Hospitals are considered to be very high-stress working environments. The shifts are long, the pressure is high, and patients’ lives and wellbeing are at stake. Nursing industry has some of the highest turnover rates, varying between 15% and 40% per year. Recurring conflicts among the nursing staff add to stress and contribute to escalating the turnover rates even higher, which is associated with increased expenses necessary for training replacement staff and overall decline in the quality of care (Nei, Snyder, & Litwiller, 2015). The purpose of this paper is to describe and investigate a recurring conflict situation that occurred in the University of Miami Hospital (Florida) and propose strategies for conflict resolution in the long-term perspective.
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The recurring conflict that I witnessed happened in University of Miami Hospital (Florida) between a first-shift (daytime) nurse and the senior nurse in charge of the shift. For the sake of anonymity, I will not mention the names of the nurses. In a report, a nightshift nurse stated that the daytime nurse performed her duties in a disorganized fashion, kept her workplace in a chaotic manner, and provided underwhelming quality of care. Upon reading the report, the senior nurse approached the daytime nurse and gave her a reprimand for neglecting her duties. The daytime nurse acknowledged a certain lack of finesse in her work but argued that during her shift she had to attend a large number of patients. As a result, she has to trade quality for quantity in order to not make other patients wait. The senior nurse said that she wants to hear none of these excuses and that she expects the daytime nurse to improve the quality of her work. According to other nurses, this kind of conflict is the most reoccurring and the most pointless one, as the quality of care among daytime nurses remains the same.
The type of conflict described above is an intragroup conflict, as the daytime nurse, the nightshift nurse, and the senior nurse are part of the same team, only working different shifts. The conflict arises out of perceived lack of responsibility and commitment to work as well as diverging actions and opinions regarding job performance.
Five Stages of Conflict
If we compartmentalize the scenario using five stages of the conflict, the final picture presents itself as follows (Maltarich, Kukenberger, Reilly, & Mathieu, 2016):
- Latent stage. At this point, neither the daytime nurse or the senior nurse is aware of the conflict, as the former was not yet reprimanded and the latter did not receive the report from the nightshift nurse yet.
- Perceived stage. After reading the nightshift nurse’s report, the senior nurse asks the daytime nurse to give her a moment of her time in order to talk about her job performance. Once that happens, both nurses become aware of the conflict.
- Felt stage. In this case, felt stage happens at two different points in time. For the senior nurse, it happens after reading the report. She knows that in case of an incident, she would also be held responsible as the nurse in charge. For the daytime nurse, the stress and anxiety come in the form of a shock during the conversation with the senior nurse.
- Manifest stage. Happens when the two nurses actually discuss the issue at hand and present their reasons for doing or not doing something. The senior nurse, as a superior, gives a vague order for the daytime nurse to improve quality of her work, and the latter begrudgingly agrees, despite presenting the reasons why she was not able to do so earlier.
- Conflict resolution stage. The senior nurse exists the stage with a feeling of accomplishment, whereas the daytime nurse still believes herself to be a victim of external circumstances rather than personal failure. Nothing changes. The conflict is bound to repeat itself after some time.
Strategies to Resolve the Conflict
The core reason behind this conflict is the daytime nurse lacking in the quality of care. Responsibility delegation was not the issue in this conflict, as there were no responsibilities delegated from one party to another. However, the issue of this conflict must be investigated in-depth. Daytime nurses tend to be overworked when compared to nightshift nurses, which explains the reduced quality and orderliness in their work (Ball et al., 2016). However, it may be possible that the issue arises out of improper workday organization on the part of the nurse. The end goal of this conflict resolution should be an increase in quality rather than a reprimand for the sake of it.
There are five basic strategies that are often used to resolve conflicts. These strategies are (Wallensteen, 2015):
- Accommodation – providing what the parties need in order for the conflict to cease. In this scenario, it would involve providing backup for the daytime nurse to decrease her workload, thus improving her quality of care, which is what the senior nurse wants.
- Avoidance – avoiding conflict in hopes that the problem resolves itself. Not applicable in this scenario.
- Collaboration – figuring out how the situation can be improved by working together as a team in order to eliminate the source of the conflict.
- Compromise – investigating the possibility of finding a middle ground that would lend acceptable results for all of the parties involved.
- Competition – one side is declared right, while the other is declared wrong. This strategy is currently in employ. It is not very efficient.
In order to resolve this conflict, the senior nurse would require taking a different approach. I would discuss the situation with her and present the evidence that her current approach is not very efficient. Out of five strategies mentioned above, only two can be feasibly utilized to resolve the issue. These are the Collaboration and Compromise strategies. These approaches can be utilized together, and both stress out the need for dialogue between the senior nurse and the daytime nurse. If the workload is manageable and the problem lies in labor organization, then it can be fixed with better planning that would eliminate the unnecessary and time-consuming steps of the process (Miyata, Arai, & Suga, 2015). If the nurse’s workload does not allow fully fulfilling her duties, then the nursing leader would need to find a way to reduce it by either introducing new shifts or prioritizing between processes to make sure the essentials are covered.
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Observing conflicts between nurses in the University of Miami Hospital taught me much about the nature of conflicts within healthcare organizations. Faced with a lack of time to deal with the patient’s problems, nurses have even less time to resolve conflicts between each other, which causes stress and increases turnover rates. In order to resolve conflicts, both sides need to listen to one another and try to figure out a way that works best for everyone, with patient safety being given priority. Giving one-sided orders without going in-depth about what needs to change is unlikely to produce any results, as it was demonstrated in this paper.
Ball, J. E., Griffiths, P., Rafferty, A. M., Lindqvist, R., Murrells, T., & Tishelman, C. (2016). A cross-sectional study of ‘care left undone’ on nursing shifts in hospitals. Journal of Advanced Nursing, 72(9), 2086-2097.
Maltarich, M. A., Kukenberger, M., Reilly, G., & Mathieu, J. (2016). Conflict in teams: Modeling early and late conflict states and the interactive effects of conflict processes. Group & Organization Management, 43(1), 6-37.
Miyata, A., Arai, H., & Suga, S. (2015). Nurse managers’ stress and coping. Open Journal of Nursing, 5, 957-964.
Nei, D., Snyder, L. A., & Litwiller, B. J. (2015). Promoting retention of nurses: A meta- analytic examination of causes of nurse turnover. Health Care Management Review, 40(3), 237-253.
Wallensteen, P. (2015). Understanding conflict resolution (4th ed.). London, UK: Sage.