leadership and management chapter 23

intrapersonal conflict

"I" conflict. occurs within a person when confronted with the need to think or act in a way that seems at odds with one's sense of self.

what are outcome consequences?

(1) the conflict being resolved with a revised approach, (2) stagnation of any current movement, or (3) no future movement

what two general outcomes are considered when assessing the degree to which a conflict has been resolved?

(1) the degree to which important goals were achieved and (2) the nature of the subsequent relationships among those involved

If You Seldom Use Accommodation, Ask Yourself the Following Questions:

1. Am I building goodwill with others during conflict? 2. Do I admit when I have made a mistake? 3. Do I know when to give in, or do I assert myself at all costs? 4. Am I viewed as unreasonable or insensitive?

Assessing the Degree of Conflict Resolution: decision quality

A. How creative are resulting plans? B. How practical and realistic are they? C. How well were intended goals achieved? D. What surprising results were achieved?

Assessing the Degree of Conflict Resolution: relationship quality

A. How much understanding has been created? B. How willing are people to work together? C. How much mutual respect, empathy, concern, and cooperation have been generated?

solution for conflicts arising from values

Because values are subjective, value-based conflicts often remain unresolved. Therefore a need to find a way for competing values to coexist is necessary for conflict management.

what is bullying associated with?

Bullying is associated with psychological and physical stress, underperformance, professional disengagement, increased job turnover, and the potential for diminished quality of care

leaders in conflict must...

adopt a strategic proactive approach that aligns conflict management approaches with the overall mission of the organization

lateral violence

aggressive and destructive behavior or psychological harassment of nurses against each other.

mode of conflict resolution: collaboration

although the most time-consuming approach is the most creative stance. It is both assertive and cooperative because people work creatively and openly to find the solution that most fully satisfies all important concerns and goals to be achieved.

what can categorizing conflict help define?

appropriate course of action for resolution

modes of conflict approaches can be viewed within, what two dimensions?

assertiveness (satisfying one's own concerns) and cooperativeness (satisfying the concerns of others).

direct care nurses and nursing students often use what two mode of conflict resolution?

avoidance and accommodation

types of action

avoiding dealing with it, deliberately delaying action, or choosing to do nothing

what are the modes of conflict resolution

avoiding, accommodating, competing, compromising, collaborating

why is compromise one of the most effective behaviors used by nurse?

because it supports a balance of power between themselves and others in the work setting

what is the element of accommodating approach?

being self-sacrificing and simply obeying orders or serving other people.

how do people, who primarily use competing as a mode to conflict resolution often react?

by feeling threatened, acting defensively or aggressively, or even resorting to cruelty in the form of cutting remarks, deliberate gossip, or hurtful innuendo.

what does an organization without conflict characterized by?

by no change;

what is conflict catalyst for?

change and has the ability to stimulate either detrimental or beneficial effects

bullying

closely related to lateral or horizontal violence, but a real or perceived power differential between the instigator and recipient must be present in bullying.

what kind of relationship results in conflict resolution?

give-and-take

what does the TJC require?

healthcare organizations have a code of conduct that defines acceptable and inappropriate behaviors and that leaders create and implement a process for managing intimidating and disruptive behaviors that undermine a culture of safety.

what are particular incidences when nurses are most vulnerable and apt to engage in negative behavior?

heavy workload, short staffing

what may some organizational conflict be related to?

hierarchical structure and role differentiation among employees. Nurse managers, as well as their staff, often become embattled in institution-wide conflict concerning staffing patterns and how they affect the quality of care. Complex ethical and moral dilemmas often arise when profitable services are increased and unprofitable ones are downsized or even eliminated.

TJC standards

hospitals manage conflict between leadership groups to promote a culture of safety. training nurse manager as conflict coaches

guidelines for confrontation

id need for it timing clearly id problem id behavior required establish credibility remain empathic avoid personal attacks use genuine humor if appropriate

what can intrapersonal conflict lead to?

involvement of people, making it an interpersonal conflict

what does significant source of interpersonal conflict stem from?

lateral violence

what can interpersonal conflicts accelerate?

needed change and innovation in approach

when may avoidance be okay?

not to say that all conflict must be addressed immediately; some issues require considerable reflection, and action should be delayed

what is the positive side of avoidance (withdrawal)

postponing an issue until a better time or simply walking away from a "no-win" situation

what provides solid foundation for conflict resolution?

shared goal of meeting patient care needs

what happens when nurses use collaboration?

use of cooperative conflict-management approaches, decision making becomes a collective process in which action plans are mutually understood and implemented.

example of collaboration

when nurses and physicians work together, they can collaborate by asking, "What is the best thing we can do for the patient and family right now?" and "How does each of us fit into the plan of care to meet their needs?"

what is solution for conflicts arising from facts (information)

Objective data can be provided to resolve a disagreement generated by discrepancies in information.

what forces are relevant to conflict in practice environment?

Organizational structure, Management style, Personnel policies and programs, Image of nursing, and Autonomy

intrapersonal conflict focus

conflict over priorities, ethical standards, and values, taking risks, personal and professional priorities, maintaining status quo

what are important factors in understanding stress and conflict?

context (particular work environment), extent to which leaders respect staff concerns, cultures that condone "shame and blame", use of compromise to avoid conflict, understanding that poor conflict resolution leads to poor patient outcomes

If You Use Competing Often, Ask Yourself the Following Questions:

1. Am I surrounded by people who agree with me all the time and who avoid confronting me? 2. Are others afraid to share themselves and their needs for growth with me? 3. Am I out to win at all costs? If so, what are the costs and benefits of competing? 4. What are people saying about me when I am not around?

collaboration examples

1. Create new possibilities to address all important concerns. 6.Find ways that everyone can win. 11.Cooperate assertively until everyone's needs are met. 16.Partner with others to find the most inclusive solution. 21.Stick with it to get everyone's highest priorities. 26.Collaborate with others to achieve our goals together.

If You Use Accommodation Often, Ask Yourself the Following Questions:

1. Do I feel that my needs, goals, concerns, and ideas are not being attended to by others? 2. Am I depriving myself of influence, recognition, and respect? 3. When I am in charge, is "discipline" lax? 4. Do I think people are using me?

If You Seldom Use Negotiation, Ask Yourself the Following Questions

1. Do I find it difficult to make concessions? 2. Am I often engaged in strong disagreements, or do I withdraw when I see no way to get out? 3. Do I feel embarrassed, sensitive, self-conscious, or pressured to negotiate, compromise, and bargain?

If You Seldom Use Avoidance, Ask Yourself the Following Questions:

1. Do I find myself overwhelmed by a large number of conflicts and a need to say "no"? 2. Do I assert myself even when things do not matter that much? Do others view me as an aggressor? 3. Do I lack a clear view of what my priorities are? 4. Do I stir up conflicts and fights?

If You Tend to Use Negotiation Often, Ask Yourself the Following Questions:

1. Do I ignore large, important issues while trying to work out creative, practical compromises? 2. Is there a "gamesmanship" in my negotiations? 3. Am I sincerely committed to compromise or negotiated solutions?

If You Seldom Collaborate, Ask Yourself the Following Questions:

1. Do I ignore opportunities to cooperate, take risks, and creatively confront conflict? 2. Do I tend to be pessimistic, distrusting, withdrawing, and/or competitive? 3. Am I involving others in important decisions, eliciting commitment, and empowering them?

If You Tend to Collaborate Often, Ask Yourself the Following Questions:

1. Do I spend valuable group time and energy on issues that do not warrant or deserve it? 2. Do I postpone needed action to get consensus and avoid making key decisions? 3. When I initiate collaboration, do others respond in a genuine way, or are there hidden agendas, unspoken hostility, and/or manipulation in the group?

If You Tend to Use Avoidance Often, Ask Yourself the Following Questions:

1. Do people have difficulty getting my input into and understanding my view? 2. Do I block cooperative efforts to resolve issues? 3. Am I distancing myself from significant others? 4. Are important issues being left unidentified and unresolved?

If You Seldom Compete, Ask Yourself the Following Questions:

1. How often do I avoid taking a strong stand and then feel a sense of powerlessness? 2. Do I avoid taking a stand so that I can escape risk? 3. Am I fearful and unassertive to the point that important decisions are delayed and people suffer?

when is it appropriate to use avoidance (4)?

1. When facing trivial and/or temporary issues, or when other far more important issues are pressing 2. When there is no chance to obtain what one wants or needs, or when others could resolve the conflict more efficiently and effectively 3. When the potential negative results of initiating and acting on a conflict are much greater than the benefits of its resolution 4. When people need to "cool down," distance themselves, or gather more information

when is it appropriate to use the accommodation approach? (6)

1. When other people's ideas and solutions appear to be better, or when you have made a mistake 2. When the issue is far more important to the other(s) person than it is to you 3. When you see that accommodating now "builds up some important credits" for later issues 4. When you are outmatched and/or losing anyway; when continued competition would only damage the relationships and productivity of the group and jeopardize accomplishing major purpose(s) 5. When preserving harmonious relationships and avoiding defensiveness and hostility are very important 6. When letting others learn from their mistakes and/or increased responsibility is possible without severe damage

when is it appropriate to use competing as mode of conflict resolution?

1. When quick, decisive action is necessary 2. When important, unpopular action needs to be taken, or when trade-offs may result in long-range, continued conflict 3. When an individual or group is right about issues that are vital to group welfare 4. When others have taken advantage of an individual's or group's noncompetitive behavior and now are mobilized to compete about an important topic

when is the collaboration mode of resolution appropriate?

1. When seeking creative, integrative solutions in which both sides' goals and needs are important, thus developing group commitment and a consensual decision 2. When learning and growing through cooperative problem solving, resulting in greater understanding and empathy 3. When identifying, sharing, and merging vastly different viewpoints 4. When being honest about and working through difficult emotional issues that interfere with morale, productivity, and growth

Appropriate Uses of Compromise

1. When two powerful sides are committed strongly to perceived mutually exclusive goals 2. When temporary solutions to complex issues need to be implemented 3. When conflicting goals are "moderately important" and not worth a major confrontation 4. When time pressures people to expedite a workable solution 5. When collaborating and competing fail

intrapersonal conflict examples

1.Do I want to pursue an advanced degree or start a family now?"), conflicts arise between personal and professional priorities. 2.Some issues present a conflict over comfortably maintaining the status quo (e.g., "I know my newest charge nurse likes the autonomy of working nights. Do I really want to ask him to move to days to become a preceptor?") 3. Taking risks to confront people when needed (e.g., "Would recommending a change in practice that I learned about at a recent conference jeopardize unit governance?"

competing examples

2.Persuade others to see it and/or do it my way. 7.Use whatever power I have to get what I want. 12.Compete until I either win or lose. 17.Put my foot down assertively for a quick solution 22.Argue and debate over the best way. 27.Compete with others for scarce resources.

use of compromising examples

3.Work out some sort of give-and-take agreement. 8.Find an agreeable compromise among people involved 13.Engage in "give a little and get a little" bargaining. 18.Negotiate for what all sides value and can live without. 23.Create some middle position everyone agrees to. 28.Emphasize compromise and trade-offs.

mediation

3rd party with trained/learned skill for which advanced training and/or certification is available. Principled negotiation can produce mutually acceptable agreements in every type of conflict.

action

A behavioral response to a conflict follows the conceptualization. This may include seeking clarification about how another person views the conflict, collecting additional information that informs the issue, or engaging in dialog about the issue

compromising

Compromising is a blend of both assertive and cooperative behaviors, although it calls for less finely honed skills for each behavior than does collaborating

conflicts arising from approaches and example

Even when all agree on a common goal, different ideas about the best approach to achieve that goal may produce conflict. For example, if the unit goal is to reduce costs by 10%, one leader may target overtime hours and another may eliminate the budget for continuing education.

what are the four stages of conflict?

Frustration, Conceptualization, Action, Outcomes (can move back and forth between stages)

horizontal violence

Involves conflictual behaviors among individuals who consider themselves peers with equal power but with little power within the system. Describes aggressive and destructive behavior of co-workers against each other

use of accommodation examples

Let other people have their way. Give in so others get what they think is important. Let others' needs be met more than my own needs. Agree to what others want to create harmony. Put my priorities below those of other people. Cool things down by letting others do it their way.

interpersonal conflict examples

Members of healthcare teams often have disputes over the best way to treat particular cases or disagreements over how much information is necessary for patients and families to have about their illness

steps of resolving conflict

Name the conflict (identify the problem) Identify your reaction to it Search for cause Identify a common goal Generate solutions Select and plan innovative solution Implement Evaluate Repeat as needed

outcome

Tangible and intangible consequences result from the actions taken and have significant implications for the work setting.

when are compromise and negotiation used?

They are chosen when less accommodating or avoiding is appropriate

conflicts arising from values

Values, opinions, and beliefs are much more personal, thus generating disagreements that can be threatening and adversarial.

use avoidance examples

Wait and let the conflict take care of itself. Withdraw from the situation. Avoid taking any action for as long as I can. Keep as far away from others involved as possible. Hope the issue does not come up. Change the subject to avoid the fighting.

frustrations

When people or groups perceive that their goals may be blocked, frustration results. This frustration may escalate into stronger emotions, such as anger and deep resignation. (patients, nurses, etc)

accommodating example

a co-worker requests you cover her weekends during her children's holiday break. You had hoped to visit friends from college, but you know how important it is for her to have more time with her family, so you agree

what is solution for conflicts arising from goals?

a common goal (e.g., quality patient care) can be identified and used to frame conflict resolution

conflict

a disagreement in values or beliefs within oneself or between people that causes harm or has the potential to cause harm

what is interest based bargaining?

a negotiation strategy that produces agreements that satisfy common interests and balance opposing positions, has been effectively used in complex organizational conflicts such as in collective bargaining situations

frustration examples

a nurse may perceive that a postoperative patient is noncompliant or uncooperative, when in reality the patient is afraid or has a different set of priorities at the start from those of the nurse. At the same time, the patient may view the nurse as controlling and uncaring, because the nurse repeatedly asks if the patient has used his incentive spirometer as instructed.

who is the mediator and what do they assist with?

an impartial person who assists each party in the conflict to better hear and understand the other

what does collaboration involve?

analyzing situations and defining the conflict at a higher level where shared goals are identified and commitment to working together is generated

what mode of conflict resolution most commonly used between nurses and physicians?

compromising, because supports BALANCE IN POWER in the workplace

nurse managers often use what mode of conflict resolution?

compromising, despite emphasis placed on collaboration for an effective strategy for conflict management

collaboration example between: nurse and charge nurse

conflict arises when a direct care nurse and a charge nurse on a psychiatric unit disagree about how to handle a patient's complaints about the direct care nurse's delay in responding to the patient's requests. At the point that they reach agreement that it is the direct care nurse's responsibility and decision to make, collaboration has occurred. The charge nurse might say, "I didn't realize your plan of care was to respond to the patient at predetermined intervals or that you told the patient that you would check on her every 30 minutes. I can now inform the patient that I know about and support your approach. OR direct care nurse and the charge nurse might talk and subsequently agree that the direct care nurse is too emotionally involved with the patient's problems and that it may be time for her to withdraw from providing the care and enlist the support of another nurse, even temporarily. Discussion can result in collaboration aimed at allowing the direct care nurse to withdraw appropriately. OR Another, less desirable choice could be to compete (CAN LEAD TO COMPETING) and let the winner's position stand (e.g., "I'm in charge; I'm going to assign another nurse to this patient to preserve our patient satisfaction scores" or "I know what is best for this patient; I took care of her during her past two admissions").

what is role of nurse leader in a conflict?

create open environment for communication and collaboration to achieve mutual goals that enable nurses to employ constructive approaches to conflicts

interpersonal conflict focus

difference of opinion, priority, or approach with others

conceptualization

different interpretations of a situation occur, including a different emphasis on what is important and what is not, and different thoughts about what should occur next. Everyone involved develops an idea of what the conflict is about, and this view may or may not be accurate. (instant or over time)

what do individuals who frequently use accommodation feel?

disappointment and resentment because they "get nothing in return." relating to overuse.

organizational conflicts

discord exists about policies and procedures, personnel codes of conduct, or accepted norms of behavior and patterns of communication

what does collaboration require?

discussion about the plan, how it will be accomplished, and who will make what contributions toward its achievement and proposed outcomes.

what does conceptualization involve?

dissimilar views due to person's own perspective, which is based on personal values, beliefs, and culture. "the conflict as I see it"

compromising is the preferred method of what type of negotiations?

during union negotiations, in which each side is appeased to some degree. In this mode, nobody gets everything he or she thinks he or she needs, but a sense of energy exists that is necessary to build important relationships and teams.

what should compromise resolution result look like?

each person can meet his or her most important priorities as much of the time as possible

personal policies and programs

efforts to promote nurse work/life balance

what may stimulate conflict?

employee diversity, high nurse-to-patient ratios, pressure to make timely decisions, and status differences

conflicts arising from facts

external written sources and include job descriptions, hospital policies, standard of nursing practice, and TJC mandates

what discrepancies in four areas do conflicts arise?

facts, goals, approaches, and values

what are the outcomes of a constructive conflict resulting in resolution?

growth, resolved problems, unity, increased productivity and commitment.

what does successful resolution stem from?

identifying a common goal that unites (e.g., quality patient care, good working relations)

what can competing generate

ill will, favor a win-lose stance, and commit people to a stalemate. Such behaviors force people into a corner from which there is no easy or graceful exit

what does appropriate use of collaboration style include?

integrating solutions, learning, merging perspectives, gaining commitment, and improving relationships

what does conflict result from?

interaction of interdependent people who perceive incompatibility and the potential for interference.

what is a key factor in reducing error and improving patient outcomes?

interprofessional collaboration

what are the 3 categories of conflicts?

intrapersonal, interpersonal, and organizational

mode of conflict resolution: compromising

involves both assertiveness and cooperation on the part of everyone and requires maturity and confidence. NEGOTIATION. Compromise is very often the exchange of concessions as it creates a middle ground.

negotiation

more like trading (e.g., "You can have this if I can have that," as in "I will chair the unit council taskforce on improving morale if you send me to the hospital's leadership training classes next week so I can have the skills I need to be effective.").

what are questions to consider for conceptualization

nature of our differences, reasons for our differences, does our leader endorse ideas or behaviors that add to or diminish the conflict?, Do I need to be mentored by someone, even if that individual is outside my own department or work area, to successfully resolve this conflict?

what are the outcomes of a unsatisfactory resolution?

negativity, resistance, increased frustration, resolutions diminish, weakened relationships, division among groups, decreased productivity and unsatisfactory

image of nursing

nurses effectively influencing system-wide processes

autonomy

nurses' inclusion in governance leading to job satisfaction, personal fulfillment, and organization success

organizational structure

nurses' involvement in shared decision making

management style

nursing leaders create an environment supporting participation, encourage and value feedback, and demonstrate effective communication with staff

conflicts arising from goals

ompeting priorities (e.g., desire to empower employees vs. control through micromanagement)

what does an organization with optimal level conflict characterized by?

optimal level of conflict will generate creativity, a problem-solving atmosphere, a strong team spirit, and motivation of its workers.

mode of conflict resolution: accommodating

people neglect their own needs, goals, and concerns (unassertive) while trying to satisfy those of others (cooperative).

modes of conflict resolution: competing

people pursue their own needs and goals at the expense of others. Sometimes people use whatever power, creativeness, or strategies that are available to "win.

what has potential to reduce lateral violence

performance expectations has the potential

what does mediation method involve?

separating the people from the problem; focusing on interests, not positions; inventing options for mutual gain; and insisting on using objective criteria. The mediator is usually an impartial person who assists each party in the conflict to better hear and understand the other

what is a form of competing

standing up for your rights or defending important principles (as when opposition to mandatory overtime is voiced)

where does major source of organizational conflict stem from?

strategies that promote more participation and autonomy of direct care nurses.

what are the benefits of compromising?

supports balance of power between self and work place. may require mediation: impartial helper, both sides must acknowledge disparities, NOT about winning or losing, WHAT WORKS BEST IN THE SITUATION

what does avoidance as conflict management style ensure?

that the conflict is postponed, and conflict has a tendency to escalate in intensity when ignored

what does conceptualization form?

the basis for everyone's reactions to the frustration. The way the individuals perceive and define the conflict has a great deal of influence on the approach to resolution and subsequent outcomes

what happens the longer ineffective action continues?

the more likely people will experience frustration, resistance, or even hostility.

what do bullying, lateral violence, and all forms of disruptive behaviors have a negative impact on?

the retention of nursing staff and the quality and safety of patient care

what may change as action is taken in a conflict?

the way that some or all parties conceptualize the conflict may change

what happens when people who use collaboration approach a conflict?

they carefully analyze situations to identify the nature and reasons for conflict and choose an appropriate approach

what is frustration a cue for?

to stop and clarify the nature and cause of the differences.

interpersonal conflict

transpires between and among patients, family members, nurses, physicians, and members of other departments.

t/f Determine any similarities and differences in facts, goals, methods, and values in sorting out the different conceptualizations of a conflict situation.

true

t/f: both physicians and nurses were likely to use avoidance as the main strategy to handle conflict

true

t/f: Conflict can be desirable at times and can be a strategic tool when addressed appropriately.

true, conflict might, in fact, be undesirable because conflict also stimulates growth, creativity, and change.

t/f Nurses and physicians do not routinely collaborate with each other in conflict situations conducive to collaboration.

true; conflicts between nurses and physicians may be intensified because of the overlapping nature of their domains and lack of clarification between roles. Power is a dominant theme (between self and others in workplace)

what does ability to resolve conflicts productively depend on?

understanding this process and successfully addressing thoughts, feelings, and behaviors that form barriers to resolution

mode of conflict resolution: avoidance (withdrawing)

very unassertive and uncooperative because people who avoid neither pursue their own needs, goals, or concerns immediately nor assist others to pursue theirs.