In recent years, organisations have witnessed an increasingly diverse workforce. As a consequence of such social diversification, conflict can occur (Labrague et al, 2018), but what exactly is conflict? According to Rahim (2011) it can broadly be defined as an interactive process manifested in incompatibility, disagreement or dissonance within or between social entities and can occur as a consequence of opposing views, opinions, interests and preferences.
Conflict within a healthcare setting
Conflict amongst healthcare professionals has been recognised as a significant issue both in the UK within the NHS and globally (McKibben, 2017; ACT Academy 2018; Labrague et al, 2018). Patton (2014) suggested it may emerge as a result of several elements including complexity in the organisation, varying role expectations, interdepartmental competition, constraints in the decision-making process and personality differences. Almost et al (2016) further suggested that poor work environments, communication problems, and a lack of organisational support also contribute towards workplace conflict. This is in congruence with Erdenk and Altuntas (2017) and Labrague et al (2018) who stated that nurses, being the largest healthcare professional group, are always confronted with complex problems involving conflicts amongst other team members, managers, patients and their relatives because of the uncertainties in duties, powers and responsibilities and status differences. It is the author's opinion that a number of these factors can be extrapolated to the role of a veterinary nurse and conflict experienced within veterinary practice due to this being a similar high stress healthcare environment.
Identifying signs of conflict
Observing a heated argument between colleagues is an obvious sign of conflict, however many of the early signs of conflict are subtle. Early signs according to ACT Academy (2018) include:
- A reduction in motivation or team morale
- A reduction in people volunteering for tasks or contributing to meetings
- A greater reluctance to offer ideas or discuss feelings openly
- An increase in dissatisfaction or the development of a ‘them and us’ culture
- Greater avoidance between team members, which may in turn contribute to increased rates of sickness absence.
It is of course important to remember that clinical professionals are in fact trained to challenge information, concepts and ideas, thus what appears as conflict may simply be them testing out the validity of a project — direct questioning does not mean that people are against you or the objectives of the proposal, it may simply be their way of gathering further information for consideration (ACT Academy 2018).
Conflict — a double edged sword
Conflict is a complex process with both negative and positive effects (Wingfield, 2012; Almost et al, 2016). As highlighted above, unresolved and unmanaged conflict may result in a number of factors that can affect the overall productivity of an organisation. The Chartered Institute of Personnel and Development (2015) suggested that organisations use over 19 days per year of management time dealing with grievances and disciplinary cases as a result of conflict. Advisory, Conciliation and Arbitration Service (Acas) (2014) stated that conflict between work colleagues can often lead to accusations of bullying or harassment. Ramsey (2001) intimated that a group or organisation can hold vicarious liability for condoning a hostile work environment if it fails to act when a complaint is made.
A well-managed conflict, however, can contribute to innovation and creativity, stronger organisational relationships and higher staff commitment, which Labrague et al (2018) suggested could in fact result in a higher level of staff and organisational performance. This is in congruence with Wingfield (2012) who suggested that constructive conflict is regarded as a component of high-functioning teams because a range of perspectives can produce innovative and resourceful outcomes to problems.
Managing conflict
As mentioned, conflict does contain a destructive element and thus appropriate management strategies are essential in order to assist both parties to arrive at an acceptable solution to resolve the conflict (Rahim, 2011). A number of conflict management styles have been described, for example: dominating/competition; obliging/accommodation; avoiding, compromising and integrating/collaboration. Such styles are multifaceted and Almost et al (2016) suggested that while a person may use a particular style more than others, the choice of style can vary depending on individual characteristics, contextual factors, organisational and socio-cultural context, and interpersonal conditions. As such, in-depth discussion of these styles is beyond the scope of this article. The focus therefore will be on practical steps in the conflict resolution process that can be used to help team members discuss and mediate conflict.
The role of a head nurse/nurse leader in the management of conflict should be to help team members work more effectively together to ensure high standards of patient care and client satisfaction. It is important to keep in mind that conflict does not only impact on the people involved. All team members and potentially clients with whom the conflicting employees interact, are affected by the resulting stress (Sherman, 2012).
Approach to conflict
In its simplest form, Acas (2014) suggested most people respond to conflict in one of three main ways (Table 1): fight, flight or freeze.
Table 1. Three common approaches to conflict (Acas, 2014)
| Fight | You react in a challenging way. At work this may mean shouting or losing your temper |
| Flight | You turn your back on what's going on. This is a common reaction — you hope that by ignoring the problem it will go away |
| Freeze | You are unsure how to react and become very passive. You might begin to deal with the issue but things drift or become drawn out through indecision |
Face the situation
For many novice head nurses/nurse leaders, the thought of confronting interpersonal conflict within their team can be frightening, however ignoring the situation will not make it go away. Unresolved conflict will lead to increased stress levels and ultimately feelings of anger, hostility and resentment, which are very damaging to a team and ultimately may threaten levels of patient care. Before addressing the individuals concerned in the conflict, it can help lessen feelings of fear to think through the strategy for addressing the issue including any salient points that need to be raised. This can help novice leaders to feel more in control, rational and stay on target (Cardillo, 2011; Acas, 2014).
Bring the individuals together
While it may seem obvious that there is a need to bring individuals together who are in conflict with one another, it is not uncommon to encounter resistance from those involved in the conflict. The temptation for novice head nurses/nurse leaders is to allow the people involved to individually tell their side of the story without the other party being in the room. Sherman (2012) suggested that in adopting this strategy, you risk polarizing their positions, and thus suggested that these discussions must not be a one-sided monologue and all parties concerned must participate in the discussion together. Bringing individuals together also provides the opportunity to observe important non-verbal cues from the parties concerned.
E-mail and letter writing should be avoided to discuss conflict as it is too impersonal and indirect and increases the potential for miscommunication and misunderstanding (Cardillo, 2011).
Agree to ground rules
Sherman (2012) suggested it can be helpful for novice head nurses/nurse leaders to establish some ground rules regarding the discussion. Such ground rules may include topics such as no interrupting, no personal attacks and no discussion of issues unrelated to the specific conflict.
Let the other person clarify their perspective
It is essential to allow each person to tell their story from their perspective without interruption. Sherman (2012) suggested that it can be helpful to apply a time limit to the discussion, as doing so helps to enable each person to speak about the issues that really matter while reducing conversational clutter which has no bearing on the conflict.
Highlight some common ground
Identifying common ground in conflict is important as it can serve as a reference point to help bring discussion back on track. Within a healthcare setting, most staff will agree that they are there to provide a high standard of patient care. Sherman (2012) suggested that when conflict escalates, it can be helpful to bring the individuals back to the point of common ground.
Develop interventions collaboratively — agree to disagree at times
The role of the head nurse/nurse leader is to aim to help the individuals to develop interventions collaboratively. Where this is not possible, and there is a major point of contention, holding desperately to a dogmatic grudge is not helpful and it may become necessary to just agree to disagree (Sherman, 2012).
Use a mediator if required
If a situation is particularly volatile or efforts at resolving the conflict have failed, Cardillo (2011) suggested that it may be necessary to invite a neutral third party to act as a mediator if this is agreeable to all concerned. The role of the mediator is to remain objective, listen to both sides, and facilitate resolution and compromise, this may involve developing longer-term strategies for resolution (Acas, 2014; ACT Academy, 2018).
Apologise if appropriate
Having one-to-one conversations with employees and managers requires a great deal of sensitivity and empathy (Acas, 2014). As a novice head nurse/nurse leader, you may struggle to express yourself clearly or make your point clear. It is important to be aware of your own part in the process; if you have inadvertently said something incorrect or inappropriate, Cardillo (2011) suggested you must be prepared to acknowledge it and apologise, even when the initial conflict was not as a result of your actions.
The checklist in Figure 1 may be useful at any stage of conflict resolution.
Minimising the potential for future conflict
As a novice head nurse/nurse leader, it is important to work at fostering good relationships amongst team members. McKibben (2017) suggested that new members of staff entering an already established team must be supported and integrated, to encourage mutual role respect between all team members and establish positive working relationships. There will always be a difference of opinion and needs amongst team members due to differing cultural backgrounds and beliefs; promoting a safe culture and providing staff with a forum for open and honest dialogue about their experiences of delivering care is important. Cornwell and Goodrich (2009) advocated a safe and recrimination-free environment in which to discuss the everyday challenges, pressures and frustrations of the job was essential to encourage communication within a team and to improve team dynamics. It is important that staff know that they are not alone — they have the names of trusted colleagues they can call on for guidance and support. This was further supported by Acas (2014) who suggested that by listening to the views of employees at an early stage, before issues become potential problems, it may be possible to gauge future reaction to proposed changes.
The implementation of employee feedback forms or questionnaires may also help the organisation to put in place preventative measures to minimise future conflict arising.
Assuming positive intent
The concept of assuming positive intent is really rather simple — you choose to give people the benefit of the doubt, rather than assuming they are out to get you! For example, if someone sends a seemingly rude e-mail, it is easy to assume that they were out to embarrass us in front of the people they copied in. Assuming positive intent would enable us to view the situation from a different angle — as busy healthcare professionals, it is easy to send a rushed e-mail and not realise it may have a negative tone. Hall (2017) stated that negative intent is much more easily assumed when people do not regularly engage with each other in person, further suggesting that when a company's work environment is more collaborative and employees better understand each other's different roles, they are less likely to get caught up in their individual silos. This in turn will make them more likely to approach a colleague in person to settle a misunderstanding rather than to send a curt e-mail or to let the situation fester.
The culture of an organisation, however, is established, in large part, by the actions of the people at the top. Hall (2017) suggested that if the management team assumes worst intent in their own employees, those employees will assume the worst in their colleagues. At the end of the day, everyone has a choice about how they communicate and interact with their colleagues. As a leader, however, you have the ability to set the tone for others and encourage them to react in a positive way. When you assume positive intent you let others know you have confidence in them, and people will often go to great lengths for someone who believes in them (Box 1).
Box 1.Positive intent exercise
- The next time a colleague sends you an e-mail that you do not like the tone of or says something that makes you feel uncomfortable, take a step back.
- Assume positive intent — if you struggle to find the positive in what the person has said, rather than allowing the situation to escalate, talk to them!
- Calmly let them know that you do not understand and open up a dialogue.
- Try assuming positive intent — you might be surprised by what you learn and how your relationships with the people around you improve.
Conclusion
Conflict cannot be avoided, however it can be minimised and in most cases resolved. Although avoidance may seem like the best route to take, facing conflict head-on in an appropriate and professional manner will ultimately lead to better working relationships, a more productive environment and empowerment of the team. When your working life is inherently stressful, Dale (2000) suggested that a comfortable working atmosphere can have a major impact on your peace of mind and that of your peers, colleagues and clients.
KEY POINTS
- Conflict amongst healthcare professionals has been recognised as a significant issue.
- Early signs of conflict can be subtle.
- Conflict is a complex process with both negative and positive effects.
- The thought of confronting interpersonal conflict within a team can be frightening.
- Unresolved conflict can be very damaging to a team.
- Leaders have the ability to set the tone for others and encourage staff to act in a positive way.