The Nurse as Conflict Manager, Negotiator, and Mediator

1. The Nurse as Conflict Manager, Negotiator, and Mediator Nancy Jenkins, RN, MSN

2. Understanding Conflict, Negotiation, & Mediation • Conflict: • Negotiation: • Mediation:

3. Conflict • The dissension that occurs when two or more individuals with different values, interests, goals, or needs view things from dissimilar perspectives

4. Negotiation • Conferring with another so as to arrive at the settlement of some matter (Merriam-Webster On-line Dictionary, 2008)

5. Mediation • The process of intervention between conflicting parties to promote reconciliation, settlement, or compromise (Merriam-Webster On-line Dictionary, 2008)

6. Where Conflict Occurs • Intrapersonal conflict • Interpersonal conflict • Organizational conflict • Organizational structure • Role ambiguity and role conflict • Scarcity of resources

7. Intrapersonal Within oneself Occurs when person has to choose between two mutually exclusive alternatives EX: SICK CHILD AND WORK Interpersonal Occurs when Between two or more individuals there are differing values, goals, actions, or perceptions Ex: Nurse questions Dr. order and the physician insists that it is correct Types and Causes of Conflict

8. Types and Causes of Conflict • Organizational structure: (“turf wars”) • aBetween two or more groups • Ex: Hospital nurses in conflict with central purchasing if supplies are defective or do not meet nurse’s needs • Ex: ANA and AMA when AMA to decrease the nursing shortage advocated RCT’s-: • b.Caused by style of management, rules, policies and procedures, and communication or lack of . Scarcity of resources: “conflict of interest” • can be staff, supplies, etc

9. Conflict Situations Specific to Nursing • Where does conflict occur? • Between members of health care team • With patient/family • Multigenerational among nurses- 4 different generations • Other-related to values and beliefs

10. Question • Illness and hospitalization create major stress for clients and their families. Often, families take out their emotions on the caregivers at the bedside. What is a normal emotion that can be directed at the nurse? A. Affection B. Anger C. Accountability D. Answerability

11. Answer B. Anger Rationale: anger, which is a normal and healthy reaction to situations and circumstances over which people have little control, may be directed toward the nurse.

12. Views of Conflict • Early views • Traditionalists • Behaviorists • Present day views • Conflict as Functional or Dysfunctional • Functional: serves greater good • Dysfunctional: doesn’t result in benefits • Conflict as Beneficial or Destructive • Beneficial: results in more equitable allocation • Destructive: results in lack of recognition of mutual objectives • Conflict as Constructive or Destructive

13. Cont. • Constructive: conflict is focused so direct action can be taken • Destructive: issues are broad allowing conflict to escalate; can be mistrust, miscommunication, misperceptions

14. Positive Aspects of Conflict • Conflict is impetus for change • Helps with understanding of others jobs and responsibilities • Facilitator for communication • Energizing • Unifying

15. Outcomes of Conflict • Win-Lose: 1.Usually power is a factor • 2.Competing will usually result in this • 3.Results when issue put to a vote • Lose-Lose: • 1. There are no winners • 2. Usually smoothing or avoidance results in this

16. Outcomes of conflict Win-Win: • 1.This is most desirable 2.Both parties achieve all or most of their goals 3.Problem solving and collaborating results in this

17. Personal Styles of Dealing with Conflict • Avoiding or Withdrawing • Person chooses not to address conflict Use this when: • a.There is more to be lost by addressing the conflict • b.There is no time to gather adequate data • c.When the problem is only a symptom of a larger problem • d. When the problem is not yours or there is nothing you can do about it • e.When the situation will take care of itself if you wait it out

18. Accommodating or Smoothing • 1. Everything will be OK                             2.  Have a strong need to be liked 3.Sacrifice personal goals and values 4. Person seeks to eliminate anger/negative feelings without addressing issue itself.   5. Use this when: • a.The conflict and anger are disrupting the work setting or interfering with patient care • b.Need another approach to solve conflict at another time

19. Forcing the issue or Competing • Person works for his solution exclusively, without consideration of others need • 1.“Let’s vote on it” • 2.Emphasize personal goals and desires • 3. Sarcasm is often used • 4.Use when: • a.You have more information or greater expertise than others • b.When your values are such that you believe no compromise is possible

20. Dealing with Conflict-Compromising or Negotiating • Person uses a give and take approach • Results in a win-lose • Helps to identify a common goal Use when: • a.The goals of both sides seem incompatible • b. There are time constraints • c.Earlier discussions have stalled

21. Personal Styles of Dealing With Conflict • Problem solving or Collaborating • Most difficult method to achieve • Persons involved in conflict work together to achieve common goals, win-win situation • More time consuming • Listen and try to understand other person’s viewpoint • *Usually considered best approach to conflict

22. Question • People who routinely address conflict in a competitive manner emphasize personal goals and desires, failing to consider the needs and opinions of others. What is this style for dealing with conflict? A. Accommodating B. Withdrawing C. Forcing the issue D. Problem solving

23. Answer C. Forcing the issue Rationale: competing or forcing the issue in a conflict involves working for your particular desired solution exclusively. People who routinely address conflict in a competitive manner emphasize personal goals and desires, failing to consider the needs and opinions of others. These individuals have a strong need to come out of any conflict as the winner.

24. Conflict and Groups • Win: increases cohesiveness • Loss: increased internal conflict, denial, lowers morale • Consensus: • May provide greater harmony than majority rule, but more time consuming • Eliminates “we-they” group positioning • Integrative decision making • Focus on means for resolving the issue rather than on the outcomes. • Works in instances where needs/desires are opposed

25. Integrative Decision Making • Spend time identifying needs and values • Search all possible alternatives • Select the one that works best *This method brings attention to the problem rather than to the person involved

26. Negotiating Role • Planning • Gather data! • Have a clear view of own position before starting • Consider one issue at a time • Implementing plan • Use assertive communication skills • Listen carefully • Summarize at end of negotiation to eliminate any misunderstandings

27. Negotiating Role • Negotiating when the sides are not even • Recognize unequal situations • Dominance power • Increase your self-awareness • Be honest • Listen closely to what others are saying • Be kind and considerate of others

28. Negotiating Role • Know what you are willing to accept in the process • Be creative • Recognize your limitations • Stay with the process

29. Mediating Conflict • Steps in Mediation Process (Display 9-3) • Assess the conflict • Analyze the information • Plan the process- review and adjust own attitudes • Implement planned strategy for mediation • Arrange meeting of all parties • Encourage expression of all viewpoints • Look at all solution alternatives • Narrow action choices down • Plan implementation of decision • Evaluate outcome of mediation (Please note similarity to Nursing APIE approach)

30. Mediation • Qualities that facilitate mediation • Trust • Clear Communication • Willingness of parties to negotiate • Stumbling blocks to effective mediation • Need to control • Need to be right • Need of participants to keep fighting • Need for vindication

31. Question • Is the following statement true or false? People who have a need to control also often feel they must make the final proposal and in the process develop an atmosphere of trust.

32. Answer False. Rationale: people who have a need to control also often feel they must make the final proposal and in the process alienate others.

33. Collective Bargaining • Collective bargaining involves a set of procedures by which employee representatives and employer representatives negotiate to reach agreement found in the form of a contract that describes conditions of employment, especially wages, hours, and benefits. In nursing, conditions of employment may also include defining the practice committees that will be in place, their memberships, and similar issues.

34. Collective Bargaining & Nursing • Negotiation of: • Salaries • Benefits • Work loads • Overtime • Protection for those who report unsafe practices • Governance structure • Grievance processes • Result is a legally enforceable contract

35. Collective Bargaining (cont’d) • Collective bargaining and nursing • National Labor Relations Act (NLRA) • Amendment to NLRA (1974) • Grievance process

36. Collective Bargaining (cont'd) • Traditional vs. nontraditional strategy • Traditional: principle of equal power • Interest-based bargaining (IBB) • Employees work jointly to problem solve strategies to meet each side’s interest

37. Issues Related to Collective Bargaining • Is it professional for nurses to bargain collectively? • Who is representing nurses at bargaining table? • Should nurses unionize? • How does the supervisor fit into collective bargaining?