When colleagues clash

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Work environment

Effectively manage workplace conflict

After reading this article, you will be able to:

  • Identify techniques for managing workplace conflict
  • Recall potential sources of workplace conflict
  • Discuss challenges nurses have when resolving conflicts with physicians

In a healthcare facility, nurses, physicians, administrators, and other employees are likely to have a wide range of personalities.

With these staff members constantly communicating and interacting, there is a good chance there will also be conflict.

Nipping conflict in the bud is important to retaining the integrity of your facility, experts say.

“It’s like gangrene; it creates a toxic workplace,” says Kathleen Bartholomew, RC, RN, MN, author of the HCPro book Speak Your Truth: Proven Strategies for Effective Nurse-Physician Communication. “If you don’t deal with it, it spreads insidiously, and you can’t see the effects of it right away.”

The potential for conflict surrounds many issues in the healthcare setting.

Treatment disagreements, end-of-life patient care, discharge issues, orders not carried out correctly or in a timely manner, and simple pettiness among staff members all have the potential to create conflict.

Nurse managers must remember to act quickly when a staff conflict arises and have those involved meet, discuss the problem, and promptly resolve it.

“It’s best when the hospital, office, or practice has a culture to allow frank and respectful discussions, and there are instilled values of respect, integrity, and caring,” says Luis T. Sanchez, MD, director at Physician Health Services, Inc., a corporation of the Massachusetts Medical Society.

Hash it out at least twice

If at all possible, the staff members involved should resolve the problem themselves, although Bartholomew says research shows healthcare professionals rarely do so.

“We are not known in the healthcare profession, on any level, for confronting each other, and we have to learn how to do that better,” Bartholomew says.

Before going to high-level administration to address a conflict, parties should try to resolve the matter on their own at least twice, Bartholomew says, adding that if you get administration involved, it’s like “running to mother” when there is a problem.

“You want to create an atmosphere where people are responsible for their own behavior, where you invite, encourage, and expect everyone to take care of their own world, to be honest in that world, and to treat everyone as they would their own family member, including the patient,” Bartholomew says.

How the problem is brought up is also important. The first rule is to avoid any kind of aggressive behavior. Bartholomew suggests having the parties involved sit down and describe the situation and its effect on them and the facility.

“Ask for what you need and describe the consequences if the behavior does not change,” Bartholomew says. “What usually happens is that these become hallway conversations, and they are high-strung.” (See “Conflict-reducing techniques” on p. 7.)

Although you want to encourage everyone to resolve their conflicts and problems, nurses will likely be hesitant when there is a problem with physicians, Bartholomew says, adding that although physicians expect nurses to come to them with their concerns, nurses are reluctant to do so. It takes a lot of courage for a nurse to approach a physician, and physicians do not realize this power difference, she says.

“You’re talking about nurses, many of which have two-year degrees and an eight-year gap in education in many places—it’s intimidating,” Bartholomew says. “And their experiences have shown them that it is intimidating to approach a physician. Even though research shows there are only a few disruptive doctors, it also shows an exponential amount of damage. Don’t let one bad apple spoil the bunch.”

Call lawyers as a last resort

If the problem escalates to issues such as sanctions or threats of termination, the facility may want to consider contacting its attorney.

“Attorney involvement can be very helpful in resolving the problems,” says Sanchez.

But Bartholomew suggests that lawyers be used only as a last resort. “You’d have to have pretty ineffective leadership and very poor confrontation skills,” she says. “The situation only escalates to a legal mess when it is allowed to continue and fester for a long period of time.”

It often helps to have rules written into the organization’s bylaws that outline what is acceptable and unacceptable behavior.

Create ‘rules for peace’

“You’re expected to be a team player; you’re expected to communicate with respect,” Bartholomew says. “You have to have these standards written into your annual evaluations and your performance evaluations. You don’t want the rules for the fight—you want rules for peace.”

Sanchez adds that the rules need to reflect that the organization promotes a communicative atmosphere when it comes to staff relations and conflict. “Rules are okay if coupled with an atmosphere of collegiality, discussions, time allowed to do this, and best if fully supported and demonstrated by the boss,” he says.

Open lines of communication between staff members in times of conflict are important to maintain quality patient care, Bartholomew says.

“When you have everybody working as a team, you have a lot of energy available to your facility,” she says. “If you have two people that are fighting all the time, it is diverting the energy and focus away from the real job of your facility, which is to provide great patient care.”



Adapted from The Doctor’s Office, February 2009, HCPro, Inc.