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Creating Healthy Work Environments 2019

Check out these articles written by presenters at the 2019 Creating Healthy Work Environments conference.

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Overcoming workplace interpersonal conflict

Monica Kennison |

Tasks of leadership seem daunting? A nurse leader offers advice.

Overcoming workplace interpersonal conflict

When unacceptable individual or group behavior goes unchallenged for years, changing the status quo becomes an uphill battle for a new leader. The author offers a battle plan.

When nurses begin new leadership positions, their well-intended attempts to establish “how we do things around here” may uncover longstanding barriers to team performance. Often, those barriers relate to ineffective conflict resolution or bullying. Determining what the actual underlying issues are becomes complicated because behaviors related to ineffective conflict resolution often overlap with behaviors associated with bullying.

When unacceptable individual or group behavior has been festering unchallenged for years, changing the status quo becomes an uphill battle for the new leader. To help minimize that battle, I distinguish below between normal day-to-day conflict and workplace bullying. I also provide structured prompts and related follow-ups that help nurse leaders identify problematic behaviors and respond effectively.

Workplace interpersonal conflict (WIC) is dynamic interaction between interdependent individuals that elicits negative emotional reactions. When used positively, conflict may enhance team performance and reveal a robust team with diversity of thought. On the contrary, in healthcare arenas, WIC has been linked to safety-compromising incidents. For healthcare professionals, unresolved conflict may be detrimental to physical health and work performance and result in a sense of impairment that is prompted by fear and defeatism.

Style under stress
Conflict invariably causes emotional upheaval. Interpersonal conflict prompts an automatic physiological response as the amygdala kicks into overdrive and induces fear or angst. Unchecked, these negative emotions—rather than calm logic—guide our response, and that doesn’t bode well for achieving effective resolution. Honest self-assessment helps recognize emotional triggers. Style under stress is one approach I use. Controlling emotions before they overrule logic may be as simple as taking a few deep breaths or taking a break to calm down. The more upset the other person is, the more I calm myself. The louder the other person’s voice, the softer mine is.

When interpersonal conflict occurs in the workplace, nurses tend to ignore or work around it. Neither response is satisfactory. One claims: “It’s easier that way. Dealing with conflict takes energy I don’t have after all the other stuff I need to do.” I understand. Earlier in my career, I had the same thoughts. I once assigned two nurses to work on a project both had expressed interest in. A few weeks later, one complained to me about the other. Naturally, I asked if she had talked to her colleague. She replied: “I tried to. She says she’s ‘not ready’ to talk with me.”

Like many, the nurse who didn’t want to talk about it didn’t want to deal with the confrontation required for conflict resolution. It made her uncomfortable and provoked anxiety. She worried that the resolution would generate more conflict and not achieve the desired result. She hoped that if she delayed the meeting long enough the other person would forget about it. The confrontation that occurs with conflict resolution can interrupt whatever modicum of peace nurses may have in an otherwise chaotic workday, so they often try to avoid it. Although it’s natural for nurses to want a peaceful work environment, their work, by its very nature, is stressful and involves handling conflict.

Failure to engage not an option
There are two points to make here. Failing to engage in conflict resolution is not an option for nurses. In fact, it could be considered a performance problem. Secondly, there are ways to structure conflict resolution that help ease the process. Written expectations that provide consistency and clarity are needed for effective conflict resolution. I prefer succinct guidelines.

For instance, the Nursing Faculty Manual we use states that faculty members are expected to resolve conflict in a private, constructive, and timely manner. I also recommend specifying facts first, then expressing feelings—and finally, stating the expected follow-up. I adapted the following template from Johns Hopkins Medicine’s Code of Professional Conduct for Faculty: When you did (describe behavior factually), I felt (describe how the behavior made you feel). Please, do not do that again. (STOP).

I added the “STOP” prompt as a reminder for the speaker to stop talking and allow the other person a chance to respond. In my experience, the conversation then goes one of two ways: The other nurse agrees to “not do that again” or tries to rationalize his or her behavior and goes off on a tangent. If the former occurs, the conversation ends. If the latter happens, the “Please, do not do that again” statement needs to be repeated. The conversation may then end. Throughout, it’s important that the discussion stays on point and doesn’t wander off into areas that are not germane.

Sometimes the conversation I’ve outlined above resolves a minor disagreement. However, if the verbal interaction becomes more convoluted and involves high stakes, intense emotions, and strong opinions, a “crucial conversation” may be in order (Patterson, Grenny, McMillan, & Switzer, 2002, pp.1–2). Prepare for it by asking what you want for the other person, yourself, and the relationship. I typically start by identifying a mutual goal; for example, “Gabriel, we both want this project to succeed.” Follow the TeamSTEPPS DESC script—describe, express, suggest, and consequences (p. 31)—as a guide for the rest of the conversation.

Speak up when you see bullying
Before I used these and other guidelines, handling workplace interpersonal conflict—especially when bullying was involved—was well outside my comfort zone. With practice, my stress levels have gone down. I’ve learned to focus on the other person, making sure he or she feels valued and heard by listening and trying to see the other point of view. For me, it comes natural to hesitate before I speak because I want to consider not only what to say but how to say it. I keep my tone and posture neutral. If a win-win is possible, with both parties sensing they’ve achieved something, I look for it.

WIC sometimes involves behaviors I consider bullying, often defined as repeated and unreasonable aggression toward individuals or groups. Workplace bullying is intended to intimidate, degrade, humiliate, or undermine its victims. Unfortunately, healthcare workers often fail to report many behaviors I consider bullying, such as gossiping, spreading rumors, abusing authority, refusing to meet, swearing, and other crucial concerns.

Uncomfortable as it may be, nurses need to speak up when bullying occurs. We are all responsible for effective team dynamics. As multiple professional standards attest, bullying is unacceptable, and silence, which condones the behavior, is also unacceptable.

Sometimes people use passive-aggressive behavior—gossip, for example, instead of dialogue—to “resolve” interpersonal conflict in the workplace. Nurse leaders who encounter such a culture have come upon a major problem. WIC itself is not a performance problem. Bullying, however, is a performance problem and the bane of nurse leaders who must deal with it.

Collaborate with human resources
Changing a culture where bullying is accepted takes time and requires astute attention to underlying intrapersonal, interpersonal, and organizational factors, which differ from workplace to workplace. Administrators must acknowledge the problem and collaborate with human resources when confronting bullies about their behaviors.

The nurse leader may be the one who needs to ascertain whether or not the bully is willing to change. If so, a performance improvement plan needs to be implemented. Documentation becomes a trusted ally because bullying incidents, related meetings, and performance improvement plans require a paper trail. Hard though it may be, termination must be initiated if the bully is unwilling to own up to the offending behavior and take steps to eliminate it. In that case, it helps to have an outside mentor who supports the nurse leader and offers wisdom throughout the process.

In the midst of workplace interpersonal conflict that may include bullying, leaders should keep themselves above reproach, aware that their behavior affects the culture of the workplace. To that end, I practice daily reflection. I ask myself if have I placed my own agenda ahead of my department’s agenda. Did I model the civil behavior I want to see in my team members? Did my emotions guide my actions, or was it logic?

As nurses strive to become the transformative leaders needed to change global healthcare, we are inevitably called upon to handle workplace interpersonal conflict—WIC—including its often-silent aspects, which may include bullying behaviors. On those days, the tasks of leadership may seem daunting. Today, I say, “Bring ‘em on.” RNL

Monica Kennison, EdD, MSN, RN, is a professor and Susan V. Clayton Nursing Chair of the Nursing Department at Berea College in Berea, Kentucky, USA. 

Editor’s note: Monica Kennison presented Conflict Resolution: From Policy to Procedure to Practice on Friday, 22 February 2019, at Sigma’s Creating Healthy Work Environments conference in New Orleans, Louisiana, USA. See the Virginia Henderson Global Nursing e-Repository for additional information. 

Check out these additional articles by presenters.                                        

Patterson, K., Grenny, J., McMillan, R., & Switzer, A. (2002). Crucial conversations: Tools for talking when stakes are high. Columbus, OH: McGraw-Hill.

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