Nursing Leadership and Conflict Management The complexities of communication in healthcare are accentuated by the urgency of providing expert-level care and continually fueling a high level of professional competence with one's peers and the broader professional communities. The more time-sensitive a given field of nursing or medical practice, the more critical it is to have highly accurate, relevant and timely patient data to make decisions on (White, Thornbory, 2007). Across the entire medical industry and specifically in nursing the greater the competency a professional has, the greater the credibility they earn over time (McElhaney, 1996). This is what makes leadership so difficult in the nursing industry, as excellent leaders will over time coach and create highly effective nursing professionals who are honest about their strengths, in addition to their weaknesses (Fuimano, 2005). Authenticity and transparency are critically important for creating a solid foundation of trust in communication, and the more intense the time pressures and the greater the demand for expertise in a given situation, the more a nurses' credibility gets tested. When a nurse portrays themselves as more competent than they are and becomes defensive when they make errors in interpreting cardiac history and laboratory data, two areas of primary nursing competence, it is inevitable major conflict will occur. This is the scenario that recently occurred with physicians and an operating room team present with a nursing trainee who claimed to have nine years of experience.

Discussion and Analysis

At the center of all successful communication strategies is shared meaning, common frames of reference and an implicit trust of shared interest (Nicotera, Mahon, 2013). When any of these factors are not present or are found to be deficient in communication, the potential for conflict escalates (Fuimano, 2005). What often makes conflicts escalate is when what is said and the ensuing experiences and perceptions don't match with the implied and often expressed facts shared. Very often in nursing these differences or disconnects between expectations and actual performance or experiences of nurses working together occur in the areas of expertise or mastery of specific areas of patient treatment programs and analysis (Conant, Kleiner, 1998). In the end, every nurses' most valuable possession is their credibility; it is the currency they trade with and earn promotions and over time, advanced their career using. It is the currency that is earned with trust and solidified with years of solid performance. When a nurses' credibility is under attack they will often react at a level not necessarily commensurate with the original claim. In other words, an attack on a nurses' competency is tantamount to attacking her future career as well. The more uncertain a nurse is of her mastery of a given area of nursing, even the most simplistic tasks including checking dates on a chart or cardiac history and laboratory data will be seen as a major threat.

In the case of the nurse who overreacted to the questions regarding checking cardiac history and laboratory data and accusing another nurse of deliberately embarrassing her in front of other physicians, the conflict management method needed to shift to a collaborating approach to mitigate further argument. Insecure about her expertise and seeing just the mention of the chart inaccuracy as a reason to lose her temper, the nurse trainee has her own self-doubts about her mastery of nursing. The contention that the mistake was deliberately amplified for all the physicians just underscores this self-doubt. Often the most self-doubting nurses will be the most contentious when presented with their mistakes. All of these factors taken together will lead to an explosive situation over time unless the nurse supervising the trainee steps in and uses conflict management and resolution techniques.

With the goal of creating a more productive outcome for each person involved, a lead nurse could have taken the following conflict management strategy to intermediate the conflict and lessen it. When credibility is on the line between two healthcare professionals, it is common to see explosive situations rapidly evolve (McElhaney, 1996). This is exactly what happened with the nurse trainee. Clearly anyone with the perception that they are being perceived as less than competent at their job will become very defensive quickly. The next step is to lash out and further create animosity. This leads to retaliation and the cycle just escalates until the conflict quickly goes out of control.

The supervisor of the nurse trainee could help to mitigate this conflict by first seeking to understand how such an error occurred in the first place -- one that...

Having the nurse trainee compromise is going to be very difficult when her competency is under question; her supervisor needs to get to her be more truthful about the error however for her to grow as a nurse. Using the conflict management technique of collaborating works well to help reduce threats to a health professionals' competency while still opening up opportunities to help them grow professionally (Martin, Wimberley, Keefe, 1994). This approach would have given the nurse trainee an opportunity to grow through the experience without feeling threatened by it.
Using the conflict management technique of smoothing would have also worked well, providing the trainee's supervisor had been trained in this technique and also had a sufficient level of leadership skills to accomplish this. Of all conflict management techniques, smoothing would have been one of the best for this situation, yet also the most difficult to accomplish as well. It would have taken an exceptionally adept nursing supervisor to get the nurse trainee to open up and trust her or him, and share that she really didn't think of change the cardiac history and laboratory data of the patient.

What all of these conflict management techniques revolve around however is trust. The more the nurse trainee is questioned about her competency, the greater the barriers to trust emerge. What an excellent supervisor or nurse manager will do is break down the barriers that lead to lack of trust and get each f other subordinates focused on personal and professional growth (Fuimano, 2005). This is the best long-term investment there is for mitigating conflict in organizations and for also fueling higher levels of professional competency and long-term growth. Yet the nurse trainee's supervisor hasn't had the luxury of time to get this done and establish that foundation of trust. The result is that the nurse loses her temper and immediately retaliates back when her competency is questioned.

Another dimension of conflict resolution is managing nurses to not take critiques of performance so personally. Clearly the nurse trainee did and the conflict quickly escalated. Excellent nurse leaders are teaching their staffs how to manage conflict creatively using assertiveness training techniques (Conant, Kleiner, 1998). The nurse trainee overreacted and showed a lack of emotional maturity that is a must-have in the field. The conflict resolution technique that her supervisor needs to rely on in this instance is concentrating on the win/win of her learning how to control her actions, emotions and temper on the one hand, and the need to continually create credibility and trust throughout the healthcare center on the other. Regardless of what was said, which in this case was just a question regarding the cardiac history and laboratory data of the patient, nurses need to be able to deal with adversity and not overreact. The nursing managing her needs to explain about how these actions, taken together, can and will lead to her being either demoted or potentially let go. Instead of reacting with such force and accusing another of yelling, I would have been better to have gone forward with actions best supporting the patient first. This would have showed maturity and a clear sense of professionalism. Her supervisor could have assisted her in seeing this and asking her to apologize for the outburst that were driven more by taking constructive criticism positively.

Conflict management and successful resolution have a direct impact on the performance of a healthcare provider and the quality of healthcare provided patients as well. This example illustrates how the nurse trainee overreacted and could have seen this as more of a learning opportunity than a personal attack. Her supervisor needed to turn this into a situation where she could learn not only about conflict management, but how to have more self-discipline and self-control. Nursing is a very stressful, challenging profession and self-control and discipline are critical to succeeding in this industry (McElhaney, 1996). This conflict also shows how quickly arguments can escalate, draining healthcare organizations of valuable time and energy. The entire situation underscore the crucial role of supervision and leadership in resolving major conflicts in the nursing profession.

Conclusion

The most costly aspects of conflict is when it is left unchecked and scales rapidly into full-scale retaliation and outright anger. This is disastrous in a healthcare provider's environment where every second needs to be focused on the patients and their treatment. The intent of this analysis is to provide insights into how the conflict of a nurse trainee missing a very fundamental step in…