7.7 Conflict Resolution

Open Resources for Nursing (Open RN)

Conflicts are inevitable when working on a team composed of members with different personalities, roles, and responsibilities. It is essential for all nurses to develop conflict resolution skills.

Common Sources of Interpersonal Conflict

Common sources of interpersonal conflict in health care settings are passive-aggressiveness, horizontal aggression, defensiveness, peer informer behavior, and victimization behaviors.[1]

Passive-Aggressiveness

Passive-aggressiveness is a behavior that shows disconnection between what a person says and does. Many times, a passive-aggressive person will agree with another person’s request, but later express feelings of frustration or anger to others and not comply with the request.

As an example, a charge nurse informs the team of RNs in a team meeting that a new policy requires bedside rounding. A nurse responds enthusiastically during the meeting but then complains to others about the policy and refuses to do it. The best method of managing passive-aggressive behavior is to confront it calmly and directly. For this example, it would be helpful for the charge nurse to say, “I was disappointed to hear you are upset about the new bedside rounding policy because you didn’t express any concerns directly to me. It would be helpful for you to directly communicate concerns to me so we can discuss them and make a plan for going forward.”[2]

Horizontal Aggression

The nursing literature describes diffuse incivility, lateral/horizontal violence, and bullying among nurses in the workplace.[3] Horizontal aggression refers to hostile behavior among one’s peers. It is not acceptable and should be directly confronted in a constructive manner or it will get worse. A suggested approach to a peer displaying horizontal aggression is to respond calmly and sincerely, “I value your expertise and experience and am looking for your help and support.” If the negative behavior continues after an attempt to address the individual directly, the nurse supervisor should be notified according to the agency’s chain of command.[4]

Defensiveness

It can be difficult to receive negative feedback. Some people respond by becoming defensive. Defensiveness puts the blame for one’s shortcomings on another person to make oneself appear better.

As an example, a charge nurse addresses a nurse about not turning on the bed alarm after repositioning a client and leaving the room. The nurse responds defensively by inaccurately blaming others, stating, “The nursing assistants are always sloppy with their responsibilities.” It is helpful to confront defensiveness by restating the facts in a calm manner and redirecting the conversation to the problem, its resolution, and the risk of jeopardizing patient safety. For example, the charge nurse could reply, “In this situation, I saw you leave the room after repositioning the patient, and when I went into the room to answer the patient’s call light, the bed alarm was off.”[5]

Peer Informer Behavior

Peer informer behavior is similar to gossip. Peer informers relay information about fellow team members to the nurse leader, and this information often lacks objective evidence. It is often best to respond to the informer by asking them to speak to their team member directly about their concerns unless it is an urgent matter that must be dealt with immediately. However, keep in mind that if concerns are shared about a staff member by more than one team member, it may be a pattern of behavior, and the nurse leader should follow up with that staff member.[6]

As an example, a nurse approaches the charge nurse and says, “Everyone is concerned about how much time Nancy is spending in the room with her patients. She gets behind in her work and the rest of us have to make up for it.” The charge nurse could reply, “Have you addressed your concerns directly with Nancy?” If the nurse replies, “No,” then the charge nurse could state, “Please talk to Nancy directly with your concerns first.” However, if another nurse shares a similar concern with the charge nurse, then the charge nurse should address this pattern of behavior with Nancy and obtain her perspective.

Victimization

Victimization occurs when a team member feels they are being singled out unfairly or held to higher expectations than their peers. Comments may include, “Why am I getting called out on this when other people are doing this and aren’t getting in trouble?” or “I was never told this; why am I always the last to know?” Team members who feel victimized should be reminded by the nurse leader they are held to the same standards as the other members. However, keep in mind that sharing information about other staff members’ performance breaches confidentiality, so do not include another employees’ performance information in conversations but instead focus on policies and procedures that apply to everyone.[7]

Types of Conflict

There are various sources of conflict that nurses may encounter in their work environment.

Role Conflict: Role conflict arises when individuals have multiple, often conflicting, expectations associated with their roles. In professional settings, an employee may face role conflict when their job responsibilities are unclear or when there are conflicting demands from different supervisors. For example, a project manager might experience tension if their role requires them to enforce strict deadlines while also being expected to accommodate frequent changes in project scope. This type of conflict can lead to stress, decreased job satisfaction, and reduced productivity. Role conflict can be mitigated by clear communication, well-defined job descriptions, and regular feedback to ensure alignment of expectations.[8]

Communication Conflict: Communication conflict occurs when there is a failure in the exchange of information. Misunderstandings, misinterpretations, and lack of effective communication can lead to disputes and frustrations. For instance, in a team setting, if one member interprets a directive differently from others, it can result in duplicated efforts or missed tasks. Communication conflict is often exacerbated by differences in communication styles, cultural backgrounds, or language barriers. Addressing this type of conflict involves fostering an environment of open and clear communication, utilizing active listening techniques, and ensuring that all parties have a mutual understanding of the messages being conveyed.[9]

Goal Conflict: Goal conflict happens when the objectives of individuals or groups are incompatible. In organizations, different departments might pursue goals that are in opposition, such as a sales team aiming for maximum customer satisfaction while a production team focuses on minimizing costs. These conflicting goals can hinder overall progress and lead to tension among team members. To resolve goal conflicts, it is crucial to align individual and departmental goals with the broader objectives of the organization. This can be achieved through strategic planning, cross-functional collaboration, and regular goal-setting meetings that ensure all efforts are directed towards a common purpose.[10]

Personality Conflict: Personality conflict arises from differences in individual temperaments, attitudes, and behaviors. Such conflicts are common in any setting where diverse personalities interact, such as workplaces, schools, or social groups. For example, a highly extroverted person might clash with a reserved colleague, leading to friction in their interactions. Personality conflicts can negatively impact team cohesion and productivity. Managing these conflicts involves fostering a culture of respect and understanding, providing training in emotional intelligence and conflict resolution, and encouraging individuals to appreciate and leverage the strengths of diverse personalities.[11]

Ethical/Values Conflict: Ethical or values conflict occurs when individuals or groups have fundamentally different beliefs and values. These conflicts are often deeply rooted and can be particularly challenging to resolve. In a corporate environment, an ethical conflict might arise if one employee believes in strict adherence to company policies while another prioritizes flexibility and personal judgment. Values conflicts can also occur over issues such as diversity, environmental responsibility, and corporate social responsibility. Addressing ethical or values conflicts requires creating an environment of mutual respect, where different perspectives are valued. Organizations can benefit from having clear ethical guidelines and fostering an inclusive culture that encourages open dialogue and ethical decision-making.[12]

Conflict Management

Individuals manage conflict differently. During conflict, a person’s behavior is typically driven by their commitment to their goals or their commitment to relationships[13]:

  • Commitment to goals: The extent to which an individual attempts to satisfy their personal concerns or goals.
  • Commitment to relationships: The extent to which an individual attempts to satisfy the concerns of another party or maintain the relationship with the other party.

Most people use different methods to resolve conflict depending on the situation and what strategy best applies. One approach is not necessarily better than another, and all approaches can be learned and used effectively with practice. However, to effectively manage conflict, it is important to first analyze the situation and then respond accordingly.

A long-standing conflict resolution model created by Thomas and Killmann describes five approaches to dealing with conflict: avoiding, competing, accommodating, compromising, and collaborating. Each of these steps is further described in the following subsections.[14]

Avoidance Approach

An avoidance approach to conflict resolution demonstrates a low commitment to both goals and relationships. This is the most common method of dealing with conflict, especially by people who view conflict negatively. See Table 7.7a for types of avoidance, potential results, and situations when this strategy may be appropriate.[15]

Table 7.7a. Avoidance Approach[16]

Types of Avoidance Approaches Potential Results Appropriate Use
  • Leaving the area
  • Withdrawing mentally
  • Changing the subject
  • Blaming or minimizing
  • Denying the problem exists
  • Postponing resolution to a later time (that may never occur)
  • Displaying emotions (tears, anger, etc.)
  • The dispute is not resolved.
  • Disputes often build up and may eventually explode.
  • Low team member satisfaction may result from lack of conflict management.
  • Stress spreads to other parties (e.g., coworkers, family).
  • The issue is trivial or unimportant.
  • Another issue is more urgent.
  • The potential disadvantages outweigh the potential benefits.
  • The timing for dealing with the conflict is currently inappropriate (due to overwhelming emotions or lack of information).

Application to Nursing

In a clinical setting, there may be times when it is appropriate to avoid confrontation. For example, on a particularly busy day in the emergency department, a patient in a life-threatening condition was recently received. The attending physician shouts orders to the nurse in a disrespectful manner. The nurse avoids addressing the conflict until after the patient has been stabilized and then shares their concerns. However, if the physician continues to bark orders to nursing staff in nonemergency situations, avoidance is no longer appropriate, and the conflict must be addressed to establish a positive and respectful working environment.[17]

Competitive Approach

A competitive approach to conflict management demonstrates a high commitment to goals and a low commitment to relationships. Individuals who use the competitive approach pursue their goals at other individuals’ expense and will use whatever power is necessary to win. A competitive approach may be displayed when an individual defends an action, belief, interest, or value they believe to be correct. Competitive approaches may also be supported by infrastructure (agency promotion procedures, courts of law, legislature, etc.).[18] See Table 7.7b for types of competitive approaches, potential results, and appropriate uses.

Table 7.7b. Competitive Approach[19]

Types of Competitive Approaches  Potential Results Appropriate Use
  • Using power of authority, position, or majority
  • Using power of persuasion
  • Using high-pressure techniques (e.g., threats, force, intimidation)
  • Disguising the issue
  • Tying relationship to conflict
  • The conflict may escalate or the other party may withdraw.
  • The quality and durability of agreement may be reduced.
  • It is assumed the other party will not reciprocate. However, when feeling threatened, people tend to reach for whatever power they have.
  • The likelihood of future problems between conflicting parties is increased.
  • Communication and trust decrease.
  • Short and quick action is vital.
  • The competitive strategy may be helpful for certain management decisions (e.g., enforcing unpopular rules, cutting costs, enforcing disciplinary measures).

Application to Nursing

A competitive approach to conflict resolution may be appropriate in a clinical setting if a nurse leader realizes a nurse has made an error while preparing to administer IV medication to a patient. The nurse leader may stop the nurse from inaccurately administering the medication and take over completing the procedure. In this case, the goal of patient safety outweighs the commitment to the relationship with that nurse. However, after patient safety is maintained, it would be inappropriate to continue the competitive approach when debriefing the nurse about a simple human error. Debriefing should focus on educating the nurse about policy and procedures to improve their performance. However, if it is determined the nurse was acting recklessly and disciplinary measures must be instituted by a manager, then the competitive approach may be appropriate.[20] This approach to responding to errors is often referred to as “Just Culture.”

Read more about Just Culture in the “Legal Implications” chapter.

Accommodating Approach

An accommodating approach to conflict management demonstrates a low commitment to goals and high commitment to relationships. This approach is the opposite of the competitive approach. It occurs when a person ignores or overrides their own concerns to satisfy the concerns of the other party. An accommodating approach is often used to establish reciprocal adaptations or adjustments, but when the other party does not reciprocate, conflict can result. Accommodators typically do not ask for anything in return but can become resentful when a reciprocal relationship isn’t established. If resentment grows, individuals relying on the accommodating approach may shift to a competitive approach from a feeling of “being used” that can lead to conflict.[21] See Table 7.7c for types of the accommodating approach, potential results, and appropriate uses.

Table 7.7c. Accommodating Approach[22]

Types of
Accommodating Approaches
Potential Results Appropriate Use
  • Playing down the conflict to maintain surface harmony
  • Self-sacrificing
  • Yielding to the other point of view
  • The accommodating approach builds relationships that encourage more effective future problem-solving.
  • Accommodation increases the chances that the other party may be more accommodating to your needs in the future.
  • Communication is not improved.
  • The outcome or issue is more important to the other party.
  • Preserving harmony is more important than the outcome.
  • It is necessary to build good faith for future problem-solving.
  • Your position could be damaged by a competitive approach.
  • Your previous action was incorrect.

Application to Nursing

It may be appropriate to use an accommodating approach when one of the nurses on your team has a challenging patient who is taking up a lot of time and effort. By being situationally aware and noticing the nurse has been involved in that patient’s room for a long period of time, you offer to provide task assistance in an effort to provide mutual support. You are aware this will increase your workload for a short period of time, but it will assist your colleague and promote a strong team. However, the accommodating approach is no longer appropriate if the nurse continues to expect you to cover their tasks after the situation has been resolved.[23]

Compromising Approach

A compromising approach to conflict resolution strikes a balance between commitment to goals and commitment to relationships. The objective of a compromising approach is a quick solution that will work for both parties. It typically involves both parties giving up something in return for something, thereby “meeting in the middle.”[24] See Table 7.7d for types of compromising approaches, potential results, and appropriate uses.

Table 7.7d. Compromising Approach

Types of
Compromising Approaches
Potential Results Appropriate Use
  • Splitting the difference
  • Exchanging concessions
  • Finding middle ground
  • Both parties may feel they lost the battle and want to “get even” next time.
  • A relationship between the two parties is not established, although it does not cause the deterioration of relationships.
  • There is a danger of stalemate if one or both parties refuse to “give up” anything.
  • Compromising does not explore the issue in depth.
  • Compromising works well when quick solutions are required due to time pressures.
  • Compromising may be appropriate when collaboration or competition fails.
  • Short-term solutions are needed until more information can be obtained.

Application to Nursing

Compromise is an appropriate approach to conflict in many clinical settings. For example, you are working with another nurse who rarely assists other team members. The nurse asks you for assistance with a blood draw for a patient. You hesitate because you are searching for a lunch tray that has not yet been delivered for a patient with diabetes. You ask your colleague to obtain the patient’s lunch tray while you complete their request for assistance with a blood draw. It would be inappropriate to refuse to assist the nurse based on their reputation because this could impact safe, effective care for the patient.[25]

Collaborative Approach

The collaborative approach to conflict resolution demonstrates a high commitment to goals, as well as a high commitment to relationships. The collaborative approach attempts to meet the concerns and priorities of all parties, but trust and willingness for risk are required for this approach to be effective.[26] See Table 7.7e for types of collaborative approaches, potential results, and appropriate uses.

Table 7.7e. Collaborative Approach[27]

Type of
Collaborative Approaches
Potential Results Appropriate Use
  • Maximizing use of fixed resources
  • Working to increase resources
  • Listening and communicating to promote understanding of others’ interests and values
  • Learning from each other’s insight
  • Collaboration builds relationships and improves potential for future problem-solving.
  • Collaboration promotes creative solutions.
  • Parties are committed to the process and adequate time is available.
  • The issue is too important to compromise.
  • New insights can be beneficial in achieving creative solutions.
  • There are diverse interests and issues at play.
  • Participants can be future focused.

Application to Nursing

An example of appropriately using the collaborative approach in conflict management in a clinical setting is when discussing vacation time off with team members. During a team meeting, time is available to discuss and focus on what is important and a priority for each member of the team. However, the collaborative approach to conflict management would be inappropriate when discussing the implementation of a new agency policy if the team has little influence in making adjustments.[28]

All approaches to conflict can be appropriate for specific situations, but they can also be inappropriate or overused. When conflict occurs, take time to consider which approach is most beneficial for the situation. Keep in mind that using wrong approaches can escalate conflict, damage relationships, and reduce your ability to effectively meet team goals. Correct conflict management approaches build trust in relationships, accomplish goals, and de-escalate conflict.[29]

Everyone has the capacity to use any of these approaches for managing conflict and can shift from their natural style as needed. We tend to react with our most dominant natural style when under stress, but other approaches can be learned and applied with practice and self-awareness. When dealing with others who have not developed their capacity to shift from their natural style of conflict management, it is important to consider their underlying needs. By understanding individuals’ needs existing beneath the surface of the conflict, you can work with the other person toward achieving a common goal.[30]

Addressing Individual Needs and Approaches

There are times when other individuals take an approach that is not helpful to resolving the conflict. It is important to remember the only person you can control during a conflict is yourself. Be flexible with your approach according to the situation and the team members with whom you are working. If someone is taking an approach that is not beneficial to resolving conflict, it can be helpful to try to understand the needs that underlie their decision to take that approach.[31]

Here are some examples of needs underlying their approaches to conflict and suggested ways to address them[32]:

  • People using the avoidance approach may need to feel physically and emotionally safe. Take the time to reassure them that their needs will be heard.
  • People taking the competitive approach often feel the need for something to be accomplished to meet their goals. It may be helpful to say, “We will work out a solution, but it may take some time to get there.”
  • People using the accommodating approach may need to know that no matter what happens during the conversation, your relationship will remain intact. It may be helpful to say, “This decision will not affect our relationship or how we work together.”
  • People using the compromising approach may need to know that they will get something in return. It may be helpful to say, “We will do Action A first, and then we will do Action B for you.” However, be sure to be true to your word.
  • People using the collaborative approach may need to know what you want before they are comfortable sharing their needs. It may be helpful to say, “I need this, this, and this…What do you need?”

Take free online Conflict Quizzes and Assessments to identify your preferred conflict management styles.

Escalating and De-Escalating Conflict

An approach taken to manage conflict can escalate (increase) or de-escalate (decrease) the conflict. Conflict on a team can take a life of its own and escalate beyond reason if not managed appropriately by nurse leaders. When conflict is not managed appropriately, negative consequences within the team often occur, and patient safety can be compromised. Increased rates of absenteeism and turnover may also occur.[33]

Conflict tends to escalate under the following conditions[34]:

  • There is an increase in emotions like anger, frustration, etc.
  • An individual feels that they are being threatened (i.e., the fight-or-flight response is triggered).
  • Other people get involved and choose sides.
  • The individuals were not friendly prior to the conflict.
  • The individuals desire to engage in conflict.

However, conflict can be de-escalated under the following conditions[35]:

  • Attention is focused on solving the problem.
  • There is a decrease in emotion and perceived threat.
  • The individuals were friendly prior to the conflict.
  • The individuals desire to reduce conflict.

Read an example of escalating conflict in the following box.

Example of Escalating Conflict[36]

A conflict begins between two team members who became short-tempered with each other while caring for a patient experiencing a medical emergency.

  • The parties become aware of the conflict but attempt to deal with it sensibly. Often, they will attribute the problem to “a misunderstanding” and indicate “we can work it out.”
  • If an appropriate conflict management approach is not used, the parties begin to move from cooperation to competition. (“I’ll bend – but only if they bend first.”) They begin to view the conflict as resulting from deliberate action on the part of the other. (“Didn’t they know this was going to happen?”) Positions begin to harden and defensiveness sets in, creating adversarial encounters. Parties begin to strengthen their positions and look to others on the team for support. (“Don’t you feel I’m being reasonable?” or “Did you know what that idiot did to me?”)
  • As communication deteriorates, parties rely on assumptions about the other individual and attribute negative motives to them. (“I bet they did that on purpose.”) Groupthink can take over the subgroups as each individual seeks others to take on their side. (“We have to appear strong and make a united front.”)
  • Parties believe that cooperation cannot resolve the problem because of the assumed negative actions of the other. (“I’ve tried everything to get them to see reason,” “It’s time to get tough,” or “I’m going to put a stop to this.”)
  • Parties begin to feel righteous and blame the other for the entire problem. Generalizing and stereotyping begin. (“I know what those kinds of people are like. . . We can’t let them get away with this.”) Parties begin to be judgmental and moralistic and believe they are defending what is “right.” (“It’s the principle of the matter” or “What will others say if we give in to this?”)
  • Severe confrontation is anticipated and planned, thus making it inevitable. The parties view this confrontation as acceptable. The objective of the conflict becomes to hurt the other more than being hurt, and the dispute is beyond rational analysis. (“I’m going to make you pay even if we both go down over this,” “There is no turning back now,” or “They won’t make a fool out of me.”)

There are positive steps to take to de-escalate conflict with another individual before it gets out of control. See Figure 7.9[37] for steps to de-escalate conflict and implement change.

Image showing a textual list of steps for de-escalating conflict
Figure 7.9 Steps to De-Escalate Conflict

Conflict Management Tips

Nurses must develop their own tool kit to manage conflict in a productive, positive way. Due to rapid turnover in the health care environment at this time, new nurses may find themselves in a “charge nurse” position within their first year of practice. See Table 7.7f for tips on managing conflict constructively.[38]

Table 7.7f. Conflict Management Tips[39]

Tip Description
Be Consistent Convey to the team that expectations are consistent and implemented fairly across the team. Set expectations and make sure the team knows those expectations via department meetings and visual reminders. Follow up to ensure expectations are met. This sets a clear picture of what is required.
Be Team-Focused Be aware of team members’ strengths and weaknesses. Address poor performance and negative attitudes. Teamwork and team dynamics impact patient safety and staff retention. Ask team members what they need from you as a leader. Coach team members and staff on a regular basis.
Convey Trust and Integrity Trustworthiness and integrity are powerful when managing conflict. Team members are more likely to handle difficult situations constructively if they know they are supported by an approachable and supportive team leader. Stay focused on the individual and remind them that you value them and want them to feel heard. It may be helpful to include a statement such as, “As health care members, we are held accountable for positive behaviors with team members.”
Lead with Truth If you need to have a difficult conversation, lead with the tough message and be clear. For example, try saying, “There’s something difficult I need to talk with you about. I’m concerned about the feedback I’ve been receiving from patients.” Even in conveying a tough message, you can build trust by showing the employee that you’ll be honest with them and share feedback openly.

Don’t leave the team member guessing about the problem or what they need to do to improve. Clearly state the performance gap, your expectations, the reason it matters, and the timeline for improvement, including a future meeting to review feedback and give a progress update. Provide support and available resources to help them make the needed change.

Anticipate Reactions Knowing how a team member will respond when conflicts arise can be a challenge. Common negative reactions to conflicts are defensiveness, deflection, and denial. Defensive comments may include, “No one’s ever brought this to me before.” You can reply, “I’m invested in you and want to see you succeed. I owe it to you and our department to be transparent with you and share these concerns.”

Deflection can take the form of an employee asking you why a coworker didn’t directly bring up the concern. Often, it’s because others are too intimidated by the individual or situation to speak up. Your reply can be, “Accountability between colleagues is always encouraged, but as your leader, I owe it to you to share this feedback. Do you feel your colleagues perceive you as approachable and open to feedback?”

Denial may include the employee refuting that the incident of concern ever happened. You can calmly remind the employee that we own others’ perceptions of our behaviors and you want to help them understand where some actions may be giving people the wrong impression.

Use Available Resources Engage in professional development for managing conflicts when they arise. Share knowledge and experiences with other nurse leaders to build networks, partner with other teams within the organization, and use the human resources department when needed.

Media Attributions

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  1. Elizabeth, A. (2019). Managing interpersonal conflict: Steps for success. Nursing Management, 50(6), 22-28. https://journals.lww.com/nursingmanagement/Fulltext/2019/06000/Managing_interpersonal_conflict__Steps_for_success.7.aspx
  2. Elizabeth, A. (2019). Managing interpersonal conflict: Steps for success. Nursing Management, 50(6), 22-28. https://journals.lww.com/nursingmanagement/Fulltext/2019/06000/Managing_interpersonal_conflict__Steps_for_success.7.aspx
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  5. Elizabeth, A. (2019). Managing interpersonal conflict: Steps for success. Nursing Management, 50(6), 22-28. https://journals.lww.com/nursingmanagement/Fulltext/2019/06000/Managing_interpersonal_conflict__Steps_for_success.7.aspx
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  13. Leadership and Influencing Change in Nursing by Joan Wagner is licensed under CC BY 4.0
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  37. "Dispute Resolution Office, Ministry of Justice (Government of Saskatchewan)" designed by JVDW Designs, is licensed under a CC BY 4.0 International License
  38. Elizabeth, A. (2019). Managing interpersonal conflict: Steps for success. Nursing Management, 50(6), 22-28. https://journals.lww.com/nursingmanagement/Fulltext/2019/06000/Managing_interpersonal_conflict__Steps_for_success.7.aspx
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