Nurses Confront Their Antagonisms Head-on

Share with your friends










Submit
Share on Pinterest

Two nurses arguingBickering among nurses may be entertaining to watch on your favorite television series. But while conflict makes for good fiction, it can make for bad reality. The extent of bullying and other conflict in the real world apparently is not exaggerated on medical dramas.

It’s a significant problem to the profession. It is a cause of stress and burnout and is a leading reason why nurses, especially new ones, leave the profession. Those problems are distressing, and also costly.

So, while TV scriptwriters are dreaming up ways to ramp up nurse conflict, the medical profession is increasingly determined to tamp it down, if not eliminate it altogether.

There may still be professions where there’s little sympathy for fear and hurt feelings brought on by cantankerous co-workers, workplaces where employees are told to ignore trouble or sweep it under a rug. But the reaction to nurse conflict is increasingly a prompt attempt at resolving it, and there are increasingly protocols for how to go about it.

Most of the protocols, however, seem to involve guidelines that lead to discussion and counseling, rather than rules that lead to consequences and punishment.

But considering that some estimates place the cost of bullying in the workplace in all professions to be about $4 billion per year in the United States, few can afford to ignore it.

Bullying in nursing

No one is denying that the problem is widespread.

According to American Nurse Today, about 18 percent of 4,000 nurses surveyed at a “large medical center” said they had been verbally abused by another nurse, and two-thirds said they often saw their peers bullying one another. Some of the nonviolent forms include verbal affront, undermining, withholding information, sabotage, scapegoating, backstabbing, gossip, eye-rolling and even silence.

The surveyors also reported that 70 percent of nurses who had been bullied left a job for that reason, compared to 35 percent with health problems who left for that reason.

Add the documented effects of stress on nurses’ performance and avoidance of errors, and it’s easy to see why conflicts can’t be allowed to fester.

Harm to the victim is often significant, leading to stress-related health problems, such as nausea, headache, insomnia, anxiety, depression, weight changes and alcohol and drug abuse, American Nurse Today reported. Research on bullied nurses in the United Kingdom indicates workplace bullying accounts for a third to one-half of stress-related absenteeism.

Bullying is a specific problem, but the focus is primarily on all conflict, and resolving it.

“It is clear we don’t like each other. We don’t need to like each other. We do, for the sake of our patients, need to respect each other. It’s dangerous to them if we don’t.”

Types of conflict

Researchers Rensit Likert and Jane G. Likert defined two kinds of conflict, substantive (how to do the job) and affective (personal differences) in a book published in 1976.

And nursing.advanceweb.com has applied those definitions to conflict among nurses.

In a substantive conflict, “a nurse who is at the patient’s bedside may want to decide how to address an urgent problem, while the physician, who is elsewhere, may want to reserve the right to make that decision. When those two individuals have a good working relationship, based on mutual trust and respect, this issue can easily be resolved.”

An affective conflict can occur “even between individuals of good will. People have different personalities, and some people may find it difficult to get along in spite of their best intentions.”

Conflict resolution strategies in nursing

Not every administrator is addressing nurse conflict, American Nurse Today reported, as many perpetuate oppressive conditions and don’t respect nurses’ decision-making abilities.

But considering that some estimates place the cost of bullying in the workplace in all professions to be about $4 billion per year in the United States, few can afford to ignore it.

Styles of addressing conflict vary. Spanish researcher Marta Elena Losa Iglesias established a version of “Conflict Resolution style in the Nursing Profession” with a 2012 study that used the standardized Thomas-Kilmann Conflict Mode regarding those variations. It identified five styles:

  1. Accommodating
  2. Avoiding
  3. Collaborating
  4. Competing
  5. Compromising

Iglesias said: “The most common style used by nurses overall to resolve workplace conflict was compromising, followed by competing, avoiding, accommodating, and collaborating. There was a significant overall difference in styles between nurses who worked in an academic vs. a clinical setting (p = 0.005), with the greatest difference seen for the accommodating style. Of those nurses for whom accommodation was the primary style, 83 percent worked in a clinical setting compared to just 17 percent in an academic setting.”

NurseWorld advice columnist “Dear Donna” Cardillo gets down to specifics in her “Seven Strategies for Managing Nurse Conflict.” Her pointers include:

  • Avoiding troublemakers
  • Choosing battles carefully
  • Dealing with it — face to face
  • Discussing the problem with outsiders such as family, and rehearsing scenarios before dealing with it
  • Using a mediator, perhaps a supervisor
  • Apologizing when necessary
  • Working to minimize conflict

The head-to-head confrontations may be scary to contemplate, but they can be as life-affirming as an episode of “Chicago Hope.”

The American Journal of Nursing published a first-person account of a conflict in which nurse Debra Gerardi had developed an aversion to a co-worker who seemed to be a slacker and a complainer. Gerardi was wearing her contempt on her sleeve and admits the onset of hostilities was largely her fault.

Gerardi reports she never thought to tell her co-worker, Maya, what she thought of her. But Maya ended up confronting Gerardi one day, saying, “It is clear we don’t like each other. We don’t need to like each other. We do, for the sake of our patients, need to respect each other. It’s dangerous to them if we don’t.”

Although she and Maya didn’t become friends, Gerardi said the tension had lifted. “But I could sense a change in the air between Maya and me. She had been right.”

So, even without clear-cut consequences for bullies, nurse conflicts can be resolved, and that’s why merely acknowledging the problem is a significant step, even when progress doesn’t seem dramatic.

Learn More: Click to view related resources.

Back to: Nursing Newsroom