Veterinary nurses are no strangers to the art of conflict resolution. The veterinary clinic is often a high-pressure environment, frequently staffed by trait perfectionists (Crane et al, 2015), and attended by sometimes stressed clients (Spitznagel et al, 2018). It is no wonder that recent studies have identified a range of wellbeing issues that can be caused by conflict, such as compassion fatigue, burnout and moral injury (Moses et al, 2018; Montoya et al, 2020; Vivian et al, 2022). Conflicts are often driven by differences in values and beliefs between the participants (Harinck and Druckman, 2017), and yet this element can sometimes be minimised in discussions of conflict resolution. This article discusses the impact of values and moral beliefs on conflicts within the veterinary industry and identifies strategies to help achieve acceptable compromise and reduce challenges to wellbeing.
What is a value conflict?
Value conflicts occur when a situation clashes with a person's deeply held moral beliefs and values, such as religious or political views (Harinck and Druckman, 2017). This article uses a range of examples to illustrate how these values can clash. It is important to note that these examples are used only for this purpose; it is not the purpose of this article to argue which points of view are correct, only to discuss how conflict might be mitigated.
An example of value conflict between veterinary staff and clients can be futile care. This is when veterinary staff feel that a patient is suffering too much to continue with treatment, and that euthanasia would be a kinder option (Moses et al, 2018). but he owner insists on continuing treatment. This could be an expression of their personal values, such as feeling they must ‘do everything possible’ because they owe it to their companion, or it may be linked to their religion; some Hindus and Buddhists believe that deliberately killing an animal violates their sacred beliefs (Rayner et al, 2020).
Another example comes from within the clinic. Consider veterinary nurse ‘A’. They believe that to be a ‘good’ veterinary nurse, they should always put animals first, even at the expense of personal health and welfare. Veterinary nurse A would consider it essential to their self-image, as a good veterinary nurse, to skip breaks and work unpaid overtime. They might also judge other veterinary nurses by this set of values, as to whether they are ‘good’ veterinary nurses or not. By contrast, veterinary nurse B might value animal welfare, but place an equal value on their own wellbeing. B might argue that they have an obligation to themselves, their family and friends not to burn themselves out in their work. Both nurses have strong personal views on what it means to be a veterinary nurse, and the values that a ‘good’ veterinary nurse would hold. These contrasting views could cause friction in the workplace.
Consequences of value conflicts
Although there is limited research on values conflict in the veterinary environment, it is among the factors that can contribute to burnout and compassion fatigue. Recent studies (Irwin et al, 2022a; 2022b) have shown that incivility is a common experience within the veterinary profession. According to a Royal College of Veterinary Surgeons (RCVS) survey carried out by the Mind Matters Initiative, 96% of surveyed staff felt that bullying and incivility were a serious problem in the veterinary nursing profession (Mind Matters Initiative Press Office, 2021). Research from New Zealand showed a lower but still serious frequency of bullying of veterinarians, with a negative effect on the wellbeing of the victims (Gardner and Rasmussen, 2018). Moore et al (2015) found that veterinary technicians in the USA were more likely than veterinarians to feel the effects of toxic work environments, and less likely to speak up about their concerns.
Studies of mental health within the veterinary field often mention value-related conflicts as stressors. One survey of American veterinary technicians showed a higher level of stress than the general population, with one major factor identified as support staff taking the blame from veterinarians and clients for negative outcomes (Foster and Maples, 2014). Moses et al (2018) surveyed American veterinarians and found that over 70% felt that conflict over animal care caused them stress. A survey regarding veterinary nurse recruitment and retention in the UK found client, team and management conflicts were frequently cited as reasons to leave the profession (Hagen et al, 2022). One survey of Japanese veterinary nurses even found that 40% of respondents had experienced verbal, physical or sexual harassment within the previous year (Yukawa and Yukawa, 2022).
Managing value conflicts
The following stages are based on works by Burke (2006), Doherty and Guyler (2008) and Levine (2009) and provide an overview of key lessons in conflict resolution.
Stage 1: be aware of your own values
All veterinary nurses should be aware of the Veterinary Nurse Code of Professional Conduct (RCVS, 2023), and most veterinary nurses would have had professional ethics embedded into their course. However, many students find ethical theories difficult to relate to real-world practice. Theories such as deontology or contractarianism can seem very abstract compared to the clinical environment. One way to evaluate these theories is to strip them down to basic statements, for example:
- Utilitarianism: always do whatever is the best for the greatest number of individuals
- Deontology: always do your duty and follow the rules.
While these may be gross oversimplifications in philosophical terms, this process can help the individual put their own values into context. This can make it easier to consider why a veterinary nurse might find a particular situation challenging, or to explain to another person why they feel an action would clash with their values.
Stage 2: be aware of the values of others
This step seems obvious, but when we are faced with apparent incivility or challenges to our beliefs, it is very easy to forget to consider the point of view of others. Often the best answer, when having an immediate emotional response to the actions of views of others, is to give your-self a chance to think. Take a deep breath, and perhaps count to ten in your head. This gives you time to think about why the person in question is acting the way they are or holding a specific opinion. None of this requires you to agree with their point of view or surrender your own, but without understanding, there can be no progress towards resolution.
Stage 3: ask questions
It can be easy, when faced with an opinion that conflicts with your values, to immediately start defending your views. However, this is likely to cause a similar response in the other person, and this often results in both parties becoming more entrenched in their beliefs. Instead, ask questions such as:
- ‘What is the most important thing to you in this situation?’
- ‘Can I ask why you prefer that option?’
This allows the other person to express themselves and explain their position, which has a double benefit. Firstly, you now have a better understanding of why they hold a particular view. This may help you think of a way to better engage with them to consider other options, or it may be that you had completely misunderstood them in the first place and you have now avoided an unnecessary conflict. Secondly, the other person now feels acknowledged and listened to. This will make them more likely to engage in discussion and consider compromise.
Stage 4: be willing to compromise
Not all values have the same importance. For example, some people consider their religious values to be unbreakable commandments. For many people, values are a preference, and are put into context by other values. For example, a client may wish to take every possible treatment option for a pet but might also feel it is unfair to put their children through the emotions involved with caring for an animal needing intensive management. Where possible, giving a range of options is best. Letting clients feel that they have made the best possible choice in a difficult situation can reduce the potential for the client feeling that their choice has been judged negatively. Showing that you respect the client – for example, by stating that you can see how much they care for their pet – can reduce defensiveness (Harinck and Druckman, 2017).
Stage 5: accept that you may not resolve the issue
Not all conflicts can be resolved. As an example, a client who strongly views pets as property might not be swayed from euthanasia of an animal they deem inconvenient, potentially viewing surrender of the animal as giving away property. The choice whether to agree to this demand might not rest well with the veterinary nurse, and they may be put in the position of euthanising a healthy animal. In such situations, veterinary nurses must cultivate personal resilience. Studies of the nursing profession have shown that moral agency is one factor that can mitigate moral distress; nurses who felt able to advocate for their patients were more resilient to distress, even though they did not always achieve the outcome that they desired (Traudt et al, 2016).
Case studies
Returning to the example of veterinary nurses A and B described earlier, it is possible to consider a situation where these two individuals might come into conflict. At the end of a hectic day, the clinic could be in a mess because urgent cases took up all staff time. Veterinary nurse A might suggest that all staff remain late to finish the cleaning; veterinary nurse B might feel that, after a hectic day, they need some time to recover. Step 1 and 2 would help these two express why they prefer one action over another, and to understand why the other felt differently. Rather than criticising each other's attitudes, they could ask questions and discuss. For example, if B asked A about their reasoning, A might say that another emergency could arrive first thing in the morning, and they worry that they might not be prepared to care for that patient properly. B could share this concern, but explain that they are trading off this risk vs the loss of limited time to spend with their children before bedtime. From a position of understanding, they might be able to compromise. They could stay a little longer and make sure all of the critical items are ready for the following day, so that veterinary nurse A's concerns are alleviated, but without cutting too much into veterinary nurse B's family time.
In the case of futile care described earlier, asking questions might help the veterinary nurse provide suitable advice. The client may feel that this pet is like a best friend or child; they may believe very strongly that they should do anything possible to give their companion the chance to continue to live. Understanding this motivation allows the veterinary nurse to discuss the possibility of euthanasia not as giving up on your companion, but making the final difficult choice to end their suffering. This client may be willing to weigh up these options and accept that there may be a point where ‘do everything you can’ has become ‘we have done all we should’. By contrast, if the client holds strong religious views regarding euthanasia, they are unlikely to change these based on welfare issues, even if they are upset by the situation. Discussion of palliative care and focusing on relieving pain and suffering as much as possible may allow the client and veterinary team to agree on a treatment plan.
Conclusions
Many cases are not as simple as the ones described above; multiple individuals may be involved, including clients and different team members, each with their own values. Factors such as realistic patient outcomes and cost will play a part and constrain what can be done. However, the steps outlined above provide a template for minimising conflict and the associated stress. In more complicated or ongoing cases, it may be best to bring in an external professional with experience in conflict resolution to provide impartial support and advice. However, understanding the fundamentals can help veterinary nurses to reduce at least some workplace stressors, and better support clients and peers.
KEY POINTS
- Values conflicts are common in the veterinary environment.
- Differences between personal and professional values of staff and clients can lead to conflict.
- Understanding of the values of self and others can reduce conflict.
- Acknowledging the values of others improves the possibility of compromise.
- Not all values conflicts can be satisfactorily resolved.