The Nurse as Conflict Manager, Negotiator, and

Mediator

Nancy Jenkins, RN, MSN

Understanding Conflict, Negotiation, & Mediation

Conflict:

Negotiation:

Mediation:

ConflictThe dissension that occurs when two or more individuals with different values, interests, goals, or needs view things from dissimilar perspectives

NegotiationConferring with another so as to arrive at the settlement of some matter (Merriam-Webster On-line Dictionary, 2008)

MediationThe process of intervention between conflicting parties to promote reconciliation, settlement, or compromise (Merriam-Webster On-line Dictionary, 2008)

Where Conflict OccursIntrapersonal conflictInterpersonal conflictOrganizational conflict

Organizational structureRole ambiguity and role conflictScarcity of resources

Types and Causes of Conflict

IntrapersonalWithin oneselfOccurs when person has to choose between two mutually exclusive alternativesEX: SICK CHILD AND WORK

InterpersonalOccurs when Between two or more individualsthere are differing values, goals, actions, or perceptionsEx: Nurse questions Dr. order and the physician insists that it is correct

Types and Causes of Conflict

Organizational structure: (“turf wars”)a     Between two or more groups

Ex: Hospital nurses in conflict with central purchasing if supplies are defective or do not meet nurse’s needsEx: 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

Conflict Situations Specific to Nursing

Where does conflict occur?Between members of health care teamWith patient/family Multigenerational among nurses- 4 different generationsOther-related to values and beliefs

QuestionIllness 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. AffectionB. AngerC. AccountabilityD. Answerability

AnswerB. 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.

Views of ConflictEarly views

TraditionalistsBehaviorists

Present day viewsConflict as Functional or Dysfunctional

Functional: serves greater goodDysfunctional: doesn’t result in benefits

Conflict as Beneficial or DestructiveBeneficial: results in more equitable allocationDestructive: results in lack of recognition of mutual objectives

Conflict as Constructive or Destructive

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

Positive Aspects of ConflictConflict is impetus for changeHelps with understanding of others jobs and responsibilitiesFacilitator for communicationEnergizingUnifying

Outcomes of ConflictWin-Lose:                                                        1.  Usually power is a factor                                                 2.  Competing will usually result in this 3.  Results when issue put to a voteLose-Lose:

1. There are no winners2. Usually smoothing or avoidance results in this

                                                                                                               

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

Personal Styles of Dealing with Conflict

Avoiding or WithdrawingPerson chooses not to address conflict

       Use this when:a.      There is more to be lost by addressing the conflictb.      There is no time to gather adequate datac.      When the problem is only a symptom of a larger problemd.      When the problem is not yours or there is nothing you can do about ite.      When the situation will take care of itself if you wait it out

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 careb.      Need another approach to solve conflict at another time

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 othersb.      When your values are such that you believe no compromise is possible

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 incompatibleb. There are time constraintsc.  Earlier discussions have stalled 

Personal Styles of Dealing With Conflict

Problem solving or Collaborating

Most difficult method to achievePersons involved in conflict work together to achieve common goals, win-win situationMore time consumingListen and try to understand other person’s viewpoint*Usually considered best approach to conflict

                                                                                                                                                                                                                                                     

QuestionPeople 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. AccommodatingB. WithdrawingC. Forcing the issueD. Problem solving

AnswerC. 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.

Conflict and GroupsWin: increases cohesivenessLoss: increased internal conflict, denial, lowers moraleConsensus:

May provide greater harmony than majority rule, but more time consumingEliminates “we-they” group positioning

Integrative decision makingFocus on means for resolving the issue rather than on the outcomes.Works in instances where needs/desires are opposed

Integrative Decision Making

Spend time identifying needs and valuesSearch all possible alternativesSelect the one that works best

*This method brings attention to the problem rather than to the person involved

Negotiating RolePlanning

Gather data!Have a clear view of own position before startingConsider one issue at a time

Implementing planUse assertive communication skillsListen carefullySummarize at end of negotiation to eliminate any misunderstandings

Negotiating RoleNegotiating when the sides are not even

Recognize unequal situations Dominance power Increase your self-awareness Be honestListen closely to what others are sayingBe kind and considerate of others

Negotiating RoleKnow what you are willing to accept in the process

Be creative

Recognize your limitations

Stay with the process

Mediating ConflictSteps in Mediation Process (Display 9-3)

Assess the conflictAnalyze the informationPlan the process- review and adjust own attitudesImplement planned strategy for mediation

Arrange meeting of all partiesEncourage expression of all viewpointsLook at all solution alternativesNarrow action choices downPlan implementation of decision

Evaluate outcome of mediation

(Please note similarity to Nursing APIE approach)

Mediation

Qualities that facilitate mediationTrustClear CommunicationWillingness of parties to negotiate

Stumbling blocks to effective mediation

Need to controlNeed to be rightNeed of participants to keep fightingNeed for vindication

QuestionIs 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.

AnswerFalse.

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

Collective BargainingCollective 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.

Collective Bargaining & Nursing

Negotiation of:SalariesBenefitsWork loadsOvertimeProtection for those who report unsafe practicesGovernance structureGrievance processes

Result is a legally enforceable contract

Collective Bargaining (cont’d)

Collective bargaining and nursing

National Labor Relations Act (NLRA)

Amendment to NLRA (1974)

Grievance process

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

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?