SPECIAL IISECTION

RETAINING NURSES THROUGHCONFLICT RESOLUTIONRetaining sufficient nursing staff is one of

the more critical problems healthcareadministrators face. The nursing short-age can be traced, to a large extent, to

. the high turnover among nurses and tothe large numbers of nurses who simply leave theprofession.'

A fundamental lack of interest in nursing.urrong those who might otherwise enter the pro-fession may have some bearing on the nursingshortage, but the primary problem relates to theretention of nurses: Something happens to causenurses to quit their jobs or leave the profession.

One might assume that nurses find out afterentering the field that they do not like nursing,but evidence suggests they enjoy their work' andbelieve they contribute significantly tohcnlthcare.' Therefore factors other than the.vork itself must be causing nurses to changeemployers or leave nursing. Two such factorsrelate to impotence:

•• ;\J urses feel they have little say in running thehc.ilthcare system'

II> Nurses feel they have little control over issues1(;1' which they are held responsible.'

L_.A.-= _

Dr, Fowler is associate professor, Department ofJf.magcment) Youngstown State University)riJlmgstoJ]Jn, OH; Dr. Bushardt is professor andciu.irpcrson, Department of Management, Uni-1';", 'sit), of Southern Mississippi, Hattiesburg; Ms.,.JiICS is independent contractor and flex nurse,1done University Medical Center, New Orleans.

Ht,\LTH PROGRESS

Training

Staff to

Confront

Problems

And

Communi-

cate

Openly Can

Improve the

Work

Climate

BY AUBREY R.FOWLER, JR., PhD;

STEPHEN C. BUSHARDT,DBA; & MARIA ALICIA

JONES, RN

This feeling of powerlessness causes nurses toview administrators, physicians, and others asadversaries and creates conflict and divided loyal-ties." Thus we might attribute the nurse retentiondifficulty to nurses' response to organizationalconflict. If administrators understood the natureof that response to conflict, its impact on jobtenure and loyalty to the profession, and how tofoster a more appropriate conflict resolutionstyle, they might be better able to retain theirnursing staff.

Summary The way nurses resolve conflictmay be leading them to quit their jobs or leave theprofession altogether. Conflict is inevitable in adynamic organization. What is important is not toavoid conflict but to seek its resolution in a con-structive manner.

Organizational conflict is typically resolvedthrough one of five strategies: withdrawal, force,conciliation, compromise, or confrontation.

A recent study of nurses in three different hospi-tals showed that the approach they use most iswithdrawal. This might manifest itself in a requestto change shifts or assignments and rnay lead to ajob change and, eventually, abandonment of thefield altogether, Given this scenario, changing nurs-es' conflict resolution style may help administratorscombat the nursing shortage,

Healthcare organizations must examine them-selves to determine why nurses so frequently usewithdrawal; then they must restructure work rela-tionships as needed. Next, organizations need toincrease nurses' awareness of the problem andtrain them to use a resolution style more conduciveto building stable relationships: confrontation,

Staff should also be trained in effective commu-nications skills to develop trust and openness intheir relationships.

JUNE 1993 • 25

ISPECIAL • SECTION

THE NATURE OF CONFLICTConflict is not inherently bad for an organization;it is inevitable in a dynamic environment.Therefore it is not necessarily desirable to elimi-nate conflict within an organization; rather, it isnecessary to handle it effectively and positively.How complex organizations handle conflict is agood indication of the extent towhich they areable to integrate the frequently competing issuesof concern for relationships and concern for out-comes' (see Figure).

Organizational conflict is typically resolvedthrough one of five strategies':

1. Withdrawal. Here the conflict is of little orno significance to either party. This approachnormally reflects their lack of concern for the out-come of the conflict or for their relationship. Insome cases withdrawal is used when one or bothparties do care about the outcomes and the rela-tionship but are attempting to deny that concernto avoid hostility or other difficulties in resolvingthe contlict. This denies the opportunity to buildtrust and creates an environment that may facili-tate the departure of one or both parties. It is alose-lose strategy.

2. Forcing. This is found when differences inorganizational power allow individuals in intluen-rial positions to force outcomes regardless oftheir effect on or the desires of the other party. Itindicates a lack of concern for the relationshipbetween the parties and creates resentment andhostility in the losing party. Forcing is a win-losestrategy.

3. Conciliation. In this approach, one party,e~ger to preserve the relationship, will give in tosettle the conflict. It can lead to resentment in theparty giving in, particularly when the other partydoes not reciprocate on other issues. It is a lose-win strategy.

4. Compromise. Here the parties, concernedfor both relationship and outcomes, seek a solu-tion that is an acceptable intermediate positionbetween their divergent interests. It is seen as aflir way to settle contlict, but can leave both par-ties with a sense of loss. It works well with groupsrh.it have complex relationships and interests, butbiis to satisfy the needs of interpersonal relation-ships because it avoids finding a common groundof understanding that would allow for a mutuallysatisfactory solution. It is, therefore, a lose-losestrnegy when used by individuals.

S. Confrontation. This involves meeting theproblem head-on by searching for the underlyingreclsons for the conflict. Parties can resolve issuesmore fundamentally by identifying all their con-cerns, clarifying erroneous or divergent assump-tions, focusing on the real reasons for the con-

HEALTH PROGRESS

MODES OF CONFLICT RESOLUTION

Modified from D. E.Wolfe and S. C. Bushardt. "Interpersonal Conflict: Strategiesand Guidelines for Resolution: Journa/ of the American Medica/RecordsAssociation.vol. 56. no. 2. 1985. p. 18.

Concernfor

RelatlonshlP$

HighConciliation

Lose-WinConfrontation

Win-Win

CompromiseLose-Lose

Withdrawal ForcingLose-Lose Win-Lose

LOw'-L-O--W-------------H-ig--h-'

Concern for Outcomes

Confrontation

offers parties in

conflict a

chance to build

lasting trust

and

understanding

and to achieve

Will-Will

outcomes.

flict, and working toward a mutually satisfyingresolution. It is more time-consuming and diffi-cult than the other approaches but offers a chanceto build lasting trust and understanding betweenthe parties and to achieve win-win outcomes toconflict.

Contlict in organizations is inevitable but gen-erally resolvable. The important issue is not toengage in a futile attempt to avoid conflict but toseek its resolution in a constructive manner.Effective contlict management enhances the func-tioning of organizations, whereas poor conflictmanagement leads to dysfunction.

NURSES' STRATEGYA survey of nurses in three different hospitalsindicates that nurses are consistent in theirapproach to conflict resolution! This suggeststhat nurses' conflict resolution styles are anattribute of the profession and have little or noth-ing to do with employer or demographic differ-ences.

The study found that the primary mode ofconflict resolution among nurses is withdrawal.Thus it is no surprise that health care institutionssuffer from substantial turnover in their nursingstaffs or that large numbers of nurses leave theprofession. When nurses encounter conflict, theyintentionally avoid the specific situation or rela-tionship, to the point of requesting a change inwork assignments or shifts, or even changingjobs. Eventually, if faced with continuing con-flict, they might leave the profession altogether.Given this scenario, a change in contlict resolu-tion style might well lead to a greater likelihoodof nurses remaining with the same employer or atleast within the profession.

At the other extreme, forcing is the contlictresolution style used least by nurses, even though

JUNE 1993 • 27

SPECIAL • SECTION

they themselves may be subjected to it. This isconsistent with nurses' feelings that they have lit-tle control in their jobs and indicates they are notin a position of imposing their solution to prob-lems on those they work with, that they have lit-tle or no authority or power to do so.

Having little authority but substantial responsi-bility, nurses cannot afford to develop muchinterest in work relationships or conflict out-comes. Moreover, in the second and third most-used styles-compromise and conciliation-thenurses lose in conflict resolution.

Given these findings, it is no wonder that nurs-es extend their withdrawal from the conflicts theyface to include withdrawal from the organizationor profession.

ADMINISTRATIVE RESPONSESTwo changes are needed to address the issuesraised here.Self·Examination and Restructuring Healthcare organi-zations should examine themselves to determinewhy nurses so frequently use withdrawal to dealwith conflict-an indication that neither the nursenor the organization has much concern about theoutcome of the conflict or the relationshipbetween them. It indicates the nurse's lack ofconcern because he or she makes a consciouschoice to leave the relationship. It indicates theorganization's lack of concern because it allowsthe continuation of an environment in whichnurses find no more acceptable means of resolv-ing conflict.

An effort by organizations to restructure workrelationships to increase nurses' authority andfeelings of control as they exercise their responsi-bilities might help stabilize their employment and

If trained ..

in the use of

confrontation,

nurses would

be much more

receptive to

organizational

efforts to

initiate change.

28 • JUNE 1993

support their commitment to the profession.Such a changed work environment might allownurses to modify their conflict resolution style,thereby reducing the problems associated withwithdrawal.Awareness and Training Organizations should in-crease nurses' awareness of the problem and trainthem to use confrontation, a conflict resolutionstyle more conducive to building stable workrelationships. Given such training, nurses wouldbe able to consciously change their behavior andwould be much more receptive to organizationalefforts to initiate change in the workplace.

Such conflict resolution training should bemade available to nurses on the job through someform of in-service or continuing education pro-gram. This training should also be available innursing-degree programs, concentrating on thedevelopment of the student's primary conflictresolution style with the understanding that eachof the styles may be appropriate, depending onthe importance of the issues and the relationshipbetween the individuals.

Such training should develop awareness of allthe conflict resolution modes, while stressingconfrontation as the one likely to yield optimalresults in most situations.

TRAINING FOR CONFLICT RESOLUTIONAppropriate Style A first requirement in trainingnurses, hospital administrators, and other staff toeffectively resolve conflict is to recognize that, inspecific circumstances, each style is applicable":

• Forcing is appropriate when the issuerequires an immediate solution, consistent acrossan organization, and one party has the clearauthority to impose a decision.

• Conciliation is best when a complete solutioncan be postponed or when the parties have a lim-ited, temporary relationship that does not requirea definitive solution between them.

• Withdrawal works best when the parties haveno real relationship or any real need to resolvetheir differences.

• Compromise is preferred when the issue ishighly complex, involving two or moreentrenched interests and not offering any win-winoptions. In this situation a compromise is betterthan no resolution at all.

Each of these styles is, in effect, an expedientsuitable for special circumstances. However, for along-term resolution to real problems, the con-frontation or problem-solving style is clearlysuperior. In it the parties work to identify theunderlying problem causing the conflict and seeka win-win solution to it.

In carrying out a confrontational approach, the

HEALTH PROGRESS

p

((:r·p

n

IT

G

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ir

at

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r{

alInod.slertc

artrtl:IearpcUI

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HI

SPECIAL • SECTION

parties need to follow several rules":• Be clear about the underlying assumptions:

(1) Mutually satisfactory agreement is possible,(2) only win-win solutions are acceptable, and (3)resolution will be based on agreement, notpower.

• Identify the issue to be confronted.• Confront the issue, not other participants.• Be an active, effective listener.• Avoid becoming defensive or getting side-

tracked.• Recognize and express the importance of the

relationship.• Focus on solving the problem.• Keep overall organizational objectives in

mind.• Include a neutral third party to aid communi-

cations.Communication The second requirement for effec-tively resolving conflict, particularly when seekinga long-term resolution through confrontation, isto train participants in the use of effective com-munications skills to develop trust and opennessin their relationship. A powerful technique foraccomplishing this is the Johari Window. 12 Itessentially involves using self-disclosure and feed-back to increase participants' knowledge of them-selves and each other (see Figure).

In this model the goal is to increase the areareferred to as the "open arena," the area of mutu-al knowledge and understanding. To initiate thisincrease, the parties must be willing to be moreopen and sharing about themselves, therebydecreasing the "hidden self." In addition, theyshould be more responsive to feedback from oth-ers and to experimentation in their own behaviorto decrease the" blind self."

As the parties learn more about each other, thearea of mutual knowledge and open trust calledthe "open arena" increases. This allows for fur-ther self-disclosure and additional feedback andleads to a self-reinforcing cycle of growing trustand openness until both parties understand theposition of the other and, eventually, use thatunderstanding to reach a mutually acceptableagreement covering the immediate issue in con-flict, as well as the underlying conditions thatcaused it.

AN IMPROVED WORK CLIMATEIf the parties to the conflict are trained to recog-nize the nature of the conflict situation, the valueof confronting the underlying issues, the rules ofeffective confrontation, and the need for openand trusting communications, they will be wellOn their way to resolving conflict between themin constructive, mutually acceptable ways.

HEALTH PROGRESS

JOHARI WINDOW: INFORMATION ON SELF

Thlnlf Others .Know abol,lt Me·

1't!lngs OthersDoNotK~W .'

abOut Me

ThIngs I Knowabout Myself

thIngs IDoNotKnow about Myself

Feedback frot'n"~eftI

i

Open BlindArena Self.Hidden Undiscovered

Self- Self SelfosureMy

. DIscI

From J. lutt. Group Processes: An Introduction to Group Dynamics. 3d ed .•Mayfield Publishirlg, Mountain View, CA, 1984. Used with permission.

As the parties

begin resolving

conflict with

WIn-WIn

outcomes, the

incidence of

conflict should

decrease.

Furthermore, as the parties begin resolving con-flict with win-win outcomes, the incidence ofconflict should decrease and the level of mutualrespect and concern should increase. Successfulresolution to conflict will lead to an improvedwork climate. 0

NOTES

1. G. A. Wolf, "Nursing Turnover: Some Causes andSolutions," Nursing Outlook, vol. 29, no. 4, 1981, pp.233-236; F. l. Huey and S. Hartley, "What KeepsNurses in Nursing?" American Journal of Nursing,February 1988, pp. 181-188.

2. C. Joiner and G. van Serve lien, Job Enrichment inNursing: A Guide to Improving Morale, Productlvity,and Retention, Aspen Publishers, Rockville, MD,1984.

3. Wolf.4. Wolf.5. M. E. Engleke, "It's Time to Take Charge," Nursing

Management, vol. 14, no. 2, 1983, pp. 71-73.6. Engleke; M. Quivey, "Conflict Arising from Being a

Health Care Professional in a Management Role,"International Nursing Review, vol. 32, no. 5, 1985,pp. 154-157.

7. G. Litwin and R. Stringer, Motivation and Organiza-tional Climate, Division of Research, HarvardUniversity, Boston, 1968.

8. D. E. Wolfe and S. C. Bushardt, "InterpersonalConflict: Strategies and Guidelines for Resolution,"Journal of the American Medical RecordsAssociation, vol. 56, no. 2, 1985, pp. 18-22.

9. M. A. Jones, A. R. Fowler, and P. Tomlinson, "AnEvaluation of the Way in Which Nurses Resolve JobRelated Conflict and a Discussion of the Ramifi-cations Thereof," Proceedings, Southern Manage-ment Association, Atlanta, 1991, pp. 133-135.

10. Wolfe and Bushardt.11. Wolfe and Bushardt.12. J. Luft, Group Processes: An Introduction to Group

Dynamics, 3d ed., Mayfield Publishing, MountainView, CA, 1984.

JUNE 1993 • 29

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