5 pages1) Read from page 1- page 35, they are the pages from the following book, make sure to add this book to the reference page.Finkelman, A. (2012). Leadership and management for nurses: Core Competencies for quality care (2nd ed.). Boston, MA: Pearson.2, The extra request about he paper are in the attached guideline. Please read the request in details and write the paper according to the request.Chamberlain College of Nursing
NR447: RN Collaborative Healthcare
Conflict Resolution Paper:
Guidelines and Rubric
PURPOSE
The purpose of this assignment is to learn how to identify and effectively manage conflicts that arise in
care delivery settings resulting in better management of patient care, including appropriate delegation.
You will gain insight into conflict management strategies and develop a plan to collaborate with a
potential nurse leader about the conflict and its impact in a practice setting.
DIRECTIONS
1. Read Finkelman (2012), page 1-page 35.
2. Observe nurses in a care delivery setting. Identify a recurring conflict with the potential to
negatively impact patient care. Decide if delegation was an issue in the conflict. This should be
from your practice setting or prelicensure experiences.
3. Provide details of what happened, including who was involved, what was said, where it
occurred, and what was the outcome that led you to decide the conflict was unresolved.
4. Identify the type of conflict. Explain your rationale for selecting this type.
5. Outline the four stages of conflict, as described in our text, and how they relate to your
example.
6. Propose strategies to resolve the conflict. Search scholarly sources in the library and the Internet
for evidence on what may be effective.
7. Discuss if delegation was an issue in the conflict. Be specific.
8. Describe how you would collaborate with a nurse leader to reach consensus on the best strategy
to employ to deal with the conflict.
9. Describe the rationale for selecting the best strategy.
10. Provide a summary or conclusion about this experience or assignment and how you may deal
with conflict more effectively in the future.
11. Write a 5– page paper (not including the title or References pages) using APA format that
includes the following.
a. Describe an unresolved (recurring) conflict that you experienced or observed. Identify
the type of conflict.
b. Provide details of what happened, including who was involved, what was said, where it
occurred, and what was the outcome that led you to decide the conflict was unresolved.
c. Outline the four stages of conflict, as described in Finkelman, and how the stages relate
to your example. Decide if delegation was an issue in the conflict. Be specific.
d. Describe the strategies for conflict resolution and how you would collaborate with a
nurse leader to resolve the conflict. Cites resources.
e. Provide a conclusion or summary about this experience and how you may deal with
conflict more effectively in the future.
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f.
NR447: RN Collaborative Healthcare
Submit to the Dropbox by the end of Week 3.
GRADING CRITERIA: CONFLICT RESOLUTION PAPER
Category
Detailed description
of conflict, including
type of conflict
Four stages of
conflict and
relationship to
identified conflict,
including delegation
issues
Strategies for
conflict resolution
and collaboration
with a leader,
including resources
Conclusion or
summary
Points
60
\%
30 \%
Description
Describes the conflict, providing details and type of conflict
40
20\%
Describes stages and their relationship to identified
conflict and delegation
60
30\%
Various strategies for resolution of identified conflict;
discusses collaborative efforts with a nurse leader to
resolve conflict; includes resources
20
10\%
Provides a conclusion about the learning experience and
how this assignment will provide guidance for future
conflict resolution skills
20
10\%
200 points
100\%
Content is organized, logical, and with correct grammar,
punctuation, spelling, and sentence structure are correct.
APA formatting is apparent and CCN template is utilized.
References are properly cited within the paper; reference
page includes all citations; proper title page and
introduction are present, and evidence of spell and
grammar check is obvious.
A quality paper will meet or exceed all of the above
requirements.
Clarity of writing
Total
GRADING RUBRIC CONFLICT RESOLUTION PAPER
Assignment
Criteria
Detailed
description of
conflict,
including type
of conflict
60 points
A (100\%)
Exceptional
B (88\%)
Exceeds
C (80\%)
Meets
Outstanding or
highest level of
performance
After an
introduction
paragraph, paper
thoroughly
provides
Very good or
high level of
performance
After an
introduction
paragraph, paper
clearly provides
observations of
conflict in
practice setting.
Competent or
satisfactory level
of performance
After an
introduction
paragraph, the
paper provides
observations of
conflict in
practice setting.
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NI (38\%)
Needs
Improvement
Poor or failing
level of
performance
After an
introduction
paragraph, the
paper provides
observations of
conflict in
practice setting.
F (0\%)
Developing
Unsatisfactory
level of
performance
After an
introduction
paragraph, the
paper does NOT
provide
observations of
2
Chamberlain College of Nursing
Four stages of
conflict and
relationship
to identified
conflict,
including
delegation
issues
40 points
Strategies for
conflict
resolution
and
collaboration
with a leader,
including
resources
60 points
NR447: RN Collaborative Healthcare
observations of
conflict in
practice setting.
The paper
thoroughly states
if negative
outcomes were
observed and
identifies the
specific type of
conflict observed.
It provides details
of what
happened,
including who
was involved,
what was said,
where it
occurred, and
what was the
outcome that led
you to decide the
conflict was
unresolved.
60 points ☐
Paper thoroughly
outlines the four
stages of conflict,
as described in
Finkelman, and
how the stages
relate to the
example. It states
if delegation was
an issue in the
conflict.
40 points ☐
It clearly states if
negative
outcomes were
observed and
identifies the
specific type of
conflict observed.
It provides some
details of what
happened,
including who
was involved,
what was said,
where it
occurred, and
what was the
outcome that led
you to decide the
conflict was
unresolved.
53 points ☐
It briefly states if
negative
outcomes were
observed and
identifies the
specific type of
conflict observed.
It provides few
details of what
happened,
including who
was involved,
what was said,
where it
occurred, and
what was the
outcome that led
you to decide the
conflict was
unresolved.
48 points ☐
It does not state
if negative
outcomes were
observed or
identifies the
specific type of
conflict observed.
It provides few
details of what
happened,
including who
was involved,
what was said,
where it
occurred, and
what was the
outcome that led
you to decide the
conflict was
unresolved.
23 points ☐
conflict in
practice setting.
It does not state
if negative
outcomes were
observed or
identifies the
specific type of
conflict observed.
It provides NO
details of what
happened,
including who
was involved,
what was said,
where it
occurred, and
what was the
outcome that led
you to decide the
conflict was
unresolved.
0 points ☐
Paper clearly
outlines the four
stages of conflict,
as described in
Finkelman, and
how the stages
relate to the
example. It states
if delegation was
an issue in the
conflict.
35 points ☐
Paper generally
outlines the four
stages of conflict,
as described in
Finkelman, and
mostly how the
stages relate to
the example.
Does not state if
delegation was
an issue in the
conflict.
32 points ☐
Paper briefly
outlines the four
stages of conflict,
as described in
Finkelman, and
minimally how
the stages relate
to the example.
Does not state if
delegation was
an issue in the
conflict.
15 points ☐
Paper describes
in detail
strategies for
conflict
resolution and
collaboration
with a nurse
leader to resolve
conflict.
Besides the
course textbook,
the paper cites
two scholarly
Paper generally
describes
strategies for
conflict
resolution and
collaboration
with a nurse
leader to resolve
conflict.
Besides the
course textbook,
the paper cites
Paper briefly
describes
strategies for
conflict
resolution and
collaboration
with a nurse
leader to resolve
conflict.
It only cites the
course textbook.
It cites an
additional source
Paper minimally
describes
strategies for
conflict
resolution and
collaboration
with a nurse
leader to resolve
conflict.
It only cites the
course textbook
and no additional
sources. The
Paper does not
outline the four
stages of conflict
as described in
Finkelman. It
does not state
how the stages
relate to the
example. It does
not state if
delegation was
an issue in the
conflict.
0 points ☐
Paper describes
NO strategies for
conflict
resolution and
collaboration
with a nurse
leader to resolve
conflict.
It does NOT cite
the course
textbook or other
sources. The
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Conclusion
and summary
20 points
Clarity of
writing
20 points
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articles and
thoroughly
summarizes all
resources.
60 points ☐
one scholarly
article.
It generally
summarizes both
of them.
53 points ☐
but NOT a
scholarly article.
The summary
lacks detail.
48 points ☐
summary lacks
detail.
23 points ☐
summary is
missing.
0 points ☐
Paper provides a
thorough
conclusion or
summary and
description of
plans for dealing
with conflict in
the future.
20 points ☐
Content is
organized,
logical, and
grammar,
punctuation,
spelling, and
sentence
structure are
correct. APA
formatting is
apparent,
utilizing CCN
template.
References are
properly cited
within the paper.
Reference page
includes all
citations; proper
title page and
introduction are
present and
evidence of spell
and grammar
check is obvious.
Less than three
errors are noted.
20 points ☐
Paper provides a
general
conclusion or
summary and
description of
plans for dealing
with conflict in
the future.
18 points ☐
Content is mostly
organized,
logical, and
grammar,
punctuation,
spelling, and
sentence
structure are
correct. APA
formatting is
apparent,
utilizing CCN
template.
References are
properly cited
within the paper.
Reference page
includes all
citations; proper
title page and
introduction are
present and
evidence of spell
check and
grammar check is
obvious. Four to
six errors are
noted.
18 points ☐
Paper provides a
brief summary
and description
of plans for
dealing with
conflict in the
future.
16 points ☐
Paper provides a
minimal
summary and
description of
plans for dealing
with conflict in
the future
8 points ☐
Paper does not
provide a
conclusion or
summary and NO
future plans for
dealing with
conflict.
0 points ☐
Content is
somewhat
organized, logical
and grammar,
punctuation,
spelling, and
sentence
structure are
correct. Minor
APA formatting
errors exist.
References are
properly cited
within the paper.
Reference page
includes all
citations; proper
title page and
introduction are
present and
evidence of spell
check and
grammar check
are not obvious.
Seven to 10
errors are noted.
16 points ☐
Content is
somewhat
organized, but
may lack logic.
Several errors
occur in
grammar,
punctuation,
spelling, and
sentence
structure. Major
APA formatting
errors exist.
Reference page
does not match
up with in-text
citations, i.e.,
references may
be missing for intext citations, or
references
appear with no
comparable intext citation.
Eleven to 15
errors are noted.
8 points ☐
Content is
disorganized and
writing has
numerous
grammar,
spelling, or
syntax errors.
APA formatting
was not used.
Spell check and
grammar check
are not obvious.
More than 15
errors are noted.
0 points ☐
Total Points Possible= 200
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Negotiation and Conflict Resolution
Conflict can never be eliminated in organizations; however, conflict can be managed.
Typically, conflict arises when people feel strongly about something. Conflicts may take place
between individual staff, within a unit, or within a department. They may be inter-unit and
interdepartmental, affect the entire organization, or even occur between multiple
organizations, between or within teams or units, or between an organization and the
community. Conflict
is the “tension arising from compatible needs, in which the actions of
one frustrate the ability of the other to achieve a goal” (Boggs, 2003, p. 366).
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Key Definitions
There are three types of conflict: individual, interpersonal, and intergroup/organizational
(Dessler, 2002). The most common type of individual conflict in the workplace is role conflict,
which occurs when there is incompatibility between one or more role expectations. When
staff does not understand the roles of other staff this can be very stressful for the individual
and does affect work. Staff may be critical of each other for not doing some work activity
when in reality it is not part of the role and responsibilities of that staff member, or staff
members may feel that another staff member is doing some activity that really is not his or
her responsibility.
Interpersonal conflict occurs between people. Sometimes this is due to differences and/or
personalities, competition, or concern about territory, control, or loss.
Conflict also occurs between groups (e.g., units, services, teams, health care professional
groups, agencies, community and a health care provider organization, and so on). When
conflict occurs something is out of sync, usually due to a lack of clear understanding of one
another’s roles and responsibilities. “Conflict can be overt or covert, and both can lead to
problems as well as opportunities. However, covert conflict processes, obviously, tend to be
fluid and difficult to describe. It is in behaviors between individuals and groups, as well as
individual behaviors that are observable. These behaviors can be categorized as reactive,
repressive, or avoidant. Reactive behaviors include high levels of competition, inefficiency,
‘yesing’ people with no real attempt to understand, whining, complaining, destructive
behavior, counter organization moves, and passive-aggressive behaviors such as escapist
drinking, irregular output, or frequent expression of low job satisfaction. In workplaces that
are ripe with unacknowledged conflict, rumor mills flourish. Repressive behaviors include
absenteeism, whereas avoidant behaviors can include withholding information, avoidance of
contact with managers or other team members, or ‘hiding out’ on the job” (Clement, 2001, p.
212).
Everyone has experienced covert conflict. It never feels good and increases stress quickly.
Distrust and confusion about the best response are also experienced. Acknowledging covert
conflict is not easy, and staff will have different perceptions of the conflict since it is not clear
and below the surface. Overt conflict is obvious, at least to most people, and thus coping
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with it is usually easier. It is easier to arrive at an agreement when conflict is present and
easier to arrive at a description of the conflict.
The common assumption about conflict is that it is destructive, and it certainly can be. There
is, however, another view of conflict. “Despite its adverse effects, conflict is viewed by most
experts today as potentially useful because it can, if properly channeled, be an engine of
innovation and change. This view explicitly encourages a certain amount of controlled
conflict in organizations because lack of active debate can permit the status quo or mediocre
ideas to prevail” (Dessler, 2002, p. 315). In reality, staff really cannot avoid conflict because
some conflict is inevitable. The following quote speaks to the need to recognize most conflict
as opportunity. “When I speak of celebrating conflict, others often look at me as if I have just
stepped over the credibility line. As nurses, we have been socialized to avoid conflict. Our
modus operandi has been to smooth over at all costs, particularly if the dynamic involves
individuals representing roles that have significant power differences in the organization. Be
advised that well-functioning transdisciplinary teams will encounter conflict-laden situations.
It is inevitable. The role of the leader is to use conflicting perspectives to highlight and hone
the rich diversity that is present within the team. Conflict also provides opportunities for
individuals to present divergent yet equally valid views that allow all team members to gain
an understanding of their contributions to the process. Respect for each team member’s
standpoint comes only after the team has
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explored fully and learned to appreciate the diversity of its membership” (Weaver, 2001, p.
83). This is a very positive view of conflict, which on the surface may appear negative. If one
asked nurses if they wanted to experience conflict, they would say no. Probably behind their
response is the fact that they do not know how to handle conflict and feel uncomfortable with
it. However, if you asked staff, “Would you like to work in an environment where staff at all
levels could be direct without concern of repercussions and could actively dialogue about
issues and problems without others taking comments personally” then many staff would most
likely see this as positive and not conflict. Avoidance of conflict, however, usually means that
it will catch up with the person again, and then it may be more difficult to resolve. There may
then be more emotions attached to it, making it more difficult to resolve.
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Causes of Conflict
Effective resolution of conflict requires an understanding of the cause of the conflict;
however, some conflicts may have more than one cause. It is easy to jump to conclusions
without doing a thorough assessment. Some of the typical causes of conflict between
individuals and between groups are “whether resources are shared equitably; insufficient
explanation of expectations, leading to performance being questioned; unexplained changes
that disturb routines and process and that team members are not prepared for; and to stress
resulting from changes that team members do not understand and may see as threatening”
(Finkelman & Kenner, 2010, p. 359). Other causes are ambiguous jurisdiction, conflict of
interest, communication confusion, and unresolved conflicts (Hansten & Jackson, 2008).
Two predictors of conflict are the existence of competition for resources or inadequate
communication. It is rare that a major change on a unit or in a health care organization does
not result in competition for resources (staff, financial, space, supplies) so conflicts will arise
between units or between those who may or may not receive the resources or may lose
resources. As has been demonstrated in some of the examples, causes of conflict can be
varied. An understanding of a conflict requires as thorough an assessment as possible.
Along with the assessment, it is important to understand the stages of conflict.
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Stages of Conflict
There are four stages of conflict that help describe the process of conflict development
(Marquis & Huston, 2009).
1. Latent conflict
. This stage involves the anticipation of conflict. Competition for
resources or inadequate communication can be predictors of conflict. Anticipating
conflict can increase tension. This is when staff may verbalize, “We know we are
going to have a hassle with this” or may feel this internally. The anticipation of conflict
can occur between units that accept one another’s patients when one unit does not
think that the staff members on the other unit is very competent and yet they must
accept orders and patient plans from them.
2. Perceived conflict
. This stage requires recognition or awareness that conflict
exists at a particular time. It may not be discussed but only felt. Perception is very
important as it can affect whether or not there really is a conflict, what is known about
the conflict, and how it might be resolved.
3. Felt conflict
. This occurs when individuals begin to have feelings about the
conflict such as anxiety or anger. Staff feels stress at this time. If avoidance is used
at this time, it may prevent the conflict from moving to the next stage. Avoidance may
be appropriate in some circumstances, but sometimes it just covers over the conflict
and does not resolve it. In this case, the conflict may come up again and be more
complicated. Trust plays a role here. How much does staff trust that the situation will
be resolved effectively? How comfortable do staff members feel in being open with
their feelings and opinions?
4. Manifest conflict
. This is overt conflict. At this time the conflict can be
constructive or destructive. Examples of destructive behavior related to the conflict
are (a) ignoring a policy, (b) denying a problem, (c) avoiding a staff member, or (d)
discussing staff in public with negative terms. Examples of constructive responses to
the conflict are (a) encouraging the group to identify and solve the problem, (b)
expressing appropriate feelings, or (c) offering to help out a staff member (
Figure 12-1
highlights the stages of conflict).
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Figure 12-1 Stages of conflict.
Prevention of Conflict
Some conflict can be prevented so it is important to take preventive steps whenever possible
to correct a problem before it develops into a conflict. A staff team or organization that says it
has no conflicts is either not aware of conflict or prefers not to acknowledge it. Prevention of
conflict should focus on the typical causes of conflict that have been identified in this chapter.
Clear communication, known expectations, appropriate allocation of resources, and
delineation of roles and responsibilities will go a long way toward preventing conflict. If the
goal is to eliminate all conflict this will not be successful, because it cannot be done.
Since not all conflict can be prevented, staff and managers need to know how to manage
conflict and resolve conflict when it exists. It is important to identify potential barriers that can
make it more likely that a situation will turn into a conflict or will act as barriers to conflict
resolution. First and foremost, if all staff makes an effort to decrease their tension or stress
level, this will go a long way in preventing or resolving conflict. In addition to this strategy, it is
important to improve communication, recognize team members as members with expertise,
listen and compromise to get to the most effective decision given the available data,
understand the roles and responsibilities of team/staff members, and be willing to evaluate
practice and team functioning.
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Conflict Management: Issues and Strategies
Conflict management is critical in any organization. When conflicts arise then managers and
staff need to understand conflict management issues and strategies. The major goals of
conflict management are as follows:
1. To eliminate or decrease the conflict
2. To meet the needs of the patient, family/significant others, and the organization
3. To ensure that all parties feel positive about the resolution so that future work
together can be productive
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Powerlessness and Empowerment
When staff experiences conflict, powerlessness and empowerment, as well as
aggressiveness and passive-aggressiveness, become important.
1. Power and powerlessness
When staff members feel that they are not recognized, appreciated, or paid attention
to, then they feel powerlessness
. What happens in a work environment when
staff feels powerlessness? First, staff members do not feel that they can make an
impact—they are unable to change situations that they feel need to be changed. Staff
members will not be as creative in
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approaching problems. They may feel that they are responsible for tasks and yet
have no control or power to affect change with these tasks. The team community will
be affected negatively, and eventually the team may feel it cannot make change
happen. Staff may make any of the following comments: “Don’t bother trying to make
a difference,” “I can’t make a difference here,” and “Who listens to us?” Morale
deteriorates as staff feels more and more powerless. New staff will soon pick up on
the feeling of powerlessness. In some respects, the powerlessness really does
diminish any effort for change. As was discussed in Chapter 3
, responding to
change effectively is very important today. In addition when staff feels powerless this
greatly impacts the organizational culture.
Power
is about influencing decisions, controlling resources, and affecting behavior.
It is the ability to get things done—access resources and information, and use it to
make decisions. Power can be used constructively or destructively. The power a
person has originates from the person’s personal qualities and characteristics, as
well as the person’s position. Some people have qualities that make others turn to
them—people trust them, consider their advice helpful, and so on. A person’s
position, such as a team leader or nurse manager, has associated power.
Power is not stagnant. It changes as it is affected by the situation. There are a
number of sources of power. Each one can be useful depending on the
circumstances and the goal. An individual may have several sources of power; for
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example, a team leader may have legitimate power due to the position held, expert
power due to team members’ recognition of the team leader’s expertise in care of
oncology patients, and persuasive power because the team leader is able to
convince team members the best steps to take to solve a problem. The common
sources of power include the following.
. This power is what one typically thinks of in relation to
Legitimate power
power. It is power that comes from having a formal position in an organization
such as a nurse manager, team leader, or vice president of patient services.
These positions give the person who holds one of them the right to influence staff
and expect staff to follow requests. Staff members recognize that they have tasks
to accomplish and job requirements.
Reward power
. A person’s power comes from the ability to reward others
when they comply. Examples of reward power include money (such as an
increase in salary level), desired schedule or assignment, providing a space to
work, or recognition of accomplishment.
. This type of power is based on punishment when a person
Coercive power
does not do as expected or directed. Examples of this type include denial of a
pay raise, termination, and poor schedule or assignment. This type of power
leads to an unpleasant work situation. Staff will not respond positively to coercive
power, and this type of power has a strong negative effect on staff morale.
. This informal power comes from others recognizing that an
Referent power
individual has special qualities and is admired. This person then has influence
over others because they want to follow the person due to the person’s charisma.
Staff feels valued and accepted.
Expert power
. When a person has an expertise the person can have power
over others who respect that expertise. When this type of power is present, the
expert is able to provide sound advice and direction.
Informational power
. This type of power arises from the ability to access and
share information, which is critical in the Information Age.
Persuasive power
. This type of power influences others by providing an
effective point-of-view or argument (Finkelman & Kenner, 2010). (Box 12-4
highlights the types of power.)
It is important to note that a leader must have legitimate power. “A mugger on the
street may have a gun and power to threaten your life, but not qualify as a leader,
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because leading means influencing people to work willingly toward achieving your
objectives. That is not to say that a little fear can’t be a good thing, at least
occasionally” (Dessler, 2002, p. 212).
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Box
12-4 Types Of Power
1. Legitimate
2. Reward
3. Coercive
4. Referent
5. Expert
6. Informational
7. Persuasive
This is a critical concept to understand about leadership and power. However, it takes
more than power to be an effective leader and manager. “If you have the traits and
you have the power, then you have the potential to be a leader” (Dessler, 2002, p.
212).
All organizations experience their own brand of “politics.” Some staff and managers
find themselves maneuvering to acquire power within the organization. This is
directly influenced by the goals that people feel are important to them. These goals
may come in conflict with the goals of others, and when this happens, holding greater
power may make a difference in who “wins.” Political power maneuvering can
become unpleasant for staff and managers and can also damage the organization’s
culture. Trust may decrease, along with effective communication, coordination,
collaboration, and resolution of conflicts. This is not to say that all political power in
the organization is negative, but it is a slippery slope and needs to be carefully
observed. Part of this process is the need to identify where the power is coming from
and to learn how to access the power to meet goals (Marrelli, 2004). As has been
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said, power can be used negatively, and this can also lead to the unethical use of
power or not doing the right thing with the power. Chapter 2
discusses examples
of ethical issues. There is no doubt that there are managers who use their power to
control staff, as well as staff who use power to control other staff, but this is not a
healthy use of power. Rather, it is a misuse of power and does not demonstrate
nursing leadership.
A self-appraisal of a person’s personal view of power allows the individual to better
understand how the person uses power and how it then affects the person’s
decisions and relationships. This can lead to more effective responses to change
during planning and decision making, coping with conflict, and the ability to
collaborate and coordinate.
2. Empowerment
Empowerment
is often viewed as the sharing of power; however, it is more than
this. “To empower is to enable to act” (Finkelman & Kenner, 2010, pp. 108). Power
must be more than words, but rather it must be demonstrated. Participative decision
making empowers staff, but only if staff really do have the opportunity to participate
and influence decisions. Recognizing that one’s participation is accepted makes a
difference. True empowerment gives the staff the right to choose how to address
issues with the manager.
Should all staff be empowered? A critical issue to answer this question is whether or
not staff can handle decision making. This implies that staff members need
leadership qualities and skills to make sound decisions and participate together
collaboratively. They need to be able to use communication effectively. When staff
members are selected, all these factors become important. Empowerment is not
gained just by being a member of the staff, but rather staff members become
empowered because they are able to handle it. Management that wants to empower
staff must transfer power over to the staff, but management must first feel confident
that staff can handle empowerment.
When staff is empowered some limits or boundaries need to be set or conflict may
develop. Some of these boundaries are established by the organization’s policies,
procedures, and position descriptions, education and experience, and by laws and
regulations (for example, nurse practice acts). The manager must be aware of these
boundaries and establish any others that may be required (for example, direct
involvement of staff in the selection process for new equipment). If staff members are
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involved in the decision making, then they should first be given a list of several
possible equipment choices that meet the budgetary requirements from which to
choose. It is critical that the manager make clear
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the boundaries, or staff members will feel like their efforts are useless if their
suggestions are rejected because they were not given the boundaries. What does
this mean? Roles and responsibilities need to be clearly described, and if they
change, they need to be discussed. At the same time the nurse manager or the team
leader must not control, domineer, or overpower staff. This type of response is
usually seen in new nurse managers or team leaders who feel insecure. Ineffective
use of empowerment can be just as problematic as a lack of empowerment.
Although empowering one’s self may seem like an unusual concept, it is an important
one. The amount of power a person has in a relationship is determined by the degree
to which someone else needs what the other person has. Anger is related to
expectations that are not met, and when these expectations are not met, the person
may act out to gain power. It is the responsibility of the nursing profession to
communicate what nurses have to offer to patient care and to the health care delivery
system, but individual nurses also need to understand what they have to offer as
nurses. To have an impact this communication and development must be ongoing.
Empowerment can be positive if the strategies that are used to gain empowerment
are constructive (for example, gaining new skills, speaking out constructively,
networking, using political advocacy, increasing involvement in planning and decision
making, getting more nurses on key organization committees, improving image
through a positive image campaign, and developing and implementing assertiveness
skill). There are many other strategies that can result in empowerment that improves
the workplace and the nurse’s self-perception.
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Aggressive and Passive-Aggressive Behavior
Aggressive and passive-aggressive behavior can interfere with successful conflict resolution
and might even be the cause of conflict. When staff members are hostile to one another, the
team leader, or the nurse manager, anxiety rises. Hostile behavior can be a response to
conflict. It is important to recognize personal feelings. The first response should be to get
under control and communicate control to the hostile staff member. The nurse manager or
team leader may be the one who is hostile, which makes it even more complex and requires
assistance from higher level management. Hopefully, someone will recognize the need to
bring the situation under control and try to move to a private place. Demonstrations of open
conflict with hostility should not take place in patient or public areas. If the suggestion to
move to a private area does not work and the situation continues to escalate, simply walking
away may help set some boundaries. Cool down time is definitely needed.
There are many times when more information is really required before a response can be
given. If this is the case, everyone concerned needs to be told that when information is
gathered the issue or problem will then be discussed. No one should be pressured to
respond with inadequate information as this will lead to ineffective decision making and may
lead to further hostility. It is critical that after further assessment is completed that there be
additional discussion and a conclusion. “Unless the behavior of a difficult person is physically
threatening, try ignoring it. Deal only with the heart of the matter. Focus your attention on the
issue and work at refocusing your ‘opponent’s’ attention. Repeatedly use his or her name.
State and restate the problem. Try to defuse emotion—yours first, because ultimately the
only person you really control is yourself” (Forman, 2001, p. 13). These are methods that
can help move a negative situation into a positive one.
When there are problems with patients and families, what is the best way to cope? Many of
the same strategies mentioned earlier can be used. Safety is the first issue, as it must be
maintained. It is never appropriate to allow patients or families to demonstrate anger
inappropriately. When this occurs, someone needs to set reasonable limits that are based on
an assessment of the situation. There may be many reasons for anger and inappropriate
behavior, such as pain, medications, fear and anxiety, psychosis, dysfunctional
communication, and so on. Staff needs to avoid taking things personally, as this will interfere
with thoughtful problem solving. When one gets defensive or emotional, interventions taken
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to resolve a conflict may not be effective. Active listening is critical to cope with emotions. If a
different culture is involved, then this factor needs
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to be considered (for example, some cultures consider it appropriate to be very emotional
and others do not). In the long term, clear communication is critical during the entire process.
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How Do Individual Staff Members Cope With Conflict?
Not everyone responds to conflict in the same way, and individuals may vary in how they
respond dependent upon the circumstances. Four typical responses to conflict are
avoidance, accommodation, competition, and collaboration (Boggs, 2003).
Avoidance occurs when a person is very uncomfortable and cannot cope with the anxiety
effectively. This person will withdraw from the situation to avoid it. There are times when
this may be the most effective response, particularly when the situation may lead to
negative results, but in many situations this will not be effective in the long term. This
response might occur when a staff member is in conflict with a manager and disagrees
with the manager. The staff member must consider whether it is worth it to disagree
publicly. Typically, avoidance occurs when one side is perceived as more powerful than
the other. It is a helpful approach when more information is needed, or when the issue is
not worth what might be lost.
A second response is accommodation. How does this occur? The person tries to make
the situation better by cooperating. The critical issue may not be resolved, or not be
resolved to the fullest satisfaction. The goal is just to eliminate the conflict as quickly as
possible. Accommodation works best when one person or team is less interested in the
issue than the other. It can be advantageous as it does develop harmony, and it can
provide power in future conflict since one party was more willing to let the conflict deflate.
Later interaction may require that the other party cooperate.
A third response is competition. How does this work? Power is used to stop the conflict.
A manager might say, “This is the way it will be.” This closes further efforts from others
who may be in conflict with the manager.
Collaboration is the fourth response, which has been discussed in this chapter. This is a
positive approach, with all parties attempting to reach an acceptable solution, and in the
end both sides feel that they won something. Collaboration often involves some
compromise, which is a method used to respond to conflict.
Using the best conflict resolution style can make a difference in success. There are many
ways that a conflict can be resolved. When conflict occurs each person involved has a
personal perspective of the issue and conflict. Today there is more conflict in the health care
delivery environment with increased workplace stress that may lead to misunderstandings,
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ineffective communication, and reduced productivity and dysfunctional organizations as
noted in the Institute of Medicine reports (2001; 2004).
Gender Issues
Are there differences in the way that women and men negotiate? There are differences in
how women and men approach leadership issues such as conflict (Caliper, 2004). Men tend
to negotiate to win while women focus more on what is fair. It is believed that this is related
to the way children play through sports and activities. Women will make an effort to reach
win-win solutions. Men will test the limits that have been set more overtly than women, so it
is important for women to ensure that limits are set and maintained. It is important, despite
the differences described, to avoid stereotyping. (See Chapter 8
for additional gender
differences.)
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Nurse–Physician Relationships
Though the nurse–physician relationship should be the strongest relationship that nurses
have in order to meet the needs of the patient, it frequently is not. Both sides of the
relationship play a role in the inadequacies of this relationship. Conflict does occur, and this
conflict can act as a barrier to effective patient care. Literature about Magnet hospitals
distinguishes between collegial and collaborative relationships and between nurses and
physicians (Kramer & Schmalenberg, 2002). Collegial relationships are those where there
is equality of power. This power is different but equal power and knowledge. In contrast,
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collaborative relationships between nurses and physicians focus on mutual power, but the
physician’s power is greater. The nurse’s power is based on the nurse’s extended time with
patients, experience, and knowledge. In addition to power, this relationship requires respect
and trust between the nurse and physician. Due to these factors, it is a complex relationship.
Nurses have long worked on teams, mostly with other nursing staff. However, the nurse–
physician relationships have become more important in the changing health care
environment with the greater emphasis on interprofessional teams. Nurse–physician
interactions and communication have been discussed for a long time in health care literature.
A study that explored the impact of nurse–physician relationships on nurse satisfaction and
retention, conducted by a physician, was reported in 2002 (Rosenstein, 2002). The results
of the 1,200 nurses, physicians, and hospital executive survey “suggest that daily
interactions between nurses and physicians strongly influence nurses’ morale (Rosenstein,
2002, p. 26). Overall, 96\% of the nurses had witnessed or experienced disruptive physician
behavior, including yelling or raising the voice, disrespect, condescension, berating
colleagues, berating patients, and use of abusive language. The survey found 344 nurses
who knew of other nurses who had left the hospital due to disruptive behavior. These nurses
did not feel that the administration supported the resolution of conflict between nurses and
physicians. This study recommended the following improvement strategies, which could
apply to most health care organizations, which continue to be important strategies to improve
the nurse–physician relationship.
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Create more opportunities for collaboration and communication through open forums,
group discussions, and collaborative relationships.
Increase availability of training and educational programs for nurses and physicians that
focus on improving teamwork and working relationships (for example, sensitivity training,
assertiveness training, conflict management, time management, and phone etiquette,
with emphasis on courtesy, respect, promptness, and preparation).
Improve organizational processes by requiring administrators to take a more proactive
approach to avoiding potential confrontations related to staffing, scheduling, and
equipment.
Establish a zero-tolerance policy for disruptive behavior, holding nurses and physicians
more accountable for their actions.
Disseminate code-of-conduct policies and reporting guidelines to both nurses and
physicians, and apply policies consistently and quickly, providing feedback to all
involved.
Ensure appropriate nurse competencies.
Have physicians sign a code-of-conduct policy when they are credentialed or recredentialed.
Appoint a physician leader who will take charge of training and education programs.
Provide an ongoing forum to increase physician awareness of the issues addressed in
this survey and raise awareness of other factors that increase nurses’ stress levels.
Place physicians on nurse recruitment teams, enabling them to gain a better
understanding and appreciation of the factors that are important to nurses as they
consider employment opportunities.
Provide a case study or conduct role-play exercises that allow physicians a firsthand
understanding of nurses’ responsibilities and work flow (Rosenstein, 2002, pp. 32–33).
Other studies have examined work relationships and patient outcomes. Rosenstein and
O’Daniel (2005) surveyed 1,500 nurses and physicians about the impact of disruptive
behavior on job satisfaction and retention. Disruptive behavior included verbal abuse. In this
study nurses were perceived as being disruptive as much as physicians. Nurses and
physicians surveyed felt that disruptive behavior had a negative impact on stress levels,
relationships, communication, collaboration, and transfer of information leading to problems
with quality of care and patient satisfaction. Lower (2007) uses the following descriptors for
disruptive behavior: verbal abuse, negative behavior, and physical abuse (e.g., profanity,
innuendo, demeaning comments), reprimanding or insulting another in public, threatening,
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telling racial or ethnic jokes, undermining team cohesion, scapegoating, silence (not
speaking to a team member), assaulting
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another, throwing objects, and outbursts of rage. In a study of 20 medical and surgical
residents nurse–physician relationships were reviewed from the perspective of relational
coordination (Weinberg, Miner, & Rivlin, 2009), which is a theory that views high-quality
relationships and communication among participants in the work process as important for
effective outcomes (Gittell, 2001). The results of this qualitative study are disturbing though
the study was small and had other limitations. Positive relationships depended on whether
the resident viewed the nurse as cooperative and competent. Most communication was
motivated by the need to tell the nurses something, not necessarily looking for professional
feedback from the nurse. The physicians had limited knowledge of the various nursing
degrees or which nurses had which degrees and also did not differentiate from RNs, LPNs,
or unlicensed assistive personnel. Physicians, however, are not the only health care
providers that nurses must work with while they provide care (for example, nurses work with
other nursing staff, social workers, support staff, laboratory technicians, physical therapists,
pharmacists, and many others). There are also other members joining the health care team
such as alternative therapists (massage therapists, herbal therapists, acupuncturists, etc.),
case managers, more actively involved insurers, and so forth. The future will probably bring
other new members into the health care delivery system. Nurses need to develop the skills
necessary to participate effectively on the team, which requires collaboration,
communication, coordination, delegation, and negotiation. Communication and delegation
are discussed in other chapters. It is difficult to practice today in any health care setting
without experiencing interprofessional interactions such as nurse–physician. As teams work
together, effective teams
Work together (collaborate).
Recognize strengths and limitations.
Respect individual responsibilities.
Maintain open communication.
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Case Study A Verbal Explosion Leads to Confrontation of a Problem
As a nurse manager in a busy OR you have to ensure that all staff is collaborating and
communicating well. In the last six months you have noticed more problems with poor
communication between nurses and physicians, some of which have impacted the quality of
care. Nurses are also frequently complaining that they are “second-class citizens” in the
department. The number of last minute call-ins has increased by 25\% over the last 6 months
causing last minute staffing problems. Today was the last straw when a nurse and a surgical
resident had a shouting match in the hallway. The nurse left the encounter crying, and the
resident said he would not work with the nurse anymore. The nurse manager went into the
OR medical director’s office. They have had a positive collaborative relationship over several
years. She went in and said, “We have a problem!” As she described the problems, he said,
“I was unaware there was so much tension and lack of collaboration. Why didn’t you tell me
this earlier?”
Questions
1. How would you respond to the medical director’s question?
2. What do you and the medical director need to do?
3. How can you avoid this being a “we–they” situation?
4. How will you involve all staff?
5. What can you do about the powerlessness the nurses feel?
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Positive professional communication is critical. Both sides should initiate positive dialogue
rather than adversarial positions. Cooperation and collaboration are also integral to the
success of this relationship. A frequent question discussed in the literature is “Why is there
conflict between nurses and physicians?” The structure of work is different for physicians and
for nurses, and this has an impact on understanding, communicating, collaborating, and
coordinating. This perspective identifies the key elements as sense of time, sense of
resources, unit of analysis, sense of mastery, and type of rewards as described by the
following.
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The nurse is focused on shorter periods of time, and time is usually short, with frequent
interruptions. The physician’s sense of time focuses on the course of illness.
If a physician gives a stat order, the physician has problems understanding what might
interfere with the nurse making this a priority. There is a lack of understanding of the
nurse’s work structure.
Physicians often are not concerned with resources, though this is certainly changing as
physicians do recognize that there is a shortage of staff as well as issues about costs
and reimbursement for care. They, however, may not be willing to accept these factors
as relevant when their patients need something. There are, of course, other resources
such as equipment availability, supplies, and funds that can cause problems and
conflicts. Nurses are typically more aware of the effect that these factors have on daily
care.
Unit of analysis is another factor; for example, nurses are caring for groups of patients
even though care is supposed to be individualized. Physicians may not have an
understanding of this if they have only a few patients in the hospital.
Physicians also do not have an understanding of nursing delivery models, and often
nurses themselves are not clear about them. This affects nurses’ ability to explain how
they work.
The sense of reward is different. Nurses work in a task-oriented environment and
typically get paid an hourly rate. Most physicians are not salaried and are independent
practitioners though some are employees of the organization (hospital, clinic, and so on).
Conflict and verbal abuse are related. Verbal abuse occurs in health care settings between
patients and staff, nurses and other nurses, physicians and nurses, and all other staff
relationships. This abuse can consist of statements made directly to a staff member or about
a staff member to others. A common complaint from nurses regards verbal abuse from
physicians. “Some nurses, particularly new ones, allow physicians to verbally abuse them
because they are insecure about their knowledge base” (Parks, 2001, p. 20MW). Verbal
abuse affects turnover rates and contributes to the nursing shortage so it is has serious
consequences. “Poor physician–nurse interaction also compromises patient care” (Stringer,
2001, p. 7).
How can this problem be improved? A critical step is to gain better understanding of each
profession’s viewpoint and demonstrate less automatic acceptance of inappropriate
behavior. This requires that management become proactive in eliminating negative
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communication and behavior. Some hospitals have tried a number of strategies to deal with
verbal abuse. Some of these are (a) encouraging staff to report abuse by allowing
anonymity, (b) using physician–nurse counseling teams to act as liaisons with employees, (c)
encouraging staff to speak firmly and address abuse, and (d) introducing staff to new
physicians and encouraging them to come for assistance (Stringer, 2001). The IOM
recommends increased interprofessional approaches to care delivery and the need for
increased interprofessional health professions education so that all health professions are
prepared to work together on teams (2003). What can nurses do about this? One suggestion
is to improve their own knowledge base and thus develop more self-confidence. “Remind
yourself that you have many valuable skills, and you don’t deserve to be verbally abused.
These efforts will help decrease the feelings of intimidation” (Parks, 2001, p. 20MW).
Another problem is that nurses think they must resolve all problems and “make things” work
correctly when this may not be realistic. The nurses then become scapegoats. Verbal abuse,
no matter who is doing it, physician or nurse, should not be tolerated. Those involved need
to be approached in private to identify the need for a change in behavior. Staff needs to be
respected. The AONE Guiding Principles for Excellence in Nurse-Physician Relationships is
found in Box 12-5
.
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Box
12-5 Aone Guiding Principles for Excellence in
Nurse–Physician Relationships
Introduction to the Guiding Principles
Excellent working relationships between nurses and physicians are key to creating a
productive, safe, and satisfying practice environment. The patient and the patient’s
family benefit from care delivered by a team practicing within this environment.
Senior leadership in health care organizations must support the development of
excellent relationships and, more importantly, create an environment that sustains
and nurtures these critical relationships.
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Guiding Principles for Excellence in Nurse–Physician
Relationships
Institutions that are committed to establishing and maintaining environments that
promote excellence in the nurse–physician relationship adhere to the following
principles.
1. Interprofessional collaborative relationships are promoted, nurtured, and
sustained.
2. This requires that practitioners be proficient in communication skills,
leadership skills, problem solving, conflict management, utilizing their
emotional intelligence, and functioning within a team culture.
3. Excellence in relationship building begins with hiring, continues with learning
and developing together, and is reinforced over time.
4. The organization has specific systems for reward, recognition, and
celebration.
5. The organization supports the “Platinum Rule” with a specific Professional
Code of Conduct that includes a system to support it. A “No Tolerance”
standard exists for those unable to adhere to the Code.
6. The organization creates and supports a “Just & Fair” environment.
7. The work of all professional caregivers is seen as interdependent and
collegial.
8. Cross-discipline job discovery is supported and encouraged.
9. Patient-focused care and better patient outcomes are the organizing force
behind creating a collaborative environment.
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Implementation Guidelines
Interprofessional collaborative relationships are promoted, nurtured, and sustained.
1. Nurses and physicians are given formal training in communication skills,
leadership development, problem solving, conflict management, development
of emotional intelligence, and team functions. Education and training is
provided to nurse–physician teams and is not discipline specific.
2. Specific education is provided in team building.
3. Organization-governing bodies and committees have representative
members from all disciplines.
4. Nurse–physician leadership teams are identified to lead the work at the unit
level (Microsystem Management).
5. All organizational task forces include representatives from those stakeholders
closest to the issue.
6. Interprofessional collaborative relationships are assessed, unit-by-unit. Each
unit has a development and improvement plan for continued growth of the
relationship.
7. Teams develop common values for their interprofessional collaboration.
8. Teams develop common language for their interprofessional collaboration.
9. Nurse–physician collaborative champions are identified at the hospital and
unit level.
Excellence in relationship building begins with hiring, continues with learning and
developing together, and is reinforced over time together and is reinforced over time.
1. Nurses and physicians work collaboratively to identify the behaviors that they
want in team members.
2. Employees, both nurse and physician, are hired using behavioral interviewing
to ascertain a good fit with the organization, teams, values, culture, and
behavioral expectations.
3. Nurses and physicians do 360-degree performance reviews.
4. Credentialing criteria includes behavioral attributes and expectations, as well
as clinical skills.
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5. The Graduate Medical Education competencies are used as hiring criteria
and for performance review.
6. Education and team training is done in work teams, as described in the
Institute of Medicine reports.
7. Personal accountability for demonstrating team behaviors is rewarded.
The organization has specific systems for reward, recognition, and celebration.
1. There is alignment of purpose among the disciplines regarding reward,
recognition, and celebration.
2.
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Mechanisms for reward and recognition are easy to access.
3. Performance appraisal is linked to patient satisfaction measurements.
4. Awards, recognition, and celebration are public and visible and across
disciplines and teams. Example: Physicians identify the Nurse of the Year;
Nurses identify the Physician of the Year.
5. Rewards and Recognition programs promote team accomplishments.
The organization supports the “Platinum Rule” with a specific Professional Code of
Conduct that includes a system to support it. A “No Tolerance” standard exists for
those unable to adhere to the Code.
1. The Golden Rule states: “Do unto others as you would have them do unto
you.” The Platinum Rule states: “Do unto others as they would have you do
for/unto them.” Thus, this principle speaks to treating others as they want to
be treated, not necessarily how you would want to be treated.
2. Code of Conduct Guidelines/Policies exists for all professionals that outline
behavioral expectations.
3. Work improvement plans and measures hold the team accountable, not just
individual.
4. Individual professional codes of ethics/conduct are known and honored.
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5. Contacts and processes/procedures for the impaired professional are easily
accessible to all staff.
6. There are identified coaches and mentors for the professionals on site in the
hospital to help with performance issues.
7. All professionals receive team training that focuses on communication skills
and processes.
8. Processes exist to identify and address conflict situations before they
become a crisis and/or deteriorate.
The organization creates and supports a “Just & Fair” environment.
1. There is a systems approach to management and decision making.
2. Internal trends and reporting processes are multidisciplinary.
3. Language for reporting and safety is analyzed to assure that it is “Just &
Fair.”
4. Processes exist for multidisciplinary critical incident debriefing.
5. Decision-making tools are used that support the “Just & Fair” processes,
such as the “Just Model.”
6. The processes outlined in the patient-safety literature that creates cultures of
safety are used as blue prints for culture changes.
7. Remedial training is offered when needed.
The work of all professional caregivers is seen as interdependent and collegial.
1. The culture of team includes all disciplines providing care on a unit.
2. Behavioral expectations are defined for all disciplines.
Cross-discipline job discovery is supported and encouraged.
1. All disciplines are educated in the role/responsibility of their colleagues.
2. Opportunities for shadowing different professions are encouraged.
Patient-focused care and better patient outcomes are the organizing force behind
creating a collaborative environment.
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1. Work is directed toward identifying and measuring those outcomes that are
sensitive to the function of collaboration.
2. Patients and families are appointed to internal committees.
3. Patient-centeredness is a key focus for processes.
Source: American Organization of Nurse Executives. Guiding Principles for Excellence in NursePhysician Relationships. Chicago, IL: Author. Reprinted with permission.
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Application of Negotiation to Conflict Resolution
Negotiation
is the critical element in making conflict a nightmare or an opportunity.
Negotiation can be used to resolve a conflict, and some types of negotiation, such as
mediation, can be very structured. When two or more people or organizations disagree or
have opposing views about a problem or solution, a conflict exists. To resolve the conflict,
the involved people need to discuss resolution in a manner that is acceptable to all of those
involved. Although it does not have to
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take long, in some cases it may be very long, such as what might occur in a union–employer
negotiation for a contract. Conflict resolution includes the use of a variety of skills and
strategies. Key skills and strategies are communication, listening, and respecting different
points-of-view. Four needs are clarification, performance, questioning, and expectations
(Marrelli, 2004). As the process begins it is important to clarify all of the issues and parties
who are involved in the conflict. Performance or potential outcomes should be established
early in the process. Questioning is important throughout resolution. For example, it is
important to ask about behaviors that started the conflict and how to avoid them in the future.
Management needs to be clear about expectations and provide these in writing, which helps
to decrease conflict over critical issues.
What strategies might be used to resolve specific conflicts?
Help involved parties settle their differences themselves whenever possible rather than
stepping in and taking over.
Maintain an objective approach.
Communicate trust to the staff members and communicate that it is believed that they
can resolve problems.
Avoid criticizing or denying feelings.
Use a problem-solving approach.
Provide privacy for sensitive discussions.
Identify staff members who chronically complain and work with them to adapt their
behavior as this behavior can increase the risk of conflict and interfere with resolving it
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when it does occur.
Listen with understanding rather than judgment. This is important throughout the
resolution process and can also assist with prevention of conflict.
Provide opportunities for all staff members to improve their problem-solving and
communication skills (Marrell, 2004).
Since conflict is inevitable, all staff nurses will encounter it. Knowing how to manage conflict
will be of great benefit to the individual nurse as well as improve the working environment
and ability to better reach patient outcomes.
Why is negotiation identified as a critical skill for nurses in the health care environment?
Patients should not become part of staff or organizational conflicts, and there is risk that this
may occur. These conflicts need to be resolved or patient care may suffer negative
consequences. Consider these examples:
The interprofessional team cannot agree on a treatment approach and must do this by
the end of the team meeting.
A patient’s insurer refuses to allow the patient to stay two more days in the hospital. As
the hospital’s nurse case manager you must work with the insurer representative to
reach a compromise.
Staffing in a hospital is being reduced, and the nurses are convinced that the new
staffing level will be unsafe for patients. Something must be done to resolve this issue.
A home health care agency has learned that the Medicare contract has decided that
specific patients will receive fewer visits.
How can these examples be resolved satisfactorily so that the quality of care does not
suffer? Finding a mentor to discuss the process as well as vent feelings may be very helpful.
Developing negotiation skills makes conflicts easier to handle and less stressful. Nurses who
become involved in unions will find that negotiation skills are also very important. If
negotiation is not used effectively, all of these conflict examples can lead to major problems
for the patient and/or staff.
When approaching conflict resolution, it is important to recognize that both sides contributed
to the conflict. One side cannot have a conflict by itself; it takes at least two. Consider how
each side has contributed to the conflict. Another critical issue is to carefully consider if this
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is the time and place to address the conflict. When the environment is too emotional, conflict
resolution will be difficult. Stepping back or taking a break may be the best position to take.
The following are strategies that can be used to effectively negotiate.
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Negotiate for agreements—not winning or losing. Clearly state that your desire is to find
a solution and to work together.
Separate people from positions.
Establish mutual trust and respect.
Avoid one-sided or personal gains.
Allow time for expressing the interests of each side/party.
Listen actively during the process, and acknowledge what is being said; avoid defending
or explaining yourself.
Use data/evidence to strengthen your position.
Focus on patient care interests.
Always remember that the process is a problem-solving one, and the benefit is for the
patient and family.
Clearly identify the priority and arrive at common goal(s).
Avoid using pressure.
Identify and understand the real reasons underlying the problem.
Be knowledgeable about organizational policies, procedures, systems, standards, and
the law, applying this knowledge as needed.
Try to understand the other side, and ask questions and seek clarification when unsure
or uncertain; understanding the other side first before explaining yours increases
effectiveness.
Avoid emotional outbursts and overreacting if the other party exhibits such behavior;
depersonalize the conflict.
Avoid premature judgments, blame, and inflammatory comments.
Be concrete and flexible when presenting your position.
Be reasonable and fair (Gebelein et al., 2000).
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Mediation
There are some conflicts that will require a third-party negotiator to reach a more effective
resolution. This is needed when there is no opportunity for cooperative problem solving and
objectivity is required. “Mediation
is a form of dispute resolution that has been used in
many cultures throughout history…. Mediation is a problem-solving process in which a
neutral third party (who has no stake in the outcome of the process) helps people who have
a disagreement or dispute reach a mutually satisfactory resolution.” (Gebelein, p. 56, 2000).
Mediators are facilitators, not decision makers (as in the case of arbitrators). In mediation,
the people with the dispute have an opportunity to tell their story and to be understood, as
well as to listen to and understand the story of the other party. A key factor in mediation is
the need for all parties to willingly participate in the process. The mediator guides the
process and discussion. Certain guidelines are established for the discussion that all parties
must follow throughout the process (for example, allowing each party time to speak and
complete a statement without interruption, calling for a break when needed, enforcing time
limited meetings, substantiating comments with facts, and so on). With these guidelines and
the presence of a mediator, this type of negotiation can result in positive outcomes. It
provides protection for both sides.
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Applying Leadership and
Management
My Hospital Unit
When you arrive at work today you are confronted with staff members that are upset
that work is not being done effectively, particularly with other departments.
Successful coordination requires identification of barriers and strategies to resolve
barriers to coordination. Coordination also requires collaboration. Identify the barriers
to effective coordination and collaboration. Clearly describe them. Then consider
what strategies could be used to prevent the barriers or to decrease the barriers on
your unit. Your strategies need to be applicable to your unit as you have designed it.
Use the virtual unit site found on the textbook website to record the work that you do
as the role of nurse manager for your unit.
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Critical Thinking Questions and Activities
1. What do nurses in practice think? Select one of the following issues to discuss with
RNs. Students should not all choose the same questions so that when data are
discussed there will be different issues described. (1) Is collaboration with other
health care professionals part of your practice? If so, describe some examples. If not,
why do you think collaboration does not exist? (2) How is coordination used in your
practice? (3) How might you and others where you work improve coordination? (4)
Describe your worst experience with conflict at work and how it was resolved or not
resolved. (5) What were the long-term consequences of conflict? (6) Do you feel
empowered at work? Why or why not? How do you think the situation could be
improved?
2. The examples of strategies to improve nurse–physician relationships are broad.
What do you think about them? Divide into teams and have each team take one of
the strategies. Discuss the advantages and disadvantages of the strategy. How
would you respond to the strategy? Have you experienced or observed any abusive
behavior among staff or with you? Do you think one of these strategies might prevent
this type of behavior? Each team should explore the strategy. How would it work?
Would it be offensive to staff (nurses or physicians)? It is important to look at both
sides, nurses’ and physicians’.
3. Conflict is complex and yet there are guidelines for understanding it. Select an
example of a conflict, which can be one you experienced or observed. Describe the
conflict, identify the type of conflict, and explain your rationale for selecting the type.
Apply the four stages of conflict described in the chapter to your example. What
resulted from the conflict?
4. Visit the website http://www.mapnp.org/library/grp_skll/grp_dec/grp_dec.htm and
read about decision making and teams. How might you use this information?
5. Visit the website http://www.livestrong.com/article/14683-handling-conflict/and learn
more about handling conflicts. How might you use this information?
6. Visit the website http://www.cnr.berkeley.edu/ucce50/ag-labor/7labor/13.htm and
explore conflict management skills. How might you use this information?
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Media Links
URL: www.nursingworld.org/MainMenuCategories/ANAMarketplace/
ANAPeriodicals/OJIN/TableofContents/Volume102005/No1Jan05/
tpc26_416011.aspx
Nurse–physician collaboration
URL: http://www.accel-team.com/
Team Building: Tools for building strong teams, plus useful links and articles
URL: http://www.au.af.mil/au/awc/awcgate/ndu/strat-ldr-dm/pt3ch10.html
Strategic Leadership and Decision Making: Read about how to create and manage
teams
URL: http://www.ihi.org
Institute for Health Improvement: Teams
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URL: http://teamstepps.ahrq.gov/
Agency for Healthcare Research and Quality: TeamSTEPPS
URL: http://www.mindtools.com/pages/article/newLDR_81.htm
MindTools: Conflict Resolution
URL: http://www.mindtools.com/pages/article/newTMM_53.htm
MindTools: How to Be a Good Team Player
URL: www.ihi.org/IHI/Topics/PatientSafety/SafetyGeneral/Tools/
CommunicationCollaborativeSurveyPhysicianAttitudes.htm
Institute for Health Improvement Communication/Collaboration Survey
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