When nurses begin new leadership positions, their well-intended attempts to establish “how we do things around here” may uncover longstanding barriers to team performance. Often, those barriers relate to ineffective conflict resolution or bullying. Determining the underlying issues becomes complicated because behaviors related to ineffective conflict resolution frequently overlap with behaviors associated with bullying.
When unacceptable individual or group behavior has been festering unchallenged for years, changing the status quo becomes an uphill battle for the new leader. To help minimize that battle, we must distinguish between normal day-to-day conflict and workplace bullying. I’m also going to outline some structured prompts and related follow-ups that help nurse leaders identify problematic behaviors and respond effectively.
Workplace interpersonal conflict (WIC) is a dynamic interaction between interdependent individuals that elicits negative emotional reactions. When used positively, conflict may enhance team performance and reveal a robust team with diversity of thought. On the contrary, in healthcare arenas, WIC has been linked to safety-compromising incidents. For healthcare professionals, unresolved conflict may be detrimental to physical health and work performance and result in a sense of impairment that is prompted by fear and defeatism.
Style under stress
Conflict invariably causes emotional upheaval. Interpersonal conflict prompts an automatic physiological response as the amygdala kicks into overdrive and induces fear or angst. Unchecked, these negative emotions—rather than calm logic—guide our response, and that doesn’t bode well for achieving effective resolution. Honest self-assessment can help you and others recognize emotional triggers. Style under stress is one approach I use. Controlling emotions before they overrule logic may be as simple as taking a few deep breaths or taking a break to calm down. The more upset the other person is, the more I calm myself. The louder the other person’s voice, the softer mine is. Before a rise of negative emotions at the audacity of another’s behavior, I fall back on Simon Sinek’s advice to “get curious” about why the behavior may have occurred, stay silent, and listen to understand.
When interpersonal conflict occurs in the workplace, I’ve seen nurses try to ignore or work around it. Neither response is satisfactory. One said to me, “It’s easier that way. Dealing with conflict takes energy I don’t have after all the other stuff I need to do.” I understand. Earlier in my career, I had the same thoughts. I once assigned two nurses to work on a project both had expressed interest in. A few weeks later, one complained to me about the other. Naturally, I asked if she had talked to her colleague. She replied, “I tried to. She says she’s ‘not ready’ to talk with me.”
Like many, the nurse who didn’t want to talk about it didn’t want to deal with the confrontation required for conflict resolution. It made her uncomfortable and provoked anxiety. She worried that the resolution would generate more conflict and not achieve the desired result. She hoped that if she delayed the meeting long enough the other person would forget about it. The confrontation that occurs with conflict resolution can interrupt whatever modicum of peace nurses may have in an otherwise chaotic workday, so we avoid it. Although it’s natural for us to want a peaceful work environment, our work, by its very nature, is stressful and involves handling conflict.
Failure to engage is not an option
There are two points to make here. Failing to engage in conflict resolution is not an option because unresolved conflict may be considered a performance problem or safety concern. Secondly, using an established method helps structure conflict resolution that should occur privately in a constructive and timely manner. Written expectations provide consistency and clarity for effective conflict resolution. I prefer succinct guidelines, such as the TeamSTEPPS 3.0 DESC script:
- Describe the facts of the situation or behavior.
- Express how you feel about the situation.
- Suggest an alternative behavior/approach.
- Specify consequences to the team or patient.
I typically start by identifying a mutual goal. For example, “Gabriel, we both agree that the policy revision should be implemented as soon as possible.” Then:
- Describe behavior factually: “In the team meeting you accused me of not revising my section of the document.”
- Express feelings: “I felt embarrassed.”
- Describe how the behavior made you feel: “I completed it but sent the wrong file by mistake.”
- Suggest an alternative: “Next time, just ask me about it privately…”
- Add consequence for the team: “…so there is no delay to the teamwork.”
The last part might be the hardest. Stop talking. Allow the other person a chance to respond. In my experience, the conversation then goes one of two ways: There is mutual consensus (i.e., the other nurse agrees to handle it privately in advance next time) or they try to rationalize their behavior and go off on a tangent. If the former occurs, the conversation ends. If the latter happens, add a clear assertive statement like, “Next time let me know privately before the meeting.” The conversation may then end. Throughout, it’s important that the discussion stays on point and doesn’t segue into irrelevant issues.
Speak up when you see bullying
WIC sometimes involves behaviors I consider bullying, often defined as repeated and unreasonable aggression toward individuals or groups. Workplace bullying is intended to intimidate, degrade, humiliate, or undermine its victims. Unfortunately, healthcare workers often fail to report many behaviors I consider bullying, such as gossiping, spreading rumors, abusing authority, refusing to meet, swearing, and other crucial concerns.
Before I used these and other guidelines, handling workplace interpersonal conflict—especially when bullying was involved—was well outside my comfort zone. With practice, my stress levels have gone down. I’ve learned to focus on the other person, making sure he or she feels valued and heard by listening and trying to see the other point of view. For me, it now comes naturally to hesitate before I speak because I want to consider not only what to say but how to say it. I keep my tone and posture neutral. If a win-win is possible, with both parties sensing they’ve achieved something, I look for it.
Uncomfortable as it may be, nurses need to speak up when bullying occurs. Barriers to speaking up range from fear of making the problem worse, to complacency with the norm, to not knowing how to speak up. These barriers can be addressed with bullying solutions for nursing practice training (free to Sigma members), practicing speaking up with scripts, and creating an open dialogue among trusting colleagues. We are all responsible for effective team dynamics. As multiple professional standards attest, bullying is unacceptable, and silence, which condones the behavior, is also unacceptable.
Sometimes people use passive-aggressive behavior—gossip, for example, instead of dialogue—to “resolve” interpersonal conflict in the workplace. Nurse leaders who encounter such a culture have come upon a major problem. WIC itself is not a performance problem. Bullying, however, is a performance problem, a safety concern, and the bane of nurse leaders who must deal with it.
Collaborate with human resources
Changing a culture where bullying is accepted takes time and requires astute attention to underlying intrapersonal, interpersonal, and organizational factors, which differ from workplace to workplace. Administrators must acknowledge the problem and collaborate with human resources when confronting bullies about their behaviors.
The nurse leader may be the one who needs to ascertain whether the bully is willing to change. If so, a performance improvement plan needs to be implemented. Documentation becomes a trusted ally because bullying incidents, related meetings, and performance improvement plans require a paper trail. Hard though it may be, termination must be initiated if the bully is unwilling to own up to the offending behavior and take steps to eliminate it. In that case, it helps to have an outside mentor who supports the nurse leader and offers wisdom throughout the process.
Amid the ubiquitous workplace interpersonal conflict that may include bullying, leaders should keep themselves above reproach, aware that their behavior affects the culture of the workplace. To that end, I practice daily reflection to problem-solve. I ask myself how I could have handled today’s conflict better. How have I placed my department’s agenda ahead of my own agenda? How have I modeled the civil behavior I want to see in my team members? How have I used logic, rather than emotions, to guide my actions? Have I accurately documented the facts of the situation? When I find myself starting to ruminate in an unproductive “could have, should have" mode of thinking, I refocus, relax, and recharge from my day.
As nurses strive to become the transformative leaders needed to change global healthcare, we are inevitably called upon to handle WIC—including its often-silent aspects, which may include bullying behaviors. On those days, the tasks of leadership may seem daunting. Today, I say, “Bring ‘em on.”
Monica Kennison, EdD, MSN, RN, CNE, is a professor and Susan V. Clayton Baccalaureate Nursing Chair at Berea College in Berea, Kentucky, USA. She is a member of Sigma’s Delta Psi at-Large Chapter.