Effective conflict resolution is an important component of any organization’s successful performance because conflicts occur in any sphere where human interaction is involved. If conflicts are suppressed, constantly avoided, or put off, there is a risk that they will be repeated bringing more adverse effects and becoming more difficult to resolve (Finkelman, 2012). That is why health organizations should address conflicts with thoroughness and aim to resolve them, ensuring constant improvement and positive development. In the studied case, a nurse and a physician had a conflict upon a patient’s complaint to the nurse about the physician’s behavior. In order to design conflict resolution strategies for the case, it is necessary to describe the conflict, classify it, and analyze its dynamics by stages.
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The studied case involved a conflict between Mrs. D, a nurse with more than ten years of experience, and Mr. O, a physician with approximately three years of practice who had been recently transferred from a different hospital. Mrs. D was always known among other members of medical staff as a nurse who had excellent skills in building close relationships with patients. She was sure that it was not only necessary to establish trust with patients but also to develop mutual liking so that care came along with comforting and accommodating. Mrs. D and Mr. O were on a team together that provided medical and nursing care to Mr. G, a patient who was receiving treatment for cancer and regularly experienced fits of pains. Mrs. D would spend more time with Mr. G than it could have normally been expected from a nurse; they were on friendly terms.
At some point, Mr. G complained to Mrs. D that his physician, Mr. O, had repeatedly been rude with him. According to the patient, the doctor was cold and unfriendly. Several times, in the absence of nurses or any other staff members, the doctor said things that disappointed Mr. G. Mr. O allegedly suggested that Mr. G’s treatment had not been showing progress, so there was little hope for recovery. The patient claimed that the physician had said it in a very detached manner, with no compassion. Mrs. D was outraged. She went to the physician and said to him in a rather loud voice that he should apologize to the patient and be more caring from then on. During this conversation, the doctor became emotional, too, and said to Mrs. D that he would not tolerate being told off by a nurse, that he knew how to do his job better than her, and, at the end, that he wanted her out of the team. After saying a few more harsh things to each other, they left the room, both convinced that the other one was wrong.
The type of the conflict presented in this case is mixed. On the one hand, it is an interpersonal conflict that involved two people who had a fight over a patient’s complaint. However, on the other hand, if examined more closely, the conflict turns out to be individual, i.e. one involving different understandings of one’s role on a medical staff team and the role of other team members (Finkelman, 2012). Individual conflicts occur when health care providers misconceive what their responsibilities and authorities are, which leads to the disruption of cooperation. In the described case, Mrs. D thought that her duty was to protect the patient from any possible mistreatment from physicians, while Mr. O thought that the nurses on his team had no right to tell him how to behave with patients. From this perspective, the conflict is considered unresolved because the hospital medical staff still lacks definitive guidelines on such issues as nurse advocacy, i.e. the nurses’ function to communicate with authority the needs and concerns of patients to doctors. Even though the interpersonal conflict was resolved (Mrs. D and Mr. O made up), the individual conflict was not: no policy or regulation measures followed. It means that there is a possibility that similar conflicts will occur again.
Four Stages of Conflict
Conflicts between nurses and physicians occur frequently in various medical organizations, primarily due to the difference in the structures of work (Finkelman, 2012). There is an ongoing debate among researchers and practitioners whether such conflicts can be eliminated completely (it does not imply elimination of conflicts between people per se but conflicts between nurses and physicians caused by the specificity of their work and roles). Nowadays, many researchers agree that the elimination of conflicts should not be the goal in nursing; rather, it should be acknowledged that conflicts have always occurred and always will, which is why the goal should be to develop effective coping strategies and learn to bring innovation and improvement through conflict resolution (Finkelman, 2012). This view suggests that, in many cases, conflicts should be regarded as opportunities.
However, this idea does not take away from the importance of analyzing conflicts and suggesting resolution strategies that would allow coping with conflicts with higher effectiveness and with more benefits in the future. One of the aspects of analyzing conflict situations is defining the stages of conflict development. Finkelman (2012) describes four stages: latent, perceived, felt, and manifest. All four can be observed in the studied case. First, the latent conflict stage implies that the conflict is anticipated, i.e. there are circumstances acknowledged as factors that are likely to cause a conflict. Finkelman (2012) points out that “[c]ompetition for resources or inadequate communication can be predictors of conflict” (p. 363). In the studied case, nurses might have experienced the lack of understanding between them and physicians of one another’s roles on the teams. This lack is caused by inadequate communication. Before the actual encounter with Mr. O, Mrs. D had repeatedly expressed in personal conversations with other nurses her dissatisfaction with physicians’ behaviors with patients. The lack of guidance on this subject was an essential component of the latent conflict.
Second, the perceived conflict stage began when Mrs. D learned from the patient that he was disappointed with his doctor. This stage is characterized by the participants’ recognition that they are in a situation where overt conflict is about to unfold. In the given case, the perceived conflict almost immediately developed into a felt conflict, as Mrs. D had an emotional response to the patient’s complaint (she became angry with the physician). This stage is characterized by the participants’ feelings such as anxiety and anger that move the conflict to a new phase. At this stage, it is still possible to avoid an overt conflict situation, but Mrs. D opted for the opposite. The manifest conflict stage was the actual encounter where the nurse and the doctor had words.
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The conflict can be regarded as destructive because it was not essentially resolved and did not cause any positive change. Mr. O’s response undermined his image among nurses, which could potentially contribute to further conflicts between the members of care provision teams. It can be deemed that delegation was an issue in this case because delegation is about distribution of responsibilities and authorities, and this distribution was exactly the reason of the conflict between Mrs. D and Mr. O.
Strategies for Conflict Resolution
Conflict resolution requires a strategic approach, i.e. a conflict should be acknowledged and characterized (possibly classified), its causes should be identified, possible solutions should be proposed with considerations of outcomes of each solution, and the implementation of proposed solutions should be monitored and evaluated. Strategies may be categorized according to one of the four types of responding to conflict: avoidance, accommodation, competition, and collaboration (Finkelman, 2012). While avoidance can help reduce adverse effects of conflicts in some cases, it is usually undesirable because it does not, in most cases, resolve conflicts. Therefore, conflict resolution strategies should be based on more positive responses, the main of which is collaboration.
Finkelman (2012) stresses that “[n]egotiation is the critical element in making conflict a nightmare or an opportunity” (p. 372). Indeed, many studies suggest that negotiation is the core of successful conflict resolution strategies (Ezziane et al., 2012; Tomajan, 2012). Ezziane et al. (2012) argue that, in conflict resolution, discussion should be encouraged because it is “important that a clinical leader is able to foster negotiation and compromise in such [conflict] situations, more specifically aiming towards group-trust, shared commitments and mutual respect of opposing views” (p. 431). Similarly, Tomajan (2012) points at three crucial elements of designing and implementing conflict resolution strategies: “collaboration, negotiation, and compromise” (para. 8). This is to emphasize that the conflicting parties should not only communicate effectively but also acknowledge one another’s positions and needs and willingly make concessions to each other to achieve a win-win situation.
Upon the occurrence of the conflict in the given case, it was necessary for the hospital’s management, as well as nurse leaders, to launch the process of resolution through communicating with the conflicting parties, i.e. nurses and physicians. The role of the nurse leader was to establish a platform where the parties could discuss the differences in understanding their roles. Through this platform, it should have been conveyed that nurses appreciate opportunities to act as advocates for their patients and deliver in a respectful manner the patients’ concerns to physicians. At the same time, physicians should have adopted a different attitude: instead of perceiving nurses’ advocacy as intervening in their responsibilities, they should have perceived it as assistance in ensuring that the patients’ needs are fully met. If this strategy to reconcile the nurses’ and physicians’ understanding of their roles in providing care had been implemented successfully, it would have reduced the risk of such conflicts in the future.
Mrs. D and Mr. O had a fight because their views on the role of a nurse in providing care were different. Instead of discussing it, they both became emotional and blamed each other. Even though they made up afterward, the conflict was considered unresolved because the misunderstanding generally persisted in the hospital’s staff. The proposed conflict resolution strategy encompasses negotiation and compromise. The main element of the strategy is communication: nurses and physicians should share their views and acknowledge one another’s contribution to providing care. The recommendation for the nurse leader and the hospital’s management is to establish guidelines that would reflect the shared understanding achieved through negotiation and thus prevent future conflicts.
Ezziane, Z., Maruthappu, M., Gawn, L., Thompson, E. A., Athanasiou, T., & Warren, O. J. (2012). Building effective clinical teams in healthcare. Journal of Health Organization and Management, 26(4), 428-436.
Finkelman, A. (2012). Leadership and management for nurses: Core competencies for quality care. Boston, MA: Pearson.
Tomajan, K. (2012). Advocating for nurses and nursing. Online Journal of Issues In Nursing, 17(1).