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Learning Objectives

Chapter 4: Decision Making and Conflict Management
After completing this chapter, the reader should be able to: 1. Define the decision-making process. 2. List the elements of the decision-making process. 3. Analyze the relationship between decision making and leadership. 4. Define conflict. 5. Differentiate conflict management from decision making. 6. Identify categories of potential conflict. 7. List conflict management strategies. 8. Analyze the relationship between leadership and the management of conflict.

Putting it All Together
Remember that you, the new nurse, have been making clinical decisions for your patients throughout your education. Each step of the way, you needed less and less guidance to decide a nursing course of action. That same process will be applied to decisions you will make within the organization context. You will consult with others as necessary to test out your course of action, modify your plan, and learn from both good and weak decisions. You have many skills to build on right now, and those skills will only become more effective as you practice them in new situations such as making assignments and delegating nursing activities. All of these activities will enhance your critical-thinking and communications skills. Conflict, on the other hand, will be a more challenging experience. This is one activity where you should stop before you speak and use your knowledge before simply reacting. Most conflict stems from misunderstandings and differing expectations among the parties. It is less a personal attack on you and more a reaction to a perceived inequality or problem. You can stay calm and reasonable by keeping your own emotions in check. This can be done by using the VENT technique: Validate that this is a real difference of opinion or view. Express emotions in a healthy way. Anger is a powerful emotion and, like all emotions, has a physiologic dimension. It has been suggested that expressing emotions often dissipates some of the intensity. In the workplace, drop a pencil on the desk or crumple a piece of paper. These psychomotor actions discharge emotional energy. Negotiate the conflict situation either immediately or later, and preferably in private. Trust yourself and your actions.

Jointly. 3. such as asking for . In turn. The nurse manager is creating a group that will be tasked to redesign the nurse’s station. and you may have to make a unilateral decision. 5. Arbitrary assignment of individuals. Reiterate the other's viewpoint. 4. Therefore. Effective communication improves understanding between parties in complex work settings. Request suggestions for a resolution. Outcomes of both are good or bad. Process models of decision making and conflict resolution are offered. should be avoided since the outcome may not be of the highest quality. They are: 1. Interest alone. Experience in decision making and conflict management leads to heightened precision in communication and improved group relations. such as pulling names from a hat. How should the nurse manager determine who will be represented in this group? Your Answer: Place a sign-up sheet in the locker room and ask for volunteers. if possible. but those that are must be managed and brought under control. but remember that you may not necessarily agree. Chapter Summary In this chapter. depending on the willingness of participants to work toward success and on improving their skill level.In addition. 1. Listen actively to the parties involved and do not interrupt. quality decision making fosters effective management of conflict. decision making and management of conflict are discussed. make a decision when emotions are cool. Management of conflict is a necessary skill that takes time and effort but is well worth the rewards. Some conflict is growth producing and leads to a revitalization of efforts. Correct Answer: Select representatives from all levels of staff who work on the unit. and healthy group dynamics facilitate decision making. 2. the nurse manager should select representatives from all levels of staff who work on the unit to participate in the redesign of the nurse’s station. simply follow the basic principles of dealing with any kind of conflict. Not all conflicts are detrimental. Consider the options. Rationale: The configuration of the group charged with formulating a decision should have adequate representation of all who are going to be directly affected by it.

which can be . Letting all ideas remain free-standing would not permit hitchhiking of ideas. let the mind wander. Rationale: There are four principles to brainstorming: don’t judge ideas. the correct direction the manager should provide to the staff prior to the brainstorming session would be “there is no such thing as a bad idea. so letting the mind wander is completely acceptable. Correct Answer: Remember that there is no such thing as a bad idea. Nursing Process: Planning Client Need: Safe. Choosing nurses with more than 5 years of experience also may be considered arbitrary and is not the ideal approach to develop this group. Which of the following should the manager counsel the staff prior to starting the brainstorming session? Your Answer: Think the idea completely through to the end before offering it as a suggestion. so letting the mind wander is completely acceptable. which will affect staff training and client care. How can the manager’s anger be directed toward a positive outcome? Your Answer: Analyze available resources. Staying focused on the number of people to be trained could compromise quality. With these principles in mind. call a staff meeting. and discuss ways in which all staff can be trained while ensuring client care needs are met. The nurse manager is planning to use brainstorming to facilitate the implementation of a computerized documentation system. The nurse manager is angry upon learning that the computerized documentation system go-live date has been moved ahead by one week. is insufficient because those who are interested might not be the best decision makers. Nursing Process: Planning Client Need: Safe.” Thinking the idea through to the end would be judging the idea. Effective Care Environment Cognitive Level: Application 2. and hitchhike on previous ideas. Effective Care Environment Cognitive Level: Application 3. aim for quality. Rationale: The nurse is experiencing situational anger.volunteers with a sign-up sheet.

energy. Effective Care Environment Cognitive Level: Application 4. and discuss ways in which all staff can be trained while ensuring client care needs are met. The nurse has learned that 8-hour shifts have been eliminated and staff will be scheduled to work 12-hour shifts. After attending a volatile committee meeting. Profession/bureaucratic conflicts are an incompatibility between the system expectations and professional responsibilities. Which of the following should the nurse say to share the committee information in a positive way? Your Answer: “Time was spent explaining why a decision was made. The other choices would not lead to a positive outcome and should not be done by the nurse manager. student. Nursing Process: Assessment Client Need: Safe. spouse. and parent. and is concerned about working while maintaining her family’s needs. all of which place demands on that individual’s time. which was very helpful to all present. the nurse wants to inform the manager of the content and outcomes. Nurse/nurse conflicts occur when differing values about the philosophy of nursing are held by nurses who work together.energizing. constructive. Effective Care Environment Cognitive Level: Analysis 5. Nursing Process: Planning Client Need: Safe. call a staff meeting. The movement of the implementation date of the computerized documentation system is an expectation that cannot be met. This nurse is experiencing which of the following types of conflict? Your Answer: Competing role Rationale: Competing role conflicts occur when the same person fills the roles of nurse. and arises when realistic expectations cannot be met. and attention. Personal competency gap conflicts occur when nurses’ skill levels interfere with their own expectations of standards of practice for themselves. The way in which the nurse manager can direct the anger toward a positive outcome would be to analyze available resources.” Rationale: Conceptualizing conflict using positive terms can lead to a .

helpful. and confrontation. use these terms in the description and would not be considered as being a positive way to explain the committee meeting. which was very helpful to all present” uses positive terms and will most likely lead to a positive outcome. and growth-producing. the nurse manager learns that an immediate family member is critically ill. depending upon the amount of money needed to cover the overtime budget. Nursing Process: Implementation Client Need: Safe. hostile. Because of the level of anxiety. creative. Once the anxiety level has decreased. Examples of negative terms include anxiety. The response “time was spent explaining why a decision was made. The other choices. Which of the following activities will the manager conduct during this step of the process? (Select all that apply. The manager tells the charge nurse to approve all nursing staff overtime until further notice. the nurse manager should reanalyze the decision made regarding the overtime and determine when it will cease. negative outcomes can occur. Nursing Process: Implementation Client Need: Safe. Effective Care Environment Cognitive Level: Application 6.positive outcome. If conflict is described using negative terms. the manager had a distorted perception about the overtime and made a blanket approval of all overtime until further notice. which of the following should be done? Your Answer: Analyze the amount of overtime and determine when it will cease Rationale: The nurse manager received news that caused an immediate panic level of anxiety. Moving budget dollars to cover the overtime may or may not be feasible. The nurse manager is working through predicting outcomes in the decision-making process. The nurse manager should not rescind all overtime the charge nurse approved nor continue with the approval of overtime until the next budget cycle. anger.) . stimulating. Terms that are considered positive include exciting. Once the manager’s stress level has decreased. Effective Care Environment Cognitive Level: Analysis 7. which are incorrect. While determining if overtime could be approved.

4. and think tanks are all techniques used to generate ideas. Centering relaxes the body. This is an activity conducted during the “predicting outcomes” step of the process. Use fact-finding techniques. They are typically used within the meeting and not before the meeting. 2. This is an activity conducting during the “plan for managing consequences” step. 5. Nursing Process: Implementation Client Need: Safe. This is an activity conducted during the “gathering of pertinent facts” step of the process.Your Answers: Use fact-finding techniques Search for variations in ideas Be honest about pros and cons Correct Answers: Remove alternatives with undesirable outcomes Concentrate on quality Rationale: 1. opens the mind. Nursing Process: Planning Client Need: Safe. forced association. Brainstorming. Effective Care Environment Cognitive Level: Application 8. This is an activity conducted during the “generation of alternative decisions” step of the process. and produces stability that affects the environment. Which of the following techniques can be employed before the meeting to enhance the outcome? Your Answer: Think tanks Correct Answer: Centering Rationale: Centering is a technique used to enhance collaboration by controlling stress during conflict resolution efforts. This is an activity conducted during the “predicting outcomes” step of the process. Effective Care Environment . A meeting is planned to discuss a conflict between the nursing staff and the physical therapy staff regarding times for clients’ therapies. Remove alternatives with undesirable results. Be honest about pros and cons. 3. Search for variations in ideas. Concentrate on quality.

Cognitive Level: Application 9. This technique minimizes the importance of . and the philosophy of the nurse are elements in this type of conflict. and an imbalance of power is often at the root of such conflicts. Correct Answer: Collegial relationship between the medical and nursing staff. legal issues. Personal competency gap conflicts occur when nurses’ skill levels interfere with their own expectations of standards of practice for themselves. The medical resident is overheard telling a group of new interns that their teacher for the next 3 months will not be the resident but rather the nursing staff. The nurse manager realizes the resident is explaining a(n): Your Answer: Personal competency gap conflict. Professional/bureaucratic conflicts arise from an incompatibility of expectations produced by the system and perceived professional standards and responsibilities. Smoothing.) Your Answer: Bargaining Correct Answers: Confrontation Bargaining Rationale: 1. This type of conflict occurs when nurses are expected to provide client care in areas in which they are unfamiliar. Which of the following techniques can the nurse manager use to achieve a successful situation between two conflicting groups of nursing staff? (Select all that apply. patient and family requests. This is a collegial relationship between the medical and nursing staff that is instrumental to avoiding the nurse/doctor conflict. personal values. Ethical issues. Effective Care Environment Cognitive Level: Analysis 10. Nursing Process: Assessment Client Need: Safe. Expressive/instrumental conflicts occur when nurses are torn between technical care demands and the human or expressive needs of patients. Rationale: The medical resident is explaining the value of the nursing staff as teachers to the new medical residents.

when successful. This leads to a win-lose outcome. This technique implies active involvement by one party while the other party avoids action or is powerless to act. is a force within people that shapes the way in which others can function. 5. 4. All parties lose. Nursing Process: Implementation Client Need: Safe. Two types of power are described in this chapter: (1) directive power. and therefore no solution is found. a positive force that cherishes others by incorporating their values. is a form of body relaxation that allows the harnessing of energy to overcome conflict by strengthening one's psychophysiological state and producing physical and emotional stability when confronted with conflict. This technique brings problems out into the open and. It can be time consuming but can lead to a win-win situation. 3. Centering Conflict Creativity Decision-Making Process Decisions Internal Climate Power . something will be given in return. is the dynamic socioemotional milieu that establishes the harmony/conflict ratio among people. is an unsettling condition that causes a clash of ideas about what is expected or established. It is purposeful and goal directed. and in time the problem presents itself again. Effective Care Environment Cognitive Level: Application Chapter 4 Key Terms Analysis is a critical function essential to sound decision making. and (2) synergic power. is a process of arriving at a conclusion after an analysis of units of related information. This technique implies that if one party is given something. Conflict can be friendly or hostile. a negative force that exploits others by advancing the power wielder's interest. Unilateral action. differences so that they are not acknowledged and/or respected. Avoidance. Bargaining. leads to a win-win situation. Confrontation. are a complex conclusion derived from a set of premises that relate to a situation.2. is a human quality needed to generate ideas in decision making. This is a no-win technique that sweeps differences off to the side where they will not go away but rather get worse.

Premises Situational Anger . given consideration of all known facts about a situation. A premise can be correct or incorrect and serves as the unit of analysis when evaluating decisions. are propositions about something that serve as bases for decisions. results when a legitimate expectation has not been met. It differs from chronic anger and can be energizing and constructive. It is a critical part of selecting a decision.Predicting is an identification of the likely outcomes of a decision.