which helps to resolve conflicts effectively, is an essential factor in retaining nurses [8] In other words, nurses and nurse managers should pay special attention to the effective management of intra-professional conflicts Conflicts at workplace occur because of several reasons, which range from nurses’ personal attributes (e.g., age, background, values, stress levels, communication styles) to group or organizational characteristics (e.g., culture, staffing model, workload, conflict management system) [2, 3, 5, 7, 8] Therefore, the approach should be comprehensive but tailored to specific institutions 190 Nurse-physician conflicts were ranked as the second most common type of conflict in this study (77.7%) Nurses and physicians work closely under the interplay of various independent and interdependent roles and responsibilities, which tends to give rise to conflicts Conflicts between nurses and physicians emerge from differences in professional judgments, goals, experience, and positions in the work hierarchy [6]; poor communication is believed to be a major cause behind such conflicts [3, 9] A review by Tan, Zhou [10] revealed that nurses and physicians had different communication styles, and they both had suboptimal communication skills To enhance communication between nurses and physicians, improvements in mutual understanding, trust, respect, and collaborative attitudes were recommended [10] More importantly, early interventions enhancing nurse-physician communication should be implemented not only at healthcare institutions but also at medical and nursing schools [9] Studies have reported an increase in nurses’ motivations when they are able to work collaboratively with physicians, on recognition of their autonomy, and when conflicts are managed constructively [6] ... is an essential factor in retaining nurses [8] In other words, nurses and nurse managers should pay special attention to the effective management of intra-professional conflicts Conflicts at workplace... conflict management styles, and consequences of conflicts among staff nurses, nurse managers, and nursing students The findings suggest that nurses face various types of intra- and inter-professional,... indicated that over 53% of nurses who participated in their survey reported frequent workplace conflicts Researchers have examined both quantitatively and qualitatively the types of conflicts, conflict