Workplace Conflict Engagement for Nurses: Consider the System

by Sachin Sandhu/Flickr

This month, Debra Gerardi writes about initial steps to managing workplace conflict as nurses. The quotes below are from her article in the March issue of AJN, “Conflict Engagement: A New Model for Nurses” (free until April 30, the article is one in an ongoing series on conflict).

Just as with most medical errors, there is usually not a single cause of workplace conflict—instead, a number of interrelated variables lead up to an event.

Sure, I was new to nursing, but I wasn’t new to work. My life as the child of small business owners had ingrained in me a certain sense of duty that I felt my colleague lacked. When you grow up with parents who make you pick up cigarette butts in their business parking lots, no work is below you, and there’s no time to complain. Maya wasn’t new to nursing, but she seemed, to me, new to the idea that work was to be done without a fight.

In my first months on the unit, I saw her complain much more than I saw her put her head down and plod through the tasks before her. Our unit was full of really sick patients, to be sure, and glitches like overflowing trash or equipment holdups too often set us back, forcing us to tend to jobs meant for others. But instead of voicing my frustration, I bit my lip and took on every task I came upon, judging my colleague for her unwillingness to silently do the same.

Maya and I soon clashed, probably because she picked up on the disapproval that I wore on my face. While I never told her that I interpreted her opposition to our daily workplace setbacks as laziness, our mutual frustration with each other became palpable. It never occurred to me to try to tell her how I felt; I had no desire to engage Maya in finding a solution. To me, she was the problem.

Effectively addressing conflict in complex systems requires an understanding of how systems function, and ultimately a shift in thinking toward a systems view of organizations.

One day, after a lunch room volley that publicly exposed our simmering conflict, Maya angrily pulled me into an empty patient room. My words to the group eating with us had implied that Maya was to blame for a slip-up, and although the incident hadn’t affected patient care, I’d made my feelings about her work ethic evident to all.

What Maya said to me that day shifted my narrow view of our conflict into one that encompassed our entire system, and changed my view of nursing work forever:

“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.”

And that was all Maya said. She left before I could muster a word in response.

Cultivating conflict competence involves both an understanding of the dynamic nature of conflict within organizations and a deeper understanding of one’s own responses to conflict.

For months afterwards, we barely spoke. But I could sense a change in the air between Maya and me. She had been right. Her understanding of the dangerous nature of our unspoken conflict was far deeper than mine. By looking beyond our immediate tiff into its potential effects on the system in which it took place, she neutralized it.

After Maya pointed out the danger of our conflict, I considered its history, and its relation to the system it endangered. What had made me engage with her in this way? I realized that the times I was most frustrated with Maya’s attitude were ones in which I felt external pressure myself. Maya, a more senior member of the team and a more senior nurse, felt the same pressures I did, but had the ability to convey them to people who might help with improvement or resolution. My novice voice was so wrapped up in the tasks at hand that I coded her objection to outside pressures and systems failures as laziness, when really she was simply trying to create positive, systems-level change to keep our patients safe.

Systems thinking provides a method for incorporating the dynamic, interconnected nature of clinical work into the approaches for managing how the work gets done.

This conversation with Maya taught me more than just how to look beyond my own assessment of conflict; it taught me how to work without taking offense and how to consider the systems view. Maya showed me that, since the nature of nursing work is interconnected and dependent upon mutual support, our very system is sometimes what brings us into conflict. But instead of brushing aside this vital and difficult piece, she made it the center of our conflict’s solution: Our conflict, although largely caused by our system, must be resolved in order to maintain it.

Fortunately, Maya scared the heck out of me that day. I saw the importance of moving past our conflict into a state of mutual respect for each other in order to better our system’s function. We didn’t plan to, but eventually, our mutual agreement brought us together—Maya remains my friend to this day.

(Podcast: AJN editor-in-chief Maureen Shawn Kennedy spoke with Gerardi about her article. Visit this page on our Web site and scroll down to listen to or download the podcast; or get it through iTunes here.)