DEFINITION OF CONFLICT

DEFINITION INVOLVES THE FOLLOWING FACTORS:

1. Existence of at least two independent persons or groups
2. Disagreement or a contradictions in ideas, interests or goals
 Independent persons or groups perceive incompatibilities between themselves, which
impedes or restricts of attaining desired goals.
3. The group interact with each other in the same way
 The parties to it must perceive conflicts; whether or not conflict exists is a perception
issue. If no one is aware of a conflict, then it is generally agreed that no conflict exist.

CONFLICT = Perception of Incompatible Aspirations

“Is a process that begins when one party perceives that another party has negatively affected, or is
about to negatively affect, something that the first party cares about.”

Conflict can be at time within yourself, when you feel that you lack some of the values that you
always wanted to adopt. These conflicts, which can be very disturbing at times, can also stake
somebody’s life. These conflicts can be taken care of with a self-discipline strategy. It can be prevented
and gradually resolved tactfully for a long run.

The absence of conflict signifies a meaningful interaction.

CONFLICT IS INEVITABLE

Conflict is a fact of life. Conflict is going to happen whether you like it or not regardless of your
best intentions or how hard you try you avoid, conflict will happen in your life…

It can occur at anytime and in any place, originating between two individuals or groups when there
is a disagreement or difference in their values, attitudes, needs, or expectations, miscommunication or
lack of information.

CONFLICT IN NURSING

Conflict is a possibility no matter what your occupation is, and nursing isn't an exception.

Nursing is a profession that is based on collaborative relationships with clients and colleagues. It
requires individuals to work closely with others with varying backgrounds or cultures. Individuals can
hold diverse values, potentially affecting these relationships, which may result in conflict. Good
communication or conflict resolution skills can decrease the risk of conflict.

There are no conflict-free work groups, small or large, conflicts are a daily occurrence in the life of
nurse and they can interfere with getting work done.

PROS AND CONS OF CONFLICT

“Conflict is neither good, nor bad, it just is,” (Marshall, 2006Over time individuals learn how to
respond to conflict, making it an unconscious process. Dealing with conflict properly requires the
individual to develop conflict resolution skills.

POSITIVE EFFECT:
Conflict is growing edge of relationships. Although many people think only of its ugly or
unfortunate results, some conflict is actually necessary and good. It all depends on how a particular
conflict is handled.

Conflict can lead to positive outcomes for nurses, their colleagues and clients. Conflict that is
managed effectively by nurses can lead to personal and organizational growth. Nurses can develop
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more open, cooperative ways of working together. Most of the time, people manage to get along with
others with consideration, helpfulness and skill. It promotes change (internal/external). It provides for
ways to facilitate reconciliation of legitimate but opposed interests.

Nurses who effectively deal with conflict demonstrate respect for clients, colleagues and profession.

NEGATIVE EFFECT:
Conflict can be a serious problem in an organization. It can create chaotic conditions that make it
nearly impossible for employees to work together on the other hand. Personality clashes are highly
common in the nursing world, as the field often brings upon a lot of stressful and emotional
circumstances, not only for workers, but also for patients and their families. Serious conflicts can be
very stressful for the people involved. Bitterness, anger and even violence can erupt in the workplace if
conflicts are not resolved. It can hinder a nurse’s ability to provide quality client care and escalate into
violence and abuse.

Workplace conflicts in the healthcare environment tend to be far more complicated because they
often involve ongoing, complex relationships that are based in emotion. Most common/problematic
type of conflict experienced in workplace involved interpersonal conflicts. Understanding the types of
conflicts that the direct care nurse commonly encounters and the way he or she responds to conflict is
an important element in identifying effective strategies to manage conflict in the healthcare
environment.

While conflict is an inherent part of nursing,8 the provision of professional services to clients does
not include accepting abuse. In addition, conflict among colleagues can lead to antagonistic and
passive-aggressive behaviours (such as bullying or horizontal violence) that compromise the
therapeutic nurse-client relationship.
.

CAUSES OF CONFLICT
WHY DO CONFLICTS OCCUR?

Conflicts can occur at any level and involve any number of people, including supervisors, subordinates
peers or patients, on the individual level, they can occur between two people on a team, between two
people in different departments, or between staff member and a patient or family member. On the group
level, conflict can occur between two teams, two departments, or two different professional groups
(nurses and social workers over who is responsible for discharge planning). On the organizational level,
conflicts occur between two organizations (when two home health agencies compete for the contract
with large hospital)

Health care brings people of different ages, gender, income levels, ethnic groups, educational levels,
lifestyles and professional together fort he purpose of restoring and maintaining peoples health.
Task related conflicts: issues related to work
Relationship conflicts: primarily related to personal and social issues

I. NURSE-CLIENT CONFLICT
A therapeutic nurse-patient relationship is the foundation of nursing care. The role of the nurse
in the therapeutic nurse-client relationship is to support the client in achieving the client’s health goals
It contributes to both the patients’ well-being and their health. The relationship is based on trust,
respect, empathy, professional intimacy and the appropriate use of the nurse’s inherent power.
Conflict can impede these collaborative relationships by not allowing the nurse to fully support the
patient in attaining his or her health goals. It requires individuals to work closely with others who have
varying backgrounds or cultures and, hold diverse values that can potentially result in conflict. Good
communication or conflict resolution skills can decrease the risk of conflict.

1. Intoxicated or withdrawing from a substance- 
induced state; 
 Active drug or alcohol

dependency or addiction; 
Being constrained (for example, not being permitted to smoke) or
restrained (for example, with a physical or chemical restraint); 

2. Tense, anxious, worried, confused, disoriented or afraid. 

3. History of aggressive or violent behavior,, or 
is acting aggressively or violently (for example,
using profane language or assuming an intimidating physical stance). Disrespect, sarcasm, finger
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 pointing, throwing things, inappropriate language and demanding remarks. Uses a threatening
tone of voice or body language (for example, speaks loudly or stands too close);
4. Medical or psychiatric condition that causes impaired judgment or an altered cognitive status; 

5. Difficulty communicating (for example, has aphasia or a language barrier exists);
6. Judges, labels or misunderstands a client;
7. Has expectations based on incorrect perceptions of cultural or other differences;
8. Does not listen to, understand or respect a client’s values, opinions, needs, ethnocultural beliefs;
9. Does not listen to the concerns of the family and significant others, and/or act on those concerns
when it is appropriate and consistent with the client’s wishes;
10. Does not provide sufficient health information to satisfy the client or the client’s family;
11. Does not reflect on the impact of her/his behaviour and values on the client.

II. WORKPLACE ITSELF: GENERATOR OF CONFLICT

Employers and nurses are partners in the delivery
 of optimal health care; they share the
responsibility 
for creating a healthy workplace for all members of the health care team. This
responsibility involves ensuring that conflicts do not negatively affect client health outcomes or
relationships among
colleagues. A healthy workplace is an environment
in which nurses can safely
identify conflict and implement systems for its management.

a. ADMINISTRATION
 There is a lack of formal performance feedback mechanisms;
 Managers and administrators abuse or bully;
 Managers and administrators show favoritism to certain staff members and ignore their
disruptive behavior;
 Lack of awareness about the need to anticipate and manage conflict.

b. CONFLICT WITH COLLEAGUES

Conflict among colleagues can have indirect influence on therapeutic nurse-patient relationship.
Poor relationships among members of health care team negatively affect delivery of care. It
erodes a nurse’s confidence and compromises her/his ability to foster therapeutic relationships
with clients.
i. Power Plays And Competition
Power dynamics are inherent among colleagues. However, misuse of power can contribute
to conflict among members of the health care team. By recognizing factors that can
contribute to misuse of power among colleagues, nurses can seek constructive and
collaborative approaches to resolving differences.
 Nurse-physician relationships conflicts
 Disagreements over professional “territory” can occur
 Disagreement over limitations on nurse practitioner independence,
 Physician dominance and authoritarian management may create an environment in
which bullying occurs
 In some setting nurses feel powerless, trapped by the demands of the task they must
complete and frustrated that they cannot provide quality care.
 Bullying or Horizontal violence exists; 

Horizontal violence: Interpersonal conflict among colleagues that includes antagonistic
behavior (gossiping, criticism, scapegoating, undermining, intimidation, passive
aggression, withholding information, insubordination, bullying, and verbal and physical
aggression)
Bullying: Any act or verbal comment that could isolate or have negative psychological
effects on a person. Bullying usually involves repeated incidents or a pattern of behavior
that is intended to intimidate, offend, degrade or humiliate a particular person or group
of people.
 Different practice perspectives are accentuated by factors such as age, length of service,
generation gap, culture and education level;

ii. Different practice perspectives are accentuated by factors such as age, length of service,
generation gap, culture and education level;

iii. Fear of reprisal impedes the reporting of conflict by staff;
iv. Team members do not support each other in achieving work responsibilities/meeting
learning needs;
v. New graduates and/or employees are not supported by experienced nurses and/or systemic
orientation practices;

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 vi. Fear of reprisal impedes the reporting of conflict by staff;

III. ROLES OF THE NURSE

Healthcare organizations are dramatically changing the way they operate due to initiatives to
increase productivity and the quality of services provided. These initiatives are forcing hospitals to
break down traditional hierarchal structures and move toward a team-managed environment. As a
result, nurses no longer function on nursing units in a typical subordinate role, but are finding
themselves in new roles.
a. Nurses and health care professionals are working at peak stress times/under stressful conditions;
organizational policies or programs aimed at identifying, preventing and managing working
conditions are poor ( lack of ventilation, too much noise, safety hazards
b. Lack of role clarity for staff
c. Increase workload:
 Emphasis on cost reductions has resulted in work intensifications, a situation in which
employees are required to do more in less time.
 Examples: Skipping lunch and unpaid overtime. This leads many health care workers
believing that their employers are taking advantage of them and causes conflict.
d. Multiple Role Demands
 Inappropriate task assignments (asking nurses to clean the floors as well as nurse their
patients) are often the result of cost control efforts, which can lead to disagreements about
who does what task and who is responsible for the outcome.
e. Colleagues are intentionally or unintentionally put into situations beyond their capabilities

IV. DIVERSITY CAN LEAD TO CONFLICT

a. CULTURAL DIFFERENCES:
 Different beliefs and how hard a person should work, what constitutes productivity, and
even what it means to arrive at work on time can lead to problems if they are not reconciled
 Cultural diversity, combined with the stress of providing quality care, often results in
conflict (Pettrey, 2003). According to the New York State Nurses Association (2005),
unresolved conflict leads to barriers for employees, teams, organizational growth, and
productivity, which results in a cultural breakdown within the organization.
 Workplace culture promotes under-reporting of incidences of conflict;
b. GENDER BASED CONFLICTS
 Equal pay for women
 Sexual harassment issues
c. A party possesses attitudes, values, skills, and goals that are salient in directing his or her
behavior but are perceived to be exclusive of the attitudes, values, skills, and goals held by the
other(s).

V. THREATS TO SAFETY AND SECURITY:

When cost saving is emphasized and staff member layoffs, peoples economic security is
threatened. This can be a source of considerable stress and tension.

VI. SCARCE RESOURCES:

Inadequate money for pay raises, equipment, supplies or additional help can increase
competition between and or amongst departments and individuals as they scramble to grab their share
of what little is available.

VII. INVASION OF PERSONAL SPACE:

Crowded conditions and the constant interactions that occur at a busy nurse’ station can increase
interpersonal tension and lead to battles over scarce work place

LEVELS OF CONFLICT

I. INTERNAL (WITHIN THE PERSON)

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 • Incompatibilities within a person's cognitive-informational processing system having to do
with Goals, Actions, Outcomes.
• Torn between two competing choices, or sides
• Feel conflicting emotions in viewing an issue, or a group
• Can see valid arguments in support of both views
II. INTERPERSONAL: (BETWEEN PEOPLE)
• Incompatibilities between the GAO's of two, or a few, people
• Disagreement or distrust develops between two or more individuals
• Leads to coolness and tensions in the relationships
• If unresolved, interpersonal conflict almost inevitably spreads among other group members.
• Awareness of self and awareness of others is critical.
• In 2009, the Center for American Nurses conducted a conflict resolution survey to identify
challenges related to conflict encountered by the professional RN. A total of 858 nurses
responded to both open-ended and closed-ended items in a web-based survey:
(http://www.medleague.com/blog/2012/06/05/doctors-and-nurses-in-conflict)
• The three prime situations of interpersonal conflicts frequently identified in the
survey included (1) patient and family, (2) nurse manager, and (3) physician.
Conflict involving nurses and patients/families/visitors was reported to occur as a
result of the disparity in perceptions regarding which patient-care issue needed to be
addressed first, limiting visiting hours, and restrictions surrounding disclosure of
confidential information. The second most frequent interpersonal conflict was
between the direct care nurse and the nurse manager. This type of conflict was
associated with lack of organizational support from the leadership team and poor
communication. The third interpersonal conflict was between other healthcare
providers and the direct care nurse. These conflicts weren't handled effectively or
were ignored, which resulted in a toxic work environment.
• The literature also reports that frequent areas of conflict in the acute care
environment are interpersonal conflict with professional peers, such as physicians
and individuals in other clinical services, and task conflict, such as getting lab
results, turnaround time for X-rays, and reaching consultants in a timely manner

III. INSTITUTIONAL:
• Involves conflict between groups
• Groups may be formal or informal
• Sometimes groups are organized for the specific purpose of engaging in conflict and other
groups are organized to counter those efforts.
• Usually find competing groups are well-intentioned, firmly convinced of rightness of their
positions

CONFLICT MANAGEMENT PROCESSES

 It is a process of resolving or managing a dispute. Therefore, learning to manage conflict is integral

to a high-performance team.
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 Manner in which this mind state is handled is called “managing”. So, the management of conflict
that surrounds you always is called “Conflict Management”.
 Conflict management involves implementing strategies to limit the negative aspects of conflict
and to increase the positive aspects of conflict at a level equal to or higher than where the conflict is
taking place. Furthermore, the aim of conflict management is to enhance learning and group
outcomes (effectiveness or performance in organizational setting) (Rahim, 2002, p. 208). It is not
concerned with eliminating all conflict or avoiding conflict. Conflict can be valuable to groups and
organizations. It has been shown to increase group outcomes when managed properly
 Conflict management is the principle that all conflicts cannot necessarily be resolved, but learning
how to manage conflicts can decrease the odds of non-productive escalation.
 The central question in Conflict Management: “How can we avoid conflict’s potential for
destruction and turn it into an agent of change and growth?”
 Conflict management is the process of limiting the negative aspects of conflict while increasing
the positive aspects of conflict.

METHODS OF CONFLICT MANAGEMENT

FIGHT OR FLIGHT?
Physiologically we respond to conflict in one of two ways—we want to “get away from the
conflict” or we are ready to “take on anyone who comes our way.” Think for a moment about when you
are in conflict. Do you want to leave or do you want to fight when a conflict presents itself? Neither
physiological response is good or bad—it’s personal response. What is important to learn, regardless of
our initial physiological response to conflict, is that we should intentionally choose our response to
conflict.
 Whether we feel like we want to fight or flee when a conflict arises, we can deliberately
choose a conflict mode. By consciously choosing a conflict mode instead of to conflict, we are more
likely to productively contribute to solving the problem at hand.

There is no one best way to deal with conflict. It depends on the current situation. Here are the major
ways that people use to deal with conflict.

I. The Turtle (WITHDRAWING)

 Turtles withdraw into their shells to avoid conflicts. They give up their personal goals and
relationships. They stay away from the issues over which the conflict is taking place and from
the persons they are in conflict with. Turtles believe it is hopeless to try and resolve conflicts.
They feel helpless. They believe it is easier to withdraw (physically and psychologically) from a
conflict than to face it.
 Avoiding conflict is not generally advised. Yet even this tactic can be used strategically, for
example to create a delay that allows people to cool down or gather more information. Experts
recommend using avoidance only when the issue is of small importance, when you know you
can’t prevail against a more powerful opponent, or when the potential damage of a
confrontation outweighs the benefits. Nurses who avoid conflict at all costs are at odds with the
profession’s goal to advance the standard of care delivery – they are not leaders.

II. The Shark (FORCING/COMPETING)

 Sharks try to overpower opponents by forcing them to accept their solutions to the conflict.
Their goals are highly important to them and relationships of minor importance.
 This is a type of conflict management strategy that is effective in certain situations where time
and decision-making abilities are most important.
 They seek to achieve their goals at all costs.
 They are not concerned with the needs of others. They do not care if others like or accept them.
 Generally a negative way to manage conflict. The goal is to “win” at all costs and the style is
characterized by high assertiveness and low cooperation – for example when a person uses her
rank to force an issue to resolution.
 Sharks assume that conflicts are either won or lost and they want to be the winner. This gives
them a sense of pride and achievement. Losing gives them a sense of weakness, inadequacy and
failure. They try and win by attacking, overpowering, overwhelming and intimidating others.
 Yet it might be a useful tactic in an emergency when quick, decisive action is vital, or where an
unpopular course of action must be implemented.
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  A manager who uses this tactic too often, however, will likely end up with a team of un-
empowered nurses who are indecisive, slow to act, and prone to withhold feedback.
 However, many managers use this style to cease hostilities and end nonproductive behavior.
Then they can revisit and resolve the underlying issues at later time.
 Example of force conflict management is: Workers who use some expensive heavy-duty
machinery have figured out a way to affect the performance of the machinery in an untested and
unproven way. When workaround is brought to management's attention, manager demonstrates
how action puts the company in non-compliance and practice will not be tolerated. Employees
insist that it makes job easier and they are willing to take risks. Manager makes it a policy that
any employee caught performing workaround will be disciplined

III. The Teddy Bear (SMOOTHING/ACCOMMODATING)

 To teddy bears the relationship is of great importance while their own goals are of little
importance. Allowing the other party to satisfy their concerns while neglecting your own.
 The goal with this tactic is to yield – to preserve harmony and relationships at all costs
(although sometimes this means ignoring the issue at hand, which can be detrimental to a long-
term solution).
 Teddies want to be accepted and liked by other people. They think that conflict should be
avoided in favor of harmony and that people cannot discuss conflicts without damaging
relationships. They are afraid that if a conflict continues, someone will get hurt and that could
ruin the relationship. They give up their goals to preserve the relationship. They like to smooth
things over.
 It may be used effectively when you’ve realized you’re in the wrong, when the issue is clearly
more important to the other party than it is to you, and when you want to build goodwill and
demonstrate that you’re reasonable. But beware! If you use this style too often, you may be seen
as weak, ineffective, or fearful of change.

IV. The Fox (COMPROMISING)

 Bargaining process that often results in a less-than-ideal solution as concessions are made (one
party may be willing to give up something on this issue to gain leverage for another).
 Foxes are moderately concerned with their own goals and their relationships with others. They
give up part of their own goals and persuade others in a conflict to give up part of theirs. They
seek a conflict solution in which both sides gain something - the middle ground between two
extreme positions.
 They compromise; they will give up a part of their goal and relationship in order to find
agreement for the common good.
 This tactic may be useful in arriving at a temporary settlement on a complex issue, or a quick
fix when time is of the essence.
 It’s best used for issues of mild to moderate importance – you wouldn’t want to compromise on
an issue of patient safety, for example. And it may work well when both parties have equal
power in the hierarchy and are equally committed to their position.
 Overuse of this style can have negative consequences, however. Parties may lose sight of long-
term goals or become cynical as concessions are made to keep people happy without resolving
the original conflict. A frequent compromiser may be seen as having no firm values.
 Ultimately, the solutions put in place cannot be in direct opposition to the long-term goals of the
group or company.
 An example of compromise conflict management is: One group of employees is outraged that
their work is made harder because of something that another group is failing to do. Both parties
feel duty belongs to the other. A compromise would allow both parties to restructure flow of
work and agree to take on shared aspects of duty so neither side is overburdened.

V. The Owl (CONFRONTING/COLLABORATING)

 Owls highly value their own goals and relationships.
 They view conflicts as problems to be solved and seek a solution that achieves both their own
and the other person's goals. Owls see conflicts as a means of improving relationships by
reducing tension between two people.
 Cooperating with the other party to understand their concerns and expressing your own
concerns in an effort to find a mutually and completely satisfactory solution (win-win). They try
to begin a discussion that identifies the conflict as a problem to be solved. By seeking solutions
that satisfy everyone, owls maintain the relationship.
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 They are not happy until a solution is found that both satisfies everyone’s goals and resolves the
tensions and negative feelings that may have been present.
 Collaborating is true problem solving. The goal is to find a mutual solution when both sets of
interests are too important to be compromised – for example, when an issue of patient safety is
at odds with the need to use limited resources strategically.
 The process of collaborating involves high amounts of both assertiveness and cooperation, as
parties with different perspectives attempt to merge their insights and work through the conflict.
This is generally considered most effective style of managing conflict yet also has pitfalls-use it
for everything and you’ll find yourself spending exorbitant amounts of time sorting out trivial
issues.
 Collaborating allows employees to choose the plan that best suits the company as a whole.
 An example of a collaborative conflict management strategy is this: Employees are notified that
the company health care insurance policy will change and there are meetings held to review and
choose a new plan. Some want a plan that offers a lower deductible with more limited options,
while others seek a more comprehensive plan with a higher deductible.

Conflict Management Style Productivity

Withdrawal / Avoidance Temporary (Fails to Resolve)

Smoothing / Accommodating
Compromising
Provides Resolution
Forcing / Competing
Problem Solving / Collaboration