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Keeping the peace: Conflict management strategies for nurse managers

Johansen, Mary L. PhD, RN, NE-BC Author Information

Mary L. Johansen is an assistant clinical professor at Rutgers, The State University of New Jersey, College of Nursing in Newark, N.J. 2000/Keeping_the_peace___Conflict_management_strategie s.13.aspx?WT.mc_id=HPxADx20100319xMP

The nurse manager needs to be purposeful and thoughtful when engaging in conflict resolution because the quality of communication and teamwork among healthcare providers has been directly linked to the safety of patient care.20 The following are recommendations for the nurse manager to strategically enhance patient safety through effective conflict management. Engage in dialogue. Nursing leaders and direct care nurses need to engage in dialogues that address conflict and conflict management behavior as a first step in creating a healthy work environment. The lack of communication and prevalent use of avoidance by today's nurses as a conflict management strategy prevents the root of the problem from being properly addressed and resolved, thus the conflict situation remains.5 This is important for the acute care setting because it's particularly susceptible to conflict due to the chaotic nature of the environment that includes constant change, poor communication, and multidimensional tasks.2123 Nonpunitive debriefing with staff regarding the management of a conflict issue provides reflective learning and removes frustration, which can lead to trust, openness, and effective conflict resolution in the future. Role-playing and the use of case scenarios are also effective methods to facilitate learning how to select an appropriate conflict management style for the situation at hand. By providing an environment of open communication and acknowledgement of each individu al's standpoint, a forum can be established for staff to addre ss issues in the future. (See Strategies to resolve conflict.) Engage in coaching. The nurse manager can minimize escalating conflict by educating nurses to learn how to effectively resolve conflict themselves. This can be accomplished through case scenarios and working with the education department on role-playing exercises. Because managers usually arrive after a dispute is in evolution, they may not have a clear understanding of the issue. Nurses who don't have the opportunity to learn about how to deal with conflict find it expedient and perhaps even necessary to have the manager intervene. Having the nurse leader walk the direct care nurse through a variety of conversations to resolve a dispute or disagreement provides the opportunity for alternative solutions to be considered.

Identify potential conflicts. Because conflicts are normal, inevitable experiences in the healthcare work environment, they're usually predictable. Situations that naturally occur as the nurse strives to manage complex patients are to be expected. Procedures and processes for identifying potential common conflicts need to be developed to transform these situations into opportunities for growth and learning. In its leadership standards, The Joint Commission recommends that organizations need to establish policies and guidelines to facilitate collaborative practice and encourage interprofessional communication across disciplines as a proactive measure to address conflict issues, working through them and moving toward resolution.20 These policies should communicate clear goals and objectives to prevent workplace violence, including a zero tolerance for workplace violence, verbal and nonverbal threats, and related actions; ensure that reporting of experiences of workplace violence may be done without fear of reprisals; encourage prompt reporting of incidents and suggest ways to reduce or eliminate risks; require documentation of incidents to assess risks and measure progress; and provide appropriate training and skills for all members of the organization. Education and training. Nurses need to be educated in the topic of conflict and conflict management strategies to address and effectively resolve conflict. Learning conflict management strategies empowers nurses to resolve conflict early and influence the work environment in which they deliver patient care. The training shouldn't be limited to the handling of interpersonal conflicts; it should include all types of conflict commonly encountered in the healthcare setting.3,19 In addition, individuals who have a propensity for managing conflict well should be identified and developed.

Nurse managers as knowledge workers

Conrad, Sharyn DNP, RN, FNP-BC; Sherrod, Dennis EdD, RN Author Information

Sharyn Conrad and Dennis Sherrod are faculty members in the Division of Nursing at Winston-Salem State University in Winston-Salem, N.C. 2000/Nurse_managers_as_knowledge_workers.14.aspx?WT. mc_id=HPxADx20100319xMP

Healthcare reform's emphasis on improved access, increased quality, and decreased costs is focusing particular attention on the use of technology and the development of electronic systems for data collection and analysis. As increasing healthcare costs are highlighted by the media, the national strategy for decreasing these costs is almost unanimously touted as implementation of electronic health records (EHRs) and technologies that will increase healthcare efficiency and prevent service delivery fraud and redundancy.

Much of the challenge of matching technologies to specific patient-care units or service lines is guided by nurse managers and their staff. Although informatics nurses are helpful in conceptualizing and managing data entry and analysis systems, it's the nurse manager and nursing staff who determine which data can be most useful in guiding patient-care delivery and ensuring positive patient outcomes. Nursing units are collecting more and more data on a daily basis and nurse managers and their staff members need to begin now to develop knowledge worker skills to ensure accurate data collection, reliable methods of analysis, and logical findings and conclusions.

It's vital that nurse managers develop knowledge worker skills related to data gathering, analysis, and identifying clinical trends and patterns. Hebda and Czar identify four specific knowledge worker skills utilized in patient-care delivery decision making: data gatherer, information user, knowledge user, and knowledge builder.2 For example, upon review of patient fall data (data gatherer) on your unit, you identify your fall rate is higher than expected. You interpret reports from patients, family members, and staff (information user) to gain insight into this important clinical issue. Individualized patient data are compared with evidence-based nursing knowledge (knowledge user). Clinical data on all patient falls in your hospital are then aggregated throughout your organization to create new knowledge, interpretations, and strategies to prevent future falls (knowledge builder) and improve patient safety outcomes. As unit leaders, nurse managers need to equip themselves with skills to harness the power of electronic data systems and rapidly translate patient findings and information into knowledge that informs and produces quality patient-care outcomes. They must champion electronic technology initiatives on their units and develop approaches to instill excitement, education, and empowerment that assist unit staff to gather clinical data and identify patterns for delivering more efficient and effective patient-care services.3 This national technologic surge will surely impact nurse managers, as they're on the frontlines of patient-care delivery systems. Nurse managers have great influence on quality, efficiency, and integration of technology in this new healthcare dimension and can lead the way in the effective use of electronic technologies. Nurse managers who develop and/or strengthen their knowledge worker skills are better equipped to be creative and visionary and are prepared to provide greater sustainability and growth for their unit and organization. These nurse managers are self-starters and have a high degree of autonomy.4 Nurse managers who develop themselves as knowledge workers and leaders are better able to understand, adapt, and drive new and evolving healthcare system technologies.

What do you do? Perceptions of nurse manager responsibilities

Baker, Susan MSN, RN, NEA-BC; Marshburn, Dianne M. PhD, RN, NE-BC; Crickmore, Kim D. PhD, RN, FABC; Rose, Silvia B. MSN, RN, NE-BC; Dutton, Kathy MSN, RN; Hudson, Patti Carr MSN, RN-BC Author Information

At Vidant Medical Center in Greenville, N.C., Susan Baker is an administrator for PeriOperative Services, Dianne M. Marshburn is a research administrator, Kim D. Crickmore is an assistant vice president of Operations Administration, Silvia B. Rose is a nurse manager in Orthopedics, Kathy Dutton is a senior administrator for the Office of Patient and Family Experience, and Patti Carr Hudson is a nurse manager. The authors have disclosed that they have no financial relationships related to this article. ptions_of_nurse_manager.7.aspx?WT.mc_id=HPxADx20100319xMP

The findings of this study confirm the complexity and variety of responsibilities of nurse managers. They spend their time on numerous activities to meet expectations of the role, including managing both the administrative and clinical activities of their units.3,7,10 If managers are expected to perform all the duties currently assigned to the role, organizations must structure education, training, and support systems for these leaders to equip them with the skills needed to be successful managers. Alternatively, organizations may need to consider a more realistic configuration of this frontline leadership role. This study found that inexperienced managers spent more time with their leaders, perhaps needing their guidance and direction. Those with less experience also spent more time on their units, mentoring their direct reports and rounding with patients and families. Being visible and accessible to staff members is a perceived priority of this group. The responsibility of meeting with senior leaders was also important for the less experienced nurse managers. The more traditional roles of discipline and performance appraisals were considered important by more mature leaders. The experienced leaders also felt they had mastered the routines of supply management, chairing meetings, ensuring compliance with regulatory standards, and facilitating/attending meetings with their leaders and peers. Variations related to the experience levels of managers call attention to the need to ensure that leadership development opportunities meet the requirements of new, emerging nurse managers, as well as seasoned leaders. Competency-based orientation plans, new manager orientations, leadership training, coaches, and peer support are critical to the success of all nurse managers. Managers should be provided with the support needed to be successful. Ready access to

education and clinical specialists, assistant nurse manager support, and expert clerical assistance are critical.