Conflict Engagement Helps Providers Focus on Care

June 15, 2021

Nurses have an innate drive to improve healthcare delivery. When I was a unit director, I focused on nursing unit turnarounds to improve quality of care. I used mediation as the model for resolving long-time conflicts and provided training to effectively engage and communicate. I started my mediation practice in 2003 to help physicians, nurses, and administrators resolve the complex issues that get in the way of patient care and create stressful work environments.  

Debra Gerardi, RN, MPH, JD, is an executive coach and consultant at Emerging HealthCare Communities in Santa Barbara, CA.

Conflict is a natural part of interpersonal relationships, but clinician conflict is most often the result of ineffective coping with the ongoing stress and tension inherent in our work. The professional subcultures of nurses, doctors, and administrators can contribute to those tensions because of power differentials, work styles, and limited time available for directly addressing sources of tension.  

Conflict resolution takes time and is an iterative process that builds on small agreements to enable larger ones. With my mediation clients, I begin by conducting listening sessions to hear the concerns, understand everyone’s perspective, and engage their help to identify solutions. I ask everyone to contribute to where we should focus and create an agenda. Not all conflicts have easy solutions, but we can’t begin to find the solution if no one engages in those conversations. 

I also create a space for people to express their emotions and move through the pain and frustration caused by the conflict. We discuss the impact it had on them, share what they need from others to move forward, and identify what they are willing to change in their own contribution to the situation. I help people shift from telling victim stories, where they feel helpless or assign blame, to possibility stories, where they imagine what is needed to move forward. The process is cathartic and relies on open sharing of concerns and ideas.

Then I meet with the groups’ leaders to share the themes I heard during the listening sessions. Together we create a process for working through the issues to restore trust and healthy communication patterns. Often, the leaders also struggle, so I coach them to discover ways they can engage more effectively.  

Finally, everyone comes together to talk directly about the conflict and share how resolving it would affect them and their patients. We create group agreements for respectful conversations and a plan for monitoring their progress and dealing with backsliding. 

I am a facilitator and coach throughout the process and use experiential learning and improvisation exercises to help clinicians recognize when certain habits are hindering effective communication.  

As clinicians, we are pathologic problem solvers always looking for a fix or solution, which has many clinical benefits but sometimes gets in the way of hearing what is driving conflict and can reinforce the misconception that others are not capable of resolving their own issues. To interrupt that pattern, I facilitate separate listening sessions and solutions sessions. I also invite them to practice being present and listening fully, without trying to solve or advise. 

Our work as nurses is relational, and we use ourselves as the instrument of that work. Caring for ourselves, learning about our habits and triggers, practicing self-management, and engaging with integrity and curiosity are crucial to addressing conflict, protecting our work relationships, and resolving the tensions inherent in our calling: helping others heal. 

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