Nursing Administration (2)

Under Supervision of:

Prof. Dr. Mahasen Ismaeil

Prepared By:

Hany Magdy Aziz

Cairo University

Nursing Administration

Master’s 2023/2024
 Outline

A. Introduction

B. Definition of conflict

C. Causes of conflict

D. Effects of conflict

E. Conflict management strategies

F. Types Of Conflict at Workplace

G. Recommendations/ Suggestions to Solve the Conflict

H. Definition of negotiation

I. Negotiation pie

J. Importance of negotiation

K. Role of head nurse during negotiation

L. Negotiation skills

M. How to develop negotiation skills.

N. References
 Conflict Management
Introduction:

Conflict is a dynamic process that can be positive or negative, healthy, or dysfunctional, within the

work environment. Conflict is the consequences of experienced or perceived variations in common goals,

values, ideas, attitudes, beliefs, feelings, or actions. Conflicts arise for many reasons: they can originate

because of competition among professionals and variations in economic and professional values. Scarce

resources, poorly defined roles and expectations, the ability to work as a team, interpersonal

communication skills, and expectations about level of performance in various nurses' roles are all sources

of conflict in health care organizations.

The impact of the conflict at workplace:

Conflicts have a significant impact on their job satisfaction, burnout, and turnover intentions. This can

result in decreased quality of care and increased patient safety risks. Therefore, if the assessment of

conflict level among nurses’ staff provides insights into the nature and causes of conflicts, it could inform

the development of interventions to address and prevent these conflicts. Such interventions could

potentially improve job satisfaction and retention rates among nurses, as well as improve the quality of

care for patients.

Causes of Conflict:
First, Communication breakdowns can lead to conflict among staff in healthcare settings, including

nurses, in several ways: Misunderstandings, when communication between healthcare providers is unclear

or inadequate, misunderstandings can arise, leading to conflicts and potential errors in patient care. For

example, if a physician orders a medication but fails to communicate the dosage clearly to the nurse, the

nurse may administer the wrong amount, potentially leading to harm to the patient.

This can cause frustration and tension among staff, leading to conflicts.
 Lack of information sharing: Effective communication is essential in healthcare settings to ensure that

all providers have access to the necessary information to make informed decisions about patient care. When

there is a breakdown in communication, healthcare providers may not have access to the information they

need, leading to conflicts and potentially compromising patient care. For example, if a nurse fails to

communicate a change in the patient's condition to the physician, the physician may not be aware of the

need for a change in treatment, potentially leading to harm to the patient.

Language barriers: In healthcare settings with diverse staff, language barriers can lead to

communication breakdowns, misunderstandings, and conflicts. For example, if a nurse and physician speak

different languages and cannot communicate effectively, important information about patient care may be

lost, potentially leading to harm to the patient.

Technical difficulties: In healthcare settings with complex technology systems, technical difficulties

can lead to communication breakdowns, potentially compromising patient care. For example, if a nurse

attempts to communicate with a physician using a malfunctioning communication system, the physician

may not receive the message, potentially leading to delays in treatment and conflicts among staff.

Second, role ambiguity can lead to conflict among staff in healthcare settings, in several ways:

Unclear responsibilities: If the roles and responsibilities of healthcare providers are not clearly defined,

conflicts can arise when providers are unsure of their duties or who is responsible for certain tasks (Task

delegation/distribution). For example, if it is unclear who is responsible for administering medication to a

patient, conflicts can arise among staff as they attempt to determine who should perform the task.

Overlapping responsibilities: When roles and responsibilities overlap between healthcare providers, it

can lead to conflicts over who has authority or responsibility for a particular task or decision. For example,

if a physician and nurse both feel responsible for making a treatment decision for a patient, conflicts can

arise as they attempt to assert their authority.

 Lack of support: When healthcare providers do not receive adequate support from their superiors or

colleagues, it can lead to conflicts and job dissatisfaction. For example, if a nurse is expected to perform

tasks outside of their job description without adequate training or support, conflicts can arise as they

struggle to meet expectations.

Conflicting expectations: When healthcare providers have conflicting expectations of their roles and

responsibilities, it can lead to misunderstandings and conflicts. For example, if a physician expects a nurse

to perform a task that is outside of their job description, conflicts can arise as the nurse attempts to assert

their boundaries.

Third, staffing shortages; insufficient staffing levels can lead to increased workload, stress, and

conflicts. Staffing shortages can lead to conflict among staff in healthcare settings, in several ways:
Increased workload: when there are not enough staff to cover patient care needs, healthcare providers

may have to take on additional responsibilities and work longer hours, leading to burnout and stress. This

can lead to conflicts among staff as they struggle to manage their workload and prioritize patient care.

Reduced quality of patient care: when staffing levels are insufficient, the quality of patient care can

suffer, leading to conflicts among staff as they attempt to provide the best possible care with limited

resources. For example, if a nurse is responsible for too many patients, they may not be able to provide

adequate attention to each patient, potentially compromising patient safety.

Safety concerns: when staffing levels are insufficient, healthcare providers may be unable to respond

to emergencies or provide necessary interventions, potentially compromising patient safety. This can lead

to conflicts among staff as they attempt to manage the situation with limited resources.

Job dissatisfaction: When healthcare providers are overworked and stressed due to staffing shortages,

it can lead to job dissatisfaction and burnout, potentially leading to conflicts among staff as they struggle

to manage their workload and prioritize patient care (Twigg et al., 2015).
Fourth, interpersonal differences can lead to conflict among staff in healthcare settings, includes:

Personality clashes: when staff members have conflicting personality traits or values, it can lead to

conflicts and tension. Example, if one nurse is outgoing and talkative, while another nurse is introverted

and reserved, conflicts can arise over communication styles and preferred work environments.

Cultural differences: in healthcare settings with diverse staff, cultural differences can lead to conflicts

over communication styles, values, and beliefs. For example, if a nurse from one culture is used to more

direct communication, while a nurse from another culture is used to more indirect communication, conflicts

can arise over communication styles.

Fifth, resources allocation, disagreements over resource allocation, such as equipment or medication.

Resource allocation can lead to conflict among staff in healthcare settings, in several ways. Including,

limited availability of resources such as limited equipment or medication, conflicts can arise over who

should have access to them and how they should be used. For example, if there is only one

Electrocardiogram (ECG) device available for two patients, conflicts can arise over which patient should

receive the procedure first.

Unequal distribution: it occurs when resources are distributed unequally among staff or departments,

conflicts can arise over fairness and equity. For example, if one department receives more funding or

resources than another, conflicts can arise over whether the distribution is fair and how it should be

addressed (Huang & Li, 2018).

Sixth, organizational culture; it can lead to conflict among staff in healthcare settings, in several ways:
Power dynamics can lead to conflicts over decision-making and control. For example, if an organization

has a hierarchical culture where decision-making is centralized, conflicts can arise when staff members

feel that they do not have a voice in decision-making.

 Five Conflict Management Strategies/Modes
First, avoiding; this method involves simply ignoring or being unassertive that there may be a conflict.

People tend to avoid conflict when they do not want to engage in it. Avoiding allows them to ignore that

there is a problem. There are situations when avoiding conflict can be an appropriate response, such as

when there is no clear solution, or a frustrated party needs time to calm down before confrontation.

Second, competing is assertive, power-oriented and an uncooperative approach, used by people who

insist on winning the dispute at all costs using power and influence to achieve one’s goals. It’s known as a

win-lose strategy. This method is not often identified as bringing satisfactory resolutions, as it doesn’t allow

for collaborative problem-solving.

Third, accommodating; this strategy, also known as smoothing, involves one party accepting, giving

the opposing party exactly what it needs to resolve the problem. This method allows you to resolve a

problem in the short-term while working toward a long-term solution.

Fourth, collaborating like the compromising method, collaboration involves working with the other

party to find a mutually agreeable solution to a problem. It’s known as a win-win strategy. This

strategy involves active listening, identifying common goals, and brainstorming to find creative

solutions that meet the needs of all parties. For example, a nurse leader and staff may work together to

negotiate contract terms until both parties find it agreeable.

Fifth, compromising; this strategy, also known as a lose-lose strategy since both parties willingly loss

some of their needs in the interest of reaching an agreement. This can be a quick way to resolve a

conflict without it becoming a bigger issue. It can also be used as a temporary method to avoid conflict

until the parties involved can implement a more permanent solution. It is appropriate to compromise

when it would not be possible to make both sides completely happy while still moving forward.
 Types Of Conflict at Workplace
1- Interpersonal conflict:

It occurs when there are disagreements or misunderstandings between two or more individuals, and it can be

caused by a variety of factors, such as differences in personality, values, or communication styles.

Miscommunication: interpersonal conflict can arise when there is a breakdown in communication between

nurses. For example, misinterpretations of tone or body language can lead to misunderstandings that worsen

into conflicts. Personality clashes when there are personality clashes between nurses.

2- Intrapersonal conflict

Refers to a type of conflict that arises within an individual. It can be caused by a variety of factors, such as

conflicting goals or values, cognitive dissonance, or emotional distress. For example, a nurse may

experience intrapersonal conflict if they have conflicting goals or values regarding patient care, such as

wanting to provide the best possible care to a patient while also needing to prioritize other tasks. Emotional

distress, such as feelings of guilt, shame, or anxiety, can also lead to intrapersonal conflict among staff.

3- Intergroup conflict:

It occurs among nurses’ staff refers to a conflict that arises between two or more groups of nurses who have

different goals, values, or interests and differences in communication styles, work methods, or other

factors that lead to misunderstandings, tension, and resentment between groups of nurses.

4- Inter-organizational conflicts:

Inter-organizational conflicts refer to conflicts that occur between different organizations or entities. These

conflicts often arise due to competition, differing interests, or incompatible goals. It includes: Competition

for resources, Disputes over contracts and agreements, and Differences in strategic objectives.

5- Intra-organizational conflicts:

Intra-organizational conflicts occur within a single organization and involve conflicts between individuals,

teams, or departments within the organization. Some common types of intra-organizational conflicts

include: Role conflicts, Communication breakdown, Resource allocation conflicts, and value conflicts.
6- Competitive conflict:
It can be considered a type of functional conflict among nurses when it is managed effectively. Functional

conflict is a type of conflict that is considered constructive and can lead to positive outcomes, such as

innovation, improved performance, and increased motivation. Competitive conflict among nurses’ staff can

be functional when it leads to competition that motivates nurses to strive for excellence, encourages them to

develop new skills and knowledge, and fosters an environment of continuous improvement.

Recommendations/ Suggestions to Solve the Conflict among Staff

1. Designing an Effective Conflict Resolution Training Program for the Staff

Training is one of the most important strategies for conflict management is to conduct conflict

resolution training. Training has many advantageous objectives for both individuals and organizations. As

it can help staff members promotes positive workplace relationships: Conflict resolution training can help

employees develop skills to manage and resolve conflicts in a constructive and respectful manner. Leading

to positive workplace relationships, increased collaboration, and better teamwork. It helps in improving

communication among employees by teaching active listening, effective communication, and empathetic

responses. This can prevent misunderstandings and promote a better understanding of different perspectives.

2- Fostering a positive work environment:

This can involve creating a culture that promotes teamwork, mutual respect, and appreciation for diversity.

This can help reduce interpersonal and intergroup conflict by promoting a sense of community and shared

purpose among staff members.

3- Suggested Workplace Conflict Policy

The purpose of this policy is to establish a process for managing workplace conflicts among staff nurses. The

policy aims to promote a positive work environment that is free from discrimination, harassment, and other

forms of misconduct.
 Negotiation

Introduction:

Nurses are negotiators. Whether with patients, families, physicians, supervisors, unlicensed staff, or with

each other, negotiation is part of the ongoing and continuous process inherent within nursing.

Negotiation is a dialogue between two or more parties to resolve points of difference, gain an advantage

for an individual or collective, or craft outcomes to satisfy various interests. The parties aspire to agree on

matters of mutual interest.

Negotiation pie:

The pie is the reason the negotiation is taking place where the resulting agreement “divides the pie” with

each participant taking their share. Since there is a fixed “pie” what one party gets comes at the expense of

the other party. In a broader perspective, every negotiation has a distributive component.

Importance of Negotiation:

1- Conflict Resolution

Negotiation is an essential problem-solving tool when resolving a conflict. By correctly identifying a

problem, anticipating the needs of patients, employees or organizations involved and weighing up

solutions, you can produce the best possible outcome, predict future conflicts and stage an early

intervention. Additionally, for employees, being able to negotiate empowers them to settle a disagreement

without needing their managers to get involved.

2. Building Relationships

Negotiating effectively can give clients, employees and employers a positive impression rooted in respect.

By dealing with problems fairly, forming strong bonds with clients and securing mutually beneficial deals.

It is valuable for bosses who feel their teams would benefit from a compassionate approach to leadership.

3- Boost the Bottom Line

It allows you to be intelligent with your agreements and better persuade others to your way of thinking.
For example, by taking the time to negotiate the cost of a job with a contractor or vendor, you could

reinvest any money you’ve saved into another project or add it to your profit margins. On a more personal

level, you could use it to negotiate a pay rise or annual bonus with your boss. In short, it is a mindset, and

knowing how to use it can give you the boost you didn’t know you needed.

4- Communication

Master negotiators aren’t just good talkers, they are excellent listeners. It allows you to listen accurately

and identify the opposition's weaknesses and strengths. Negotiation teaches you to get to the point and be

direct about what you desire and need without being distracted. So being able to make an excellent point

in just a few words saves everyone time, energy and money.

Role of the head nurse during negotiation: they have to

1. Keep an Open Mind

It’s important to go in with an open mind and be prepared. “Adaptability is imperative in negotiation from

start to finish. Opportunities will come up”

2. Show their Cards

People may think “holding cards close to the vest,” or not giving away your agenda, is wise in a

negotiation, the opposite is correct. Stating what you want it can improve the opportunity for both sides.

3. Set and Stretch their Goals

As in most things, preparation is paramount. Going to the negotiating table with a clear goal. Write it

down and commit it to memory. Also, setting a stretch goal and making that your starting point.

4. Turn Anxiety into Excitement

Approaching a negotiation can cause blood pressure to fly, but keeping your cool is key. "Try your utmost

to avoid feeling anxious while negotiating,” “How can you manage that? Train, practice, rehearse, and

keep sharpening your negotiating skills. Anxiety is often a response to novel stimuli, so the more familiar

the stimuli, the more comfortable and the less anxious you will feel.”
5. Take a Timeout/Break

Knowing when to take a break before you actually need. It can be a powerful tool. Not only will it give

you time to collect yourself, but it can disarm your “opponent.”

6. Silence Can Be Golden

If you can’t physically leave the room, at least take deep breaths. Pausing can even be a great way to get

what you want. It gives you time to absorb, digest, and carefully consider your response, but might also

create discomfort on the other side, which could lead to a better deal.

Negotiation Skills:

1. Communication

Effective negotiators develop communication skills that allow them to engage in discussion and work

toward an agreeable solution.

2. Emotional Intelligence

Positive emotions can increase feelings of trust. Similarly, you can channel anxiety or nervousness into

excitement. You need a high degree of emotional intelligence to read other parties’ emotions. This can

enable you to pick up on what they’re implying rather than explicitly stating and usefully manage and use

your emotions.

3. Planning

Planning ahead with a clear idea of what you hope to achieve and where your boundaries lie is essential to

any negotiation.

4. Value Creation

It is a key skill in negotiation. When participating in a negotiation, you and the other parties typically try

to obtain the biggest “slice of the pie” possible. Fighting to maximize your slice inherently means

someone will get a smaller piece. To avoid this, shift your goals from growing your slice to expanding the

whole pie. Greater value and establish a sense of rapport and trust will benefit future discussions.
 5. Reflection

After each negotiation—successful or not—think about:

What went well and what could have gone better.

Doing this can allow you to evaluate the tactics that worked in your favor and those that fell short.

Next, identify areas you want to work on and create a plan of action.

How to Develop Negotiation Skills?

➢ Do your research, and have a plan in place.

➢ Take the time to strategize with your team before a meeting.

➢ Listen carefully to what the other people are saying, and ask considered questions.

➢ Engage with audience, and think before you speak.

➢ Focus on the discussion at hand, and take an active role.

➢ Be open-minded, flexible and solution-oriented.

➢ Before you close a negotiation, consider whether your agreement is mutually beneficial.

➢ Practice using negotiation strategically at work and home.

➢ Book into training, and get expert advice on how to level up negotiation skills.
References List:

➢ American Association of Critical-Care Nurses. (2016). Standards for establishing and sustaining healthy

work environments: A journey to excellence (2nd ed.). Jones & Bartlett Learning.

➢ Barnett, J. E., & Limberg, D. (2019). Intrapersonal conflicts among nurses: An exploratory study. Journal of

Nursing Education and Practice, 9(11), 1-9. https://doi.org/10.5430/jnep.v9n11p1

➢ Davis, D. M., & Hayes, J. A. (2017). What are the benefits of mindfulness? A practice review of

psychotherapy-related research. Psychotherapy, 48(2), 198–208. https://doi.org/10.1037/a0022062

➢ De Dreu, C. K. W., & Weingart, L. R. (2013). Task versus relationship conflict, team performance, and team

member satisfaction: A meta-analysis. Journal of Applied Psychology, 88(4), 741–749.

https://doi.org/10.1037/0021-9010.88.4.741

➢ De Dreu, C. K. W., & Gelfand, M. J. (2008). Conflict in the workplace: Sources, functions, and dynamics across

multiple levels of analysis. In C. K. W. De Dreu & M. J. Gelfand (Eds.), The psychology of conflict and conflict

management in organizations (pp. 3-54). Erlbaum.

➢ Hegney, D. G., & McCarthy, A. (2019). Intergroup conflict among nurses: A qualitative study. Journal of

Nursing Management, 27(1), 79-87. https://doi.org/10.1111/jonm.12656

➢ Huang, Y. T., & Li, C. F. (2018). Effects of nursing workload and nurse staffing on patient outcomes: A

systematic review. Journal of Nursing Management, 26(8), 918-929. https://doi.org/10.1111/jonm.12624