Conflict In Nursing: Types, Strategies, and Resolutions
No job is completely drama-free, and travel nursing is no exception: conflict in nursing definitely exists, making conflict resolution an important (albeit underrated) skill.
Conflict In Healthcare Settings
Different people with different personal and professional backgrounds will often have different opinions on the best course of care. Misunderstandings, especially in a fast-paced healthcare setting, can and will occur. Add in the stress inherent in caring for (and saving) lives, and it’s no wonder that we expect to face conflict in nursing and other healthcare specialties.
But there’s a difference between conflict and hostility. In fact, most sources of conflict in nursing shouldn’t lead to hostility. While you may disagree with the patient care plan, be unhappy with the way that someone is handling a situation, or even seriously question the ethics of certain procedures, there are ways to de-escalate tension and practice conflict resolution skills in nursing.
And by learning (and practicing) how to do so, you’ll not only be making your day-to-day easier, you’ll be redirecting everyone’s energy and focus to the patients and their families―the people who need it most.
Types of Conflict in Nursing
The Merriam Webster dictionary defines conflict in part as any “struggle resulting from incompatible or opposing needs, drives, wishes, or external or internal demands.” Interpersonal conflict occurs when that struggle is between two or more people and can actually arise at many different relationship levels: between doctors and nurses, between patients and nurses, and even between nurses!
Not all conflicts are created equal, and that’s important to know. Developing a reliable way to determine the basis of any issue in which you’re not seeing eye-to-eye with someone else is the first step to creating a roadmap to conflict resolution. And by taking this step, you’re increasing your ability to leverage empathy and pay attention to behavioral clues that can help you identify the best approach to resolve the situation at hand.
Issue-Based Conflict in Nursing
Issue-based conflicts occur when the root cause is a disagreement about how to handle a problem at hand. This is the most straightforward of the types of conflict that you’ll encounter in nursing, as the main source of tension is simply a difference in approach to a common solution. Accordingly, it’s often the easiest type of conflict to resolve.
As long as communication remains open, clarification (and sometimes compromise) can forge a path agreeable to both parties.
Example: Based on his experience from previous travel nurse assignments, a travel nurse new to a facility disagrees with the way a staff nurse is changing a patient’s bandages. Instead of trying to coerce the staff nurse into adapting his preferred method, the travel nurse consults with other nurses on the unit and realizes that his preferred way of changing bandages is different from facility protocol. The travel nurse adapts to the facility’s protocol for changing patient bandages while on that assignment.
Ego-Based Conflict in Nursing
Ego-based conflicts occur when a disagreement about how to handle a problem at hand is complicated or exacerbated by the risk of damaging one or more party’s sense of self-esteem or perceived standing in the relationship. This type of conflict is more complex, as the issue at hand is deeper than surface-level; one or more of the individuals involved may need to examine themselves more introspectively to better understand where their conviction comes from.
For example, is the conflict driven by a desire to create a better solution, or is it driven by the need to be “right?"
A simple way to reduce ego-based interpersonal conflict in nursing is to avoid situations that may worsen personality clashes with coworkers, superiors, or patients as much as possible. Instead, choose a private, or neutral, setting to engage individual(s) in dialogue as early as possible to de-escalate any perceived tensions.
Example: A travel nurse approaches a physician to double-check an order for medication before administering the medication to its intended patient. The physician―interpreting the question as a sign of distrust in his own expertise―publicly lashes back at the nurse and reports his dissatisfaction with the travel nurse to the charge nurse on duty. Instead of responding publicly in kind, the travel nurse enlists the help and support of the charge nurse to find an opportunity to discuss the incident and resolve hard feelings with the physician privately.
Values/Ethics-Based Conflict in Nursing
Value-based conflicts occur when the source of disagreement arises because of a difference in each individual’s values or ethics. Our values and ethics come from a variety of places: personal background, life experience, work environment, industry norms, education, and so many other places. They’re also traits that guide the way we interact with and identify others.
Because values and ethics often create such a cornerstone to our beliefs, tensions based a difference of values and ethics may not come to a clean resolution, and that’s okay.
It’s important to understand that differences in personal values, ethics, and conflicts in nursing may occur because a procedure, practice, or opinion that you’re witnessing (or holding) is against the rules, regulations, or ethics of the nursing and travel healthcare industry. If you’re caught in one of the first two situations, not only are these conflicts reasonable and expected, they're something you should take the initiative to resolve conflict (in fact, you might have to if you want to keep your job as a nurse).
On the other hand, codes of ethics exist to keep patients and providers safe, and as a clinician, it’s important to do your part to uphold them.
Example: A travel nurse overhears her patients and their families discussing moral beliefs and political views that are completely different from her own. Regardless of their differences in opinion, this nurse still strives to provide this patient with the highest level of care and compassion possible and even makes an extra effort to chat about common interests with the patient, making the patient’s stay in the hospital a bit more bearable.
Conflict Resolution Strategies in Nursing
Anyone who faces interpersonal conflict in nursing has a variety of options on how to handle it. In fact, people’s approaches to conflict usually follow one of five routes:
- Competing: Nurses whose conflict resolution strategies revolve around competing tend to be overly assertive and preoccupied with “winning” the argument rather than coming to the best possible solution.
- Obliging: Nurses who choose to use obliging as their main conflict resolution strategy are people-pleasers. They’re fine accommodating other ideas even at the expense of shelving or de-prioritizing their own. This can be helpful when it moves the best solution forward, but it can also be dangerous because it may lead to a case where an individual withholds valid convictions or opinions just to “keep the peace.”
- Avoiding: Nurses who rely on avoidance as a conflict resolution strategy choose to avoid the source of conflict or leave it alone altogether rather than confronting it head on. Similar to obliging, avoiding increases the chances of a group going with unvetted (or under-vetted) ideas, which can be harmful in the long run.
- Compromising: Instead of adopting a “me vs. you” mentality, nurses approaching interpersonal conflict resolution from a compromising mentality aim to reach a solution that makes both sides at least partially happy. By doing so, both sides leave with something they want and are able to move forward with implementing a solution.
- Collaborating: Nurses who choose collaboration as their conflict resolution strategy incorporate others’ ideas into their own; while the result may not be as half-and-half as with the compromising method, the solution still has aspects of everyone’s opinions and input, increasing group buy-in and general satisfaction with the final decision.
Now, which strategy do you most commonly rely on? Chances are, you’ve done one of the first three.
And according to researchers, out of the five conflict resolution strategies outlined above, nurses tend to rely most heavily on the avoiding method.
This is a problem: not only does this method often fail to result in satisfaction with those involved, but it also carries negative effects on patient care outcomes and group cohesion.
So, when faced with conflict in nursing (or anywhere, for that matter), what are the best methods to employ? Compromising and Collaborating.
The next time you end up in a situation that demands conflict resolution, remember to rely on the compromise and collaborate strategies―together, these approaches ensure that you approach your next conflict in the right way.
Attitude Is Everything
Beyond understanding what strategies you’re likely to use (and comparing them to the most effective strategies that should be used), you should also be aware of the attitude you embrace in any situation that may result in tensions or conflict in nursing.
You should enter any conversations aimed at conflict resolution with the goal of fully understanding all sides of the story. Empathize with their point of view (and the aspects that could justify their opinion) to the best of your ability.
When working toward conflict resolution with patients, fellow nurses, or other healthcare professionals, it’s also important to stay calm and positive, celebrate each step of progress you’re making in coming closer to a mutual solution, and keep your focus on moving forward as a team rather than ruminating on past issues.
Finally, you should remember that the person on the other side is just that―a person. As such, their opinions, convictions, and voice should be respected, regardless of how strongly you disagree with them. Everyone is right and wrong at different times.
Separate your feelings for the issue from your feelings for the person.
But Don’t Forget Communication Skills
In addition to the right attitude, monitoring your communication style is also crucial when handling conflict resolution as a nurse.
Remember to come prepared. That’s right: you should rehearse (or at minimum, have an idea of) what you want to say before sharing your feelings and concerns with the patients, fellow nurses, or other healthcare professionals whom they’re intended for. If you’re asking someone to sit down and chat through an issue, chances are, things are already a little more tense than usual.
In these situations, it becomes even more important to choose your words wisely, and the best way to ensure that your words are chosen wisely is to choose them ahead of time.
When preparing what you’ll say, remember that it’s not enough to simply prepare an explanation of what you perceive the problem to be and how it negatively affects you, but also a possible solution that would make sense for all sides to carry through. It’s likely that you’ll end up tweaking your proposed solution based on feedback from the person on the other side.
However, coming to the table with a solution in hand both shows that you’re serious about moving forward and orients the conversation toward working together to find a common solution.
At the core of any great communicator is a great listener. And for us nurses, that should come as no surprise: listening to patients make us more effective, approachable, and knowledgeable caregivers. Yet, it’s a super common (and terrible) habit for people to prepare a “rebuttal” or response to what someone is saying while they’re saying it. So first and foremost, instead of making sure you’re heard, make the effort to ensure that you’re hearing the other side. You can always ask for a moment to collect your thoughts for your reply afterward!
While communicating your concerns and opinions with the other side, remember to bring your points back to the issue at hand. Following up a conflict in nursing with criticism over opposite perspectives or beliefs (rather than empathy and validation) will likely only put the individual you’re speaking with on the defensive. This will only lessen your chances of coming to a mutually agreeable solution.
Likewise, your proposed solutions should focus on the problem, not the person.
Steps Toward Conflict Resolution
Now that we understand the basics of effective conflict resolution strategies in nursing, let’s go over the steps that you can take to follow through the next time you and another person don’t see eye-to-eye on an issue.
First, choose your battles.
Some differences in opinion simply aren’t worth turning your 13-week assignment into a battleground. Some facilities and units routinely treat their permanent staff better than their travel nurses, and drawing a line in the sand will only make your stay there more difficult and less productive. Be clear on where your red line truly lies and what behaviors and activities truly cross it.
Actions that put patient safety at risk, hinder your ability to keep patients safe, or neglect an agreement outlined in writing in advance between yourself, your agency, and the facility are absolutely grounds for speaking up. Getting stuck with a difficult patient with a penchant for the call bell? Not so much.
Second, know your part.
Before confronting any other parties about an issue that you’re experiencing, analyze the role that you may have played in worsening the situation. Were you unclear or unreasonable in any of your requests? Could anything that you said or did be taken as rude, condescending, unhelpful, or mean-spirited (even if it wasn’t your intent)? Remember that there are at least two sides to every story and always enough blame to go around.
You should approach conflict resolution willing to first own up to your part then create a roadmap to meet the other side halfway.
Third, reach out to the other person or people involved.
Set up a time to speak with them in private. This can take a bit of planning on your part. Choose a time that’s well after the event so that emotions have a chance to fizzle out, yet not so far out that your talk is rehashing old wounds. Pick a spot away from the stress and rush of the hospital floor if possible, and prepare what you’d like to say ahead of time so that you’re able to express your thoughts clearly.
Fourth, keep an open mind.
Often, these disagreements are based on fundamental misunderstandings, and ultimately the person on the other end―whether they be a physician, a nurse, or a patient’s family member or friend―want the same thing as you do: to see the patient healthy, happy, and out of the hospital! That shared goal is more than enough to start building the common ground you need to move past whatever conflict in nursing that originally occurred.
Fifth, if you’ve taken the steps above to no avail, you may need to turn to higher-ups for mediation.
Unfortunately, some issues are simply out of your hands and above your pay grade―in these cases, your best option is ensuring that it’s thoroughly and swiftly reported to someone in authority. This way, if any fallout does occur, you have a clear record of any roles you did and did not play in the ultimate outcome.
Finally, remember to keep your recruiter (or Nurse Advocate) in the loop at every step of the way.
While different recruiters will have varying levels of involvement in your experience on assignment, most are willing and happy to help escalate any or your concerns or issues at the facility whenever possible. Remember, your happiness and job satisfaction is in their best interests, too!
If you end up having conflict with your coworkers, bosses, or patients, remember to keep your recruiter in the loop at every step of the way.
The Best Option? No Conflict in the First Place
“An ounce of prevention is worth a pound of cure.”
You’ve gotta admit: Ben Franklin was one smart dude.
While conflict resolution is a helpful and effective tool to manage both social and working relationships, avoiding sources of conflict in nursing altogether is by far the preferred method. And doing so isn’t as hard as you think!
Five Tips to Help You De-escalate Conflict Situations:
- Be respectful: Remember that you are a guest at each facility. They’ve also given you a chance to learn, grow, and help others. You are also a representative of your agency and yourself. Everyone deserves respect, so be respectful to those around you, regardless of personal feelings or initial impressions.
- Stay in your lane: Your primary role as a travel nurse is always to help. Not to judge, not to criticize, and certainly not to serve as impromptu management consultant. Facilities often have reasons for doing things the way they do them, and these decisions may be for reasons above your pay grade and out of your control. Your opportunity as a travel nurse will teach you what practices to aspire to and what to avoid, but your assignment is not the time to voice those opinions.
- Be friendly (or at least approachable): Approachability is an underrated trait, and it isn’t just important for building a relationship with patients. Make an early effort to get to know the other nurses you’ll be working with and ensure that they’re comfortable coming to you for help, and vice-versa! Doing so builds a sense of camaraderie on the unit, and it’s a lot easier to talk things through with a friend than a stranger.
- Communicate clearly: As we mentioned before, misunderstandings are one of the biggest causes of conflict in nursing. And how do we clarify misunderstandings? Clear communication.
- Assume the best: Amidst the stressful environment caused by heavy patient loads, it can be easy to forget that everyone in the room wants the best for the patient. It’s why you’ve chosen to be a nurse, why the physician decided to pursue medicine, and why the patient’s loved ones are there supporting them. Even if you believe that an opinion or decision may carry negative effects, remember that it’s likely well-intentioned; so, respond accordingly.
Not all cases of conflict in nursing will come to a thorough and speedy resolution―indeed, some may not be resolved at all by the time you’ve completed your assignment. And that’s okay! Not having to deal with indefinite workplace drama is one of the many upsides of being a travel nurse.
Regardless of your relationship with medical staff or patients at your medical facility, remember to strive to be as courteous and empathetic as possible. You never know when (or if) your paths will cross again; you also don’t know who else is connected to your situation.
Word of mouth travels fast in this industry, so the best thing that you can do for yourself and the environment of your medical facility is stay positive, upbeat, and gracious.
Looking for a new contract? Interested in travel nursing? Let our Nurse Advocates find the right assignment for you!