11 Difficult Conversations and Conflict Resolution
Laura K. Garner-Jones
Chapter 11 Overview
- View conflict in a positive light
- Describe the different causes of conflict
- Analyze conflict styles
- Recognize how conflict escalates
- Review different approaches to managing conflict
Introduction
“Conflict: to struggle, clash, be incompatible” (Oxford Dictionary, n.d.).
For centuries, people accepted adversarial disputes and harsh conflict as a by-product of human nature. This acceptance led people to focus solely on resolving conflict, that is, finding ways to make it disappear. Over the past decade or two, many people have also begun to ask, “Why is conflict resolved in that way?” and “Might there be a better way?”
To make progress toward better conflict resolution, it is essential that we understand why conflicts arise and how people have traditionally reacted to conflict situations. When we can analyze the causes of disputes more clearly, we will be better able to determine the processes that need to be implemented to achieve a more positive outcome in the conflict.
Conflict: A Positive Lens
Conflict is a variance in perceptions and opinions that involves a perceived or actual threat.
Threat is embedded in conflict because a person’s perception or position quickly becomes part of who they are, and opposition to this perception creates defensiveness. A perceived threat or an actual threat happens with conflict because you perceive that something/someone is challenging your beliefs or needs and may affect your sense of self or the relationship you have with them.
- Have you ever perceived a threat when having a difference of opinion or disagreed with someone else?
- Have you ever felt a sense of threat in a setting where deeply ingrained power dynamics are present?
- Have you been engaged in a class discussion where you had a different perspective on things than another person?
You may feel worried about speaking up because the other person has a different perspective from yours. You may fear that if you speak up, they will think you are ignorant or that it may affect your relationship with them.
Conflict can trigger strong emotions and has the potential to negatively impact how you respond and communicate. Consider how you have responded to conflict in the past.
- Did you ignore or avoid the conflict?
- Did you take the disagreement personally?
- Did you engage in an intense and relentless argument?
- Have you ever not addressed it with the person, but instead posted on social media or gossiped to a friend or peer?
These are all ineffective ways to deal with conflict because they never address the actual problem – the conflict itself.
It is essential to understand and address conflict, as it is a natural part of any relationship, both at home and in professional settings. If you change your perspective on how you perceive conflict, you will be more likely to resolve it effectively.
Conflict as an Opportunity
You can learn and grow by truly listening to another person’s view and sharing your own. Part of this is seeking to understand what the perceived threat is for you and for the other person(s).
If approached professionally, this sharing can help you feel good about having shared your opinion, why it matters to you, and participating collaboratively and respectfully to manage the conflict.
Additionally, by learning and growing while engaging professionally with another person, this can sometimes create a connection that cultivates your relationship with them. It can also add to a positive resolution related to the conflict, with the potential for creative and divergent thinking.
Common Sources of Interpersonal Conflict
Conflicts are inevitable when working on a team composed of members with different personalities, roles, and responsibilities. Common sources of interpersonal conflict in healthcare settings include passive-aggressiveness, horizontal aggression, defensiveness, peer informer behavior, and victimization behaviors (Elizabeth, 2019).
Passive-Aggressiveness
Passive-aggressiveness is a behavior that reveals a disconnection between what a person says and what they do. Often, a passive-aggressive person will initially agree with another person’s request, but later express feelings of frustration or anger to others and fail to 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 would be helpful for you to directly communicate concerns to me so we can discuss them and make a plan for going forward” (Elizabeth, 2019).
Horizontal Aggression
The nursing literature describes diffuse incivility and bullying among nurses in the workplace (Bambi et al., 2017). Horizontal aggression refers to hostile behavior among one’s peers. It is unacceptable and should be directly confronted in a constructive manner; otherwise, it will worsen.
Incivility is a serious issue within the nursing profession (intraprofessional) and across various healthcare professionals (interprofessional). Incivility within communication encounters or interactions involves the covert (subtle) or overt disrespect of another person. Most often, they take the form of non-verbal and verbal behaviours. This includes demeaning, humiliating, and belittling language, hurtful teasing/jokes, name-calling, slurs, insults, and criticism as opposed to critique. Non-verbal behaviours, specifically eye-rolling and other facial and bodily expressions, can also be included. Other behaviours include ostracism and purposefully ignoring someone, not helping colleagues, or continually assigning someone workloads that are considered difficult and problematic.
Keep in mind that intraprofessional or interprofessional conflict does not constitute incivility or harassment. You will likely encounter conflicts in the workplace where you have strong opposing points of view. Additionally, your supervisor or a peer may even provide feedback or constructive criticism in a supportive manner; this also does not constitute incivility.
You may not readily recognize that you are being bullied or harassed, and not everyone who bullies or harasses is aware of their own behaviour. Sometimes, these behaviours arise due to interprofessional conflict, but they can also be caused by personal issues. For example, healthcare team members could have stress at home, financial concerns, or anger management issues. All of these factors can influence how individuals engage with others in various settings, including the healthcare environment, and the stresses associated with this environment can also be contributing risk factors. Whatever the reason, you have the right to a workplace that is free from any form of incivility.
- 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 (Elizabeth, 2019).
- If you observe incivility, step in and support the person on the receiving end. If you feel comfortable and safe, consider having a discussion with the person exhibiting uncivil behavior. Engage in an inquisitive discussion to better understand why it is occurring, and, if the person understands what they are doing and its impact on the other person. For example, you might say to them, “I noticed that you have repeatedly rolled your eyes and interrupted ______ when they were sharing their perspective. Were you aware of your behaviour?”
Defensiveness
Receiving negative feedback can be challenging. 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” (Elizabeth, 2019).
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 to support it. It is best to respond to the informer by asking them to speak directly with their team member about their concerns, unless the matter is urgent and requires immediate attention. 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 (Elizabeth, 2019).
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 am I always the last to know?” Team members who feel victimized should be reminded that they are held to the same standards as other nurses (Elizabeth, 2019).
As an example, a bedside nurse is reminded by the charge nurse to complete hourly rounding documentation in the electronic health record before the end of her shift. The nurse becomes upset and responds, “I’m always the one getting told to do extra charting—no one else gets talked to about this!”
In this situation, the charge nurse should respond calmly and explain that all nurses are expected to complete hourly rounding documentation as part of the unit’s standard of care. It is important to focus the conversation on the policy and expectations rather than comparing staff performance. The charge nurse might say, “Hourly rounding documentation is required for all patients on our unit. I’m reminding everyone about it because it helps us ensure patient safety and continuity of care.”
Conflict Management
Individuals manage conflict differently. During conflict, a person’s behavior is typically driven by their commitment to either their goals or their relationships.
- 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 employ various methods to resolve conflicts, selecting the strategy that best suits the situation. 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 (2017) describes five approaches to dealing with conflict: avoiding, competing, accommodating, compromising, and collaborating. Each of these steps is further described in the following sections.
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, particularly among individuals who tend to view conflict in a negative light. See Table 11.1 for types of avoidance, potential results, and situations when this strategy may be appropriate.
Table 11.1 – Avoidance Approach
| Types of Avoidance Approaches | Potential Results | Appropriate Use |
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Application to Nursing—Avoidance
When might avoidance be an appropriate approach to conflict in a hospital or clinic setting?
In a hospital or clinical setting, there may be times when it is appropriate to avoid conflict. For example, on a particularly busy day in the emergency room, when a patient in a life-threatening condition has just been received, the attending doctor may bark directions at the assisting nurses to get equipment. The nurses may feel offended by the doctor’s actions; however, it may be appropriate for the nurses to avoid the conflict at that moment, given the emergency situation. The nurse, if they felt it was inappropriate behavior by the doctor, could then address the conflict after the patient has been stabilized.
When might avoidance be an inappropriate approach to conflict in a hospital or clinic setting?
Avoiding the conflict may be inappropriate if the same doctor continues to bark directions at the nursing staff in non-emergency situations. In this case, avoidance is no longer appropriate, and the conflict must be addressed to establish a positive and respectful working environment.
Competitive Approach
A competitive approach to conflict management demonstrates a high commitment to goals and a low commitment to relationships. Individuals who employ the competitive approach pursue their goals at the expense of others and will use whatever power is necessary to win. A competitive approach may 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.). Refer to Table 11.2 for details on types of competitive approaches, potential results, and their appropriate uses.
Table 11.2 – Competitive Approach
| Types of Competitive Approaches | Potential Results | Appropriate Use |
|---|---|---|
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Application to Nursing—Competitive
Accommodating Approach
An accommodating approach to conflict management demonstrates a low commitment to goals and a 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 employed to establish reciprocal adaptations or adjustments; however, when the other party fails to reciprocate, conflict can arise. 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, driven by a feeling of “being used,” which can lead to conflict. Refer to Table 11.3 for details on the types of accommodating approaches, potential results, and suitable applications.
Table 11.3 – Accommodating Approach
| Types of Accommodating Approaches | Potential Results | Appropriate Use |
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Application to Nursing—Accommodation
When might accommodation be an appropriate approach to conflict in a hospital or clinic setting?
It may be appropriate to use an accommodating approach when, for example, one of the nurses on your shift has a particularly challenging patient who is consuming a lot of time and effort. Seeing that the nurse is having difficulty, you take on some of her or his tasks. This increases your workload for a period of time, but it allows your colleague the time needed to deal with the difficult patient.
When might accommodation be an inappropriate approach to conflict in a hospital or clinic setting?
This approach may no longer be appropriate if the same nurse expects you to continue covering their tasks after the situation with the difficult patient has been resolved.
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 to achieve a quick solution that works for both parties. It typically involves both parties giving up something in return for something, thereby “meeting in the middle.” Refer to Table 11.4 for details on types of compromising approaches, potential outcomes, and suitable applications.
Table 11.4 – Compromising Approach
| Types of Compromising Approaches | Potential Results | Appropriate Use |
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Application to Nursing—Compromise
When might compromise be an appropriate approach to conflict in a hospital or clinic setting?
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 to 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.
You are currently on shift with Pam, a nurse who does the bare minimum and rarely likes to help his or her colleagues out. Pam 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 to a patient with diabetes. You ask Pam to obtain the patient’s lunch tray while you complete their request for assistance with a blood draw. Pam agrees.
When might a compromise be an inappropriate approach to conflict in a hospital or clinic setting?
It would be inappropriate to continue to ask the nurse to do tasks for you that are less appealing than the tasks you take on. It would also be inappropriate to refuse to assist the nurse based on their reputation, as this could compromise safe and effective care for the patient.
Collaborative Approach
The collaborative approach to conflict resolution demonstrates a strong commitment to both goals and relationships. The collaborative approach aims to address the concerns and priorities of all parties, but trust and a willingness to take risks are essential for this approach to be effective. Refer to Table 11.5 for details on types of collaborative approaches, potential outcomes, and suitable applications.
Table 11.5 – Collaborative Approach
| Types of Collaborative Approaches | Potential Results | Appropriate Use |
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Application to Nursing—Collaboration
When might collaboration be an appropriate approach to conflict in a hospital or clinic setting?
It may be appropriate to use collaboration in a hospital or clinic setting when discussing vacation time off with team members at a team meeting. During a team meeting, time is available to discuss and focus on what is important for each member of the team.
When might collaboration be an inappropriate approach to conflict in a hospital or clinic setting?
Collaboration would be inappropriate in a discussion of a new policy that has been implemented if the team has little influence in making adjustments.
Identifying Conflict Management Approaches in Others
There are times when other individuals take an approach that is not helpful in resolving the conflict. It is important to remember that 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.
Here are some examples of needs underlying their approaches to conflict and suggested ways to address them:
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- 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 a competitive approach often feel the need to accomplish something 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, regardless of what happens during the conversation, the 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 keep your word.
- People using the collaborative approach may need to understand what you want before they feel comfortable sharing their own needs. It may be helpful to say, “I need this, this, and this…What do you need?”
All approaches to conflict can be appropriate for specific situations, but they can also be inappropriate or overused. When conflict arises, take a moment to consider which approach is most beneficial for the situation. Keep in mind that using the wrong approach can escalate conflict, damage relationships, and reduce your ability to effectively meet team goals. Effective conflict management approaches foster trust in relationships, achieve goals, and mitigate conflict.
Everyone has the capacity to utilize 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 the needs that exist beneath the surface of the conflict, you can work with the other person toward achieving a common goal.
Take this Conflict Assessment Quiz to identify your preferred conflict management style.
Escalating Conflict in Patient Care
Communication is a particularly important strategy to use when your purpose is to de-escalate a situation. Escalation can occur in any healthcare situation when clients are encountering intense emotions and experiences entangled with stress, fear, anger, uncertainty, pain, and lack of control. This can lead to the client spiraling out of control, agitation, aggression, and even violence. Contextual factors may include clients who have received bad news, such as a diagnosis, clients who are under the influence, and/or clients who are having a mental health crisis. Attend to your own safety and be aware of the potential risk factors. It is important to notify a colleague(s) when interviewing a client who is at risk of, or has a history of, escalating.
Case Example – Patient Care
A family is upset about the nursing care their loved one is receiving, and tells you that after watching you do an assessment on the client, you “clearly don’t know what you’re doing.”
Analysis
- The family member’s words could cause a sense of threat for you. Perhaps you fear being falsely accused and reported, and are unsure of the consequences that might ensue. You may get very defensive and insist that you did “nothing wrong.”
- On the other hand, this family may be feeling a very different threat, i.e., perhaps they fear their loved one’s condition is deteriorating, and they may lose them soon. Any small error (or perceived error) in their loved one’s care may trigger fear around losing them.
- Having a conversation with the family to acknowledge the threat (i.e., fear) they are experiencing may be beneficial to resolving the conflict over their perception of your care.
De-escalation encompasses strategies to mitigate and prevent escalation. De-escalating communication strategies include:
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- Acknowledge and value how the patient feels and be non-judgmental.
- Avoid downplaying or judging the patient’s feelings.
- Engage in active listening to understand the situation and explore the reason for the escalation.
- Offer genuine interest, concern, and empathy.
- Remain calm and do not let your voice or nonverbal communications reveal rising emotions.
- Recognize the patient’s self-determination and collaborate with them on how to address the issue.
- Maintain your safety, but do not act afraid.
- Maintain your professionalism and refrain from taking the situation personally.
Watch this video on dealing with difficult patients
Escalating Conflict in the Healthcare Team
Conflict can also happen between healthcare providers and colleagues you work with. It can take on a life of its own and escalate beyond reason. Negative consequences within the team often occur, and patient safety can be compromised. Increased rates of absenteeism and turnover may also occur (Michigan State University, 2009).
Conflict tends to escalate under the following conditions:
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- There is an increase in emotions such as anger and frustration.
- 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 (Michigan State University, 2009).
However, conflict can be de-escalated under the following conditions:
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- 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 (Michigan State University, 2009).
Escalating Conflict – Colleagues
(See Associated Graphic – Figure 11.1)
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A conflict begins between two team members who become short-tempered with each other while caring for a patient experiencing a medical emergency.
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Cooperation: 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.”
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If an appropriate conflict management approach is not employed, the parties tend to shift from cooperation to competition. (“I’ll bend – but only if they bend first.”)
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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?”)
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Positions begin to harden, and defensiveness sets in, creating adversarial encounters.
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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?”)
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As communication deteriorates, parties rely on assumptions about the other individual and attribute negative motives to them. (“I bet they did that on purpose.”)
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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.”)
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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.”)
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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?”)
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Parties begin to feel righteous and blame the other for the entire problem. Personalization and stereotyping begin. (“I know what those kinds of people are like. . . We can’t let them get away with this.”)
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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.
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Mutual self-destruction: 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.”)
(The Center for Congressional Health, 2011)
Figure 11.1 – Conflict Escalation
Conflict Resolution
Conflict resolution involves finding a reasonable solution to varying perspectives. This may involve you and the other person(s) sharing your perspectives to enhance understanding of the issue. It may result in you or the other person shifting your perspective in a way that leads to a reasonable solution being arrived at regarding the conflict.
An appropriate level of risk must be taken by the individuals involved to resolve the conflict. Taking these risks can be scary as it requires people to be vulnerable and express emotions. You may feel uncertain about how to address it and frightened that it will affect your relationship with the other person(s). There may also be power dynamics involved. Be courageous and act despite the fear, vulnerability, and uncertainty you may feel. It is better to be direct with the person you have a conflict with than to harbour resentment. You get courageous by being courageous. By taking necessary risks to resolve conflict, nurses can convey that they want to rebuild trust, respect, and effective communication.
Typically, when conflict is not resolved appropriately, it leads to further conflict in the relationship. The relationship continues in a state of heightened sensitivity to actions, and assumptions can be formed quickly. Actions that may have been previously viewed as innocent or acceptable may now be perceived as threatening. Every unresolved conflict reduces the time it takes to escalate the conflict due to this heightened sensitivity.
Conflict Resolution Strategies
When conflict is left unresolved, the conflict can lead to tension, decreased morale, and compromised patient care. When resolving conflict, the desired goal is for both parties to reach a satisfactory resolution, known as a “win-win solution.” However, it is essential to acknowledge that a win-win solution is not always feasible in every situation.
Engaging in effective conflict resolution takes practice. Fortunately, conflict resolution is a skill that you can learn, and that is a good thing. There are several conflict resolution strategies that can inform your communication.
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- Utilize effective communication strategies (Russotto et al., 2019)
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- Open communication: Communication is a two-way process where individuals express their thoughts, feelings, and concerns while also actively listening to the thoughts, feelings, and concerns of others.
- Assertive communication: When communicating, express yourself in a direct, honest, and appropriate ways that also respect the rights of others.
- Respectful communication: Communicate respectfully by maintaining good eye contact, conveying empathy, being aware of nonverbal communication, and focusing on the concern rather than making personal attacks.
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- Approach the situation with an open mind and a spirit of inquiry
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- You should enter the discussion with an open mind and strive to understand the other person’s perspective.
- Reflect on what the perceived or actual threat is for you, and seek to understand what the other person(s)’ perceived or actual threat is. This may be a very different conversation from the issue that started the conflict.
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- Assume the goodwill of another person
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- This means avoid entering a situation with a negative attitude. It is best to assume the other person’s willingness to engage in kind and professional discussions. However, do note that assuming goodwill does not mean that the other person will end up agreeing with your perspective or behave in that manner. It may be that after a full discussion, you agree to disagree.
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- Use “I” statements when you engage in conflict resolution
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- These statements are important because they convey how you feel (from your standpoint) and open the opportunity for discussion. “I” statements are difficult to counter-argue because they are your perspective on the situation, as opposed to “you” statements, which insinuate knowing the other person’s position without understanding and can lead to accusations and feelings of blame.
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- Do not raise your voice
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- Raising your voice is not helpful to resolve a conflict; it escalates the situation and makes people defensive. There is a famous quote by Desmond Tutu, who says, “Don’t raise your voice, improve your argument” (Nelson Mandela Foundation, 2004).
- In email, avoid using capital letters, bolding, and exclamation marks, as they can be interpreted as shouting or expressing anger. Also, never write anything in an email that you would not directly say to a person.
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- Be clear and provide a rationale for your perspective
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- This strategy can help the other person understand your perspective.
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- Utilize effective communication strategies (Russotto et al., 2019)
Tip: One strategy to help you address conflict is to write it down on a piece of paper and say it out loud. This can help you identify and acknowledge the emotions associated with the conflict. Then, when addressing the conflict with the individual, focus on the issue rather than the personal emotions, which could impact the discussion.
Conflict and Conflict Resolution in Teams
Conflict is a natural occurrence on teams. It arises when two or more individuals have opposing thoughts, ideas, feelings, perceptions, behaviors, values, opinions, or actions. It is an inevitable part of professional, social, and personal life and can lead to either constructive or destructive consequences. The constructive consequences of conflict include stimulating growth, fostering open and honest communication, increasing group cohesion and commitment to common goals, facilitating understanding and problem-solving, motivating change, and promoting creativity. On the other hand, conflict can also have destructive consequences, such as fostering hostility within a group, promoting rivalry and competition, and creating misperceptions, distrust, and frustration, ultimately leading to group dissatisfaction with the outcome.
Effective conflict resolution (See Table 11.6) enables the early identification and resolution of issues, preventing conflicts from escalating and negatively impacting both the team and patient care (Ambrose et al., 2021).
Table 11.6 – Team Conflict Resolution Approaches (Haack & Hughes, 2019).
| Conflict Resolution Approach | Description | Examples |
|---|---|---|
| Collaborative Problem-Solving | Parties work together to find a mutually beneficial solution. | In a health care team, conflict arises between two nurses regarding the fairness of client assignments. They engage in open dialogue, actively listening to each other’s concerns, and collaboratively devise a fair and balanced plan for client assignments based on acuity. |
| Mediation | A neutral third party facilitates communication and negotiation. | A conflict arises between a nurse and a respiratory therapist regarding a client’s care plan. A nurse manager acts as a mediator, guiding both parties through open communication, helping them understand each other’s perspectives, and reaching a resolution through compromise. |
| Compromising | Both parties make concessions to reach a middle ground. | A conflict arises between two nurses regarding the scheduling of a committee meeting. They compromise by adjusting the meeting time to accommodate both parties’ availability and reach a mutually agreeable solution. |
| Active Listening and Assertively Communicating | Parties express their concerns and actively listen to each other, using assertive communication. | Two team members have differing opinions on a client’s treatment plan. They express their concerns assertively, while actively listening to understand each other’s viewpoints, leading to a mutually agreed-upon plan that incorporates the best of both perspectives. |
| Escalating Up the Chain of Command | Parties involve higher-level supervisors to intervene. | A conflict between two healthcare professionals persists and remains unresolved. The issue is escalated to the department head or supervisor, who intervenes to find a resolution and restore cohesiveness and function within the team. |
| Avoiding | Parties ignore or withdraw from a conflict. In the short term, this may be effective in calming heated emotions. However, if this approach is used chronically, it can damage trust and rapport by signaling a lack of interest or commitment (LinkedIn, 2023). | A conflict arises between two nurses, escalating into a heated discussion as they debate a client’s nursing care plan. They agree to take a “time out” and revisit the discussion at a later time. |
| Accommodating | One party resolves the conflict by “giving in” to the other party. This may be useful when one party realizes they are in error or if the other party is an expert or has more experience. However, it is also crucial to be aware of when accommodating might be detrimental to you or your team’s best interest (Indeed, 2025) | A conflict arises when two nurses disagree on the best method for initiating IV access for a client. |
| DESC Tool | A bedside nurse is caring for a patient who was admitted with pneumonia. The physician plans to discharge the patient later that afternoon. However, the nurse observes that the patient’s oxygen saturation drops when ambulating and feels the patient is not stable for discharge. The nurse uses the DESC tool to address the concern in a respectful and collaborative manner.
The DESC tool can be used to help resolve conflict by using “I statements.” DESC is a mnemonic that stands for the following:
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D – Describe: E – Express: S – Suggest: C – Consequences: |
Consider the following example of a conflict in a healthcare setting that requires conflict resolution, and reflect on the strategies that could be implemented to resolve it.
Team Scenario: Conflict Requiring Resolution
In a long-term care facility, Sarah, an LPN/VN, and Emma, a certified nursing assistant, find themselves in a conflict regarding the delegation of tasks and workload distribution. Sarah believes that Emma is not taking on her fair share of responsibilities or providing adequate support to the residents. On the other hand, Emma feels overwhelmed by the assigned workload and believes that Sarah is not acknowledging her efforts. Both parties firmly believe they are “right” within their positions and are unwilling to compromise.
What conflict resolution strategy could be used to satisfactorily address the conflict between these two team members?
Conclusion
Conflict is inevitable. Nurses should be able to understand the causes of conflict and learn how to manage and resolve them. The first step to managing conflict is to reflect on your own experiences and understand your personal approach to conflict. After learning their own preferred style, learn to understand the styles of others and adapt your approaches accordingly. Managing conflict is not something to be feared; rather, it is something that can be learned and practiced. It just takes time.
“Change the way you think about disagreements, and how you behave during conflict. Be willing to listen, engage directly, constructively, and collaboratively with your colleagues.”
—Cloke and Goldsmith, 2011
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Media Attributions:
- Brown Ram on Unsplash by Jean Wimmerlin is licensed under CC0
- NurseMinder.n(2022, March 15). Dealing with difficult patients for nurses [Video]. YouTube. https://www.youtube.com/watch?v=3eFXLcHZIcs
