5

Conflict Negotiator

It is important that the nurse manager remember that not all conflict needs intervention. Welcome the existence of differences in your work setting, especially when creativity and individuality are being encouraged. Often, the presence of conflict can also be a possible indicator of the need for change or problem solving in the department or work area.

As a manager, a proactive, multifaceted management stance is the most effective approach to positive conflict resolution. Successfully handled, it can take the best aspects of conflict and make them work, while minimizing the negative effects. The following areas are recommended for specific management attention according to Paul Decker:

n Staff development. This is a primary area of focus. Staff members should be taught to assume responsibility for openly communicating their feelings and needs in a nonblaming and nonthreatening manner. One successful way to accomplish this is to use "I" statements, instead of "you" or "they" statements.

For example, one might state, "I become uncomfortable when voices are raised and I am unable to focus on what is being said" instead of saying, "When you yell at me you make it hard for me to understand you." Staff members should be encouraged to discuss their issues and concerns directly with each other and not to share those issues and concerns with everybody else. This is both an adult behavior and a common professional courtesy. It may be helpful also to encourage members to validate what they believe is being said before they respond or react because so much conflict is the result of confusion and misunderstanding.

Both passive or withdrawn behavior and aggressive behavior should be addressed soon and often, so that the expectation of professional communication is clear to all. Establishing a trusting environment and modeling these communication behaviors will also facilitate the staff's adoption of them.

n Clear direction. The aspects of a clear direction and unifying vision facilitate a positive environment as well as a collaborative atmosphere. This is especially true if the staff members are incorporated into the planning process, and subsequent goals and objectives are clear and well communicated. Many potential problems and conflicts are avoided when carelessness, responsibility, and expectation boundaries are established and understood.

Clear policies and procedures developed in collaboration with those involved in their implementation help to define roles and responsibilities in a concrete and operational manner for staff. Communication is a critical piece of this process.

n Open communication system. A multidirectional communication provides everyone with an opportunity to know and comment openly about what is going on in the department or organization. This opportunity decreases both misunderstandings, rumors, speculation, and twisted stories. It also allows problem-solving and decision-making with input from those who will be carrying out the decisions in their daily practice. This process avoids many of the problems inherent in making decisions in isolation without full knowledge of critical information.

The decision is more likely to be effective because the problem is more likely to have been clearly identified. This process also increases the staff's individual investment in assuring that the decision is carried out. As a result, there is generally an increased commitment by everyone to a common set of goals. Within this environment, conflict is more readily resolved when it does occur.

n Performance evaluations. The use of performance evaluations also provides the manager with an opportunity to facilitate positive conflict resolution. This is a sequential process. Formal or informal, direct, public feedback at the time a desired behavior occurs should be used to recognize and reinforce the behavior as well as to allow other staff to see an example of what the manager is expecting. Staff members pay attention to those things their managers pay attention to, so they should see these reinforcements fairly often initially and then on an intermittent basis later. Anecdotal records or formal written notes of recognition should also be included in the employees' annual performance appraisal.

Goals should be set for each employee concerning personal responsibility for communication, participation in decision making, and for contribution to the unit or organizational goals. Direct feedback should be provided during their review. New, related goals should then be identified or an action plan developed to assist the employee in meeting the previously established goals. It should be clear to employees that this is not an optional behavior. Additionally, great attention should be paid, formally and publicly, to employees who have used the issues discovered in conflict situations to increase understanding and collaboration within the department or organization.

[Paul Decker. A Micro-Macro Approach for Effective Nurse Executives (East Norwalk, Connecticut: Appleton and Lange Publishers, 1992), 87].

The following tips can help the manager facilitate effective conflict resolution.

    ü The two traits of trust and rationality need to be used.

    ü Know that conflict is inevitable and not all conflict is destructive.

    ü Always work toward helping staff members.

    ü View yourself as a mediator or facilitator, not as a parent.

    ü Let the staff know you will not take sides.

    ü Be objective.

    ü Support harmony and resolution.

    ü Verbalize that staff members need to talk to each other and that you trust them with problem solving skills.

    ü Listen with understanding, not judgment.

    ü Clarify the issues only when necessary.

    ü Do not criticize or deny feelings, such as anger or fear.

    ü Focus on maintaining the relationship between the parties.

    ü Create a problem solving atmosphere.

    ü Offer conference or office space for those trying to resolve disputes and

    ü conflicts.

    ü Be able to identify chronically complaining employees. This is important because such behavior can contribute to a depressing tone for the entire work force or environment.

The "Nice-Guy" Manager

Conflict avoiding managers can cause havoc. A manager who is charming, who appears to "care" about his or her staff, can by his or her manner encourage staff members to share personal varying viewpoints on controversial issues. Such managers, if he or she is a "nice guy," will often seem to agree with each person's differing position. This type of manager also may listen, do favors, act with sensitivity and "niceness." Such managers desperately want to believe that all their niceness will make up for the inability to look someone in the eye and say, "No, I don't agree." They don't know how to deal with the things people say and do when their feelings are hurt.

Take Mary, for example, a new head nurse in the medical surgical department. She charmed everyone and soon several people, including Laura, a new charge nurse, opened up to her. Every staff member left Mary's office believing she was behind him or her. True, she never said she agreed or disagreed, but she listened in a very supportive way.

In reality, she didn't agree at all. She was saying no; but it just sounded like yes. Laura decided to talk to Mary about her mixed signals. Suddenly, the nurse manager with the open-door policy was too busy for a discussion. Somehow the meeting never materialized. Now Laura was left wondering what it was that she did wrong.

Mary is not really avoiding Laura; it's conflict that she's avoiding. What she really needs is some words to say to herself to allow her to tolerate the hurt feelings and anger that "no" often generates, and the motivation to deal with them. Because people have such difficulty dealing with conflict, it is suppressed and discouraged in some organizational cultures. In many work environments, the last thing most people would see in a conflict situation is a real issue that might have some substance, one that requires taking a stand or trying to help get the issue settled.

As conflicts are inevitable in any organization, managers who avoid conflicts and tell everyone what they want to hear often make themselves (and everybody else) miserable. "No problem" management can lead people to believe that they cannot count on you to tell them the truth.

The rewards for dealing directly with conflict come mostly in the form of trust from the people below you. You may not win any popularity contests. Your own organizational culture will have to dictate which is more important: trust or popularity.

The Negotiation Aspect

The health care environment is a stressful environment because of the nature of the work. The complexity of that care requires that many people need to work closely together. Interdependence, particularly when there are limited resources, inevitably leads to conflict.

The manager, as a conflict negotiator, must be able to deal with his or her expression of conflict. The manager must also be able to face underlying disagreements and develop norms in the workplace that promote: (1) the expression of difference with respect and tolerance for alternative positions, and (2) the constructive criticism of ideas without attacking the promoters of those ideas. Armed with strategies to manage conflict successfully, the manager increases his or her effectiveness. A manager who also exhibits observable, positive behaviors can serve as a role model for staff members.

Interpersonal skills are also important to a manager and include a variety of overlapping traits, activities, and attitudes. The successful manager, as a negotiator, is open and supportive of staff members, truly valuing their appropriate behavior as a necessary resource to the unit or department. Constant communication, which is well planned, executed, and validated, combined with real caring and an investment in staff, creates an environment that fosters motivation, retention and success.

The successful use of problem solving also ensures that the feelings and energy generated by conflict are directed toward creative resolution. This approach welcomes the uniqueness of all staff members and is potentially growth enhancing for managers, staff members and teams.

The nurse manager's success in a unionized practice environment or one of collective bargaining may benefit from facilitating a mutual gains negotiation process. This style encompasses innovation, empowerment, a shared sense of purpose and has a basis that is mutually acceptable to all parties, according to Joyce Koerner. In this method, there is no room for an "us" verses "them" approach. If it is successful, it will evolve into a "we" situation. This process is interest based, emphasizing open communication with discussion and understanding of issues from both sides. This mutual gains concept has four stages:

v Basic interests and key issues are analyzed and past problems and possible solutions discussed by staff members, management, and union representatives.

v A training session, which consists of several days, introduces the process of mutual gains negotiations.

v This stage consists of developing interest statements, generating options, and negotiating an agreement. Parties are given an opportunity to openly communicate their goals, issues and priorities as equals, not as adversaries. This process requires active listening skills on behalf of the other party. An example would be for administration to share financial statements with the union, outlining the intensity of the managed care environment and benchmarking the competition within the marketplace. The union could present information on the need for increased staffing, increased resources, and financial compensation.

v This phase is designed for mediation to prevent the breakdown of negotiations, resolve communication problems, and preserve good working relationships.

[Joyce Koerner. Transformational Leadership: The Power of Symbol (New York: Medcom Publishers, Inc., 1996), 189].

With the use of this method, the organization must establish a climate conducive to successful negotiations where suggestions for continued improvement are encouraged and policies, procedures and regulations are defined. The manager creates a new focus on work relationships that emphasize new strategies, new dialogue, and a new understanding of the workplace. It can also enhance day-to-day communications and negotiations that includes involvement of the union board and the staff members in problem solving and decision making on a continuous, ongoing basis.

The Biggest Challenge: The Manipulator

Stressors of change affect staff, managers, and patient services. Destructive behavior, such as manipulation, further disrupts teamwork, and a flow of information within an organization, diverting energy that could be used positively for planning and problem resolution. The ability to understand manipulative behavior and corresponding interventions may assist the nurse manager in personal growth and proactive care in a changing environment. Manipulation does not promote efficient or productive care.

Manipulation is a common behavior shown by staff experiencing stress during change; it is central to disruptive scenarios in the health care arena, and consumes time and energy that would better be expended on achieving positive patient care outcomes. Samuel Flexner has described manipulation as insidious and cunning behavior to attain a personal goal. Destructive manipulation is aimed at fulfilling a personal need, sometimes at the expense of others.

Feelings and needs of colleagues and coworkers may not be considered. The dynamics of manipulation may even impede communication needed to accomplish goals and could lead to an unsafe working environment. Manipulators often use tactics learned in childhood and continue game playing in the adult arena to achieve personal means. Behavior may be covert or overt, and verbal or nonverbal.

[Samual Flexner. Family Work Book: A New Anthology in DictionaryForm (Pleasantville, New York: Bantam Books, 1996) 92].

An example may be a staff member who uses covert behavior when a goal cannot be accomplished through the appropriate chain of command. The staff member than circumvents the immediate supervisor to accomplish what is desired through another who may be in a position of power. Overt manipulation is displayed when a staff member exclaims to the nurse manager in the presence of other staff, "The charge nurse is unfair and I want a reassignment off this floor."

A nonverbal example would be a staff member who receives an unwelcome assignment, glares at the supervisor with arms crossed and is very negative in his or her comments. Extreme manipulation that could result in unsafe staffing occurs when a staff member resigns immediately, in anger, because of having been denied a request for time off.

Collette Deering has categorized manipulators into four types:

v Aggressive.This type of manipulator interacts forcefully and often with an audience. They tend to be angry, punitive, never at fault, and frequently will undermine a supervisor or coworker. Aggressors may confront, then turn on the supervisor in mid sentence, and stalk off. An example might be, "I don't care what the staffing figures show; this nurse is assigned to me and I need her! If my old supervisor was here, she'd do something about this!"

v Docile. Passive manipulators control voice tone, speak quietly, and tend to snipe or tease. With tongue in cheek, a passive manipulator may state, "Oh, I can see you have been busy with all these charts left to finish. You know I never mind picking up the slack." Then while walking away, a docile manipulator may quietly add, "Look, Jeanie, they did it to us again." This type of manipulator may further frustrate by avoiding confrontation and leaving notes on "what must be done" the next day or appear to have heard the assignment, but fail to follow through. Passive or docile manipulators will often "call in" during off hours to avoid speaking directly to the manager.

v Social. This description of a manipulator may function under the guise of team builders. Behavior exhibited might include stating, with a large smile, "I can't help you out right now because I have to order the pizza. Perhaps Joan can do it." A negative tone from the team implies the presence of social manipulation. Another example might be, "Every time I need Nancy to help with care on the unit, she is off on a break. She is the first one to emphasize the need for cohesive unit activity; however, we need her more to help with the patient care." Social manipulation may also be shown by attempts to influence those in positions of power.

v Silent. Body language, which varies in degree and intensity, carries the message of the silent manipulator. A terse, verbal response may reinforce the body language. An example of the silent manipulator attempting to achieve a guilt response may run the gamut of "eye rolling" and sighing to stomping off down the hall in response to direction. Tight, compressed lips characterize the silent type as well as the accompanying sigh, "Of course, I can do everything."

[Colette Deering. Giving and Taking Criticism (New York: Commerce Pub-lishing Company, 1996), 131].

It is important that the manager develop successful counter manipulation strategies to promote staff development and working relationships. Experience, personal growth and a willingness to look at one's self are also helpful traits during this time. A novice manager may be unprepared for a seasoned "sniper." Identifying a mentor and reviewing staff development strategies may assist this manager in developing a menu of approaches for effective, spontaneous responses to the manipulator. Further, the clarification of personal and leadership values become the basis for introspection and can assist the manager in knowing what goals are important when confronted by manipulative staff members.

The manager must recognize manipulative behavior when it occurs and address the event, while remaining calm. Approaches may be general for the group of staff members, or specific to the type of manipulation and the individual. An aggressor must be calmly but assuredly confronted. When aggressive manipulation occurs, it must be quietly squelched and followed through in private. Eye contact, combined with a self-assured verbalization of expectations, is imperative in this case. Another approach may be to say, "Let's discuss this in private," or "This is a matter to discuss in private." An approach to the docile or passive manipulator might be, "Your statement tells me you are upset; let's discuss this further in private."

Social manipulators should be guided through team building. "This is a good idea, Mary, but further discussion now will interfere with care. How about an appointment at 2 p.m. tomorrow to discuss this further?" Another approach to the social manipulator might be, "The team is upset when you are unavailable to help us with the assignments on the B pod, Mary. Now, please assist Sue in Room 10 with Mr. Brown. I will schedule a team meeting later to discuss assignments."

Silent manipulation is best dealt with in private to maintain the dignity of the staff. An example, expressed to a staff member might be, "It is apparent that you are upset. What is it that you would like for me to know?" Body language that is "mirrored" is effective. Expectations of positive messages in the work environment should be clearly stated.

Manipulation never involves just one person. And unit strategies require implementation strategies as well. The manager should have assessed the tone of the unit through staff member statements and direct observation. Staff meetings expose issues underlying manipulation and allow for group resolution. Inform staff members of the purpose of the meeting beforehand, and establish ground rules for open communication.

The manager can allow discussion from staff members regarding the "state of the unit." A nonthreatening technique that can be used is brainstorming. Discuss troublesome behavior and the destructive dynamics. Ask staff members to express concerns. Determine staff members' perspectives. Ask, what would make communication better? The manager should facilitate participation by all staff members and assure respect is shown for everyone. An action plan for improving communication could be developed by the group as well as some team building exercises.

Visibility and openness of the manager will allow the discourse necessary for the evaluation of the plan of action. Timely feedback to both the individuals and to the group will allow improvement in the communication process. Organizational cultures vary, but all are in a state of change. The rapid pace of change may contribute to unproductive behavior. Although change is inevitable and stressful, disruptive and manipulative behavior further affects the tone and morale of the work environment. Understanding the dynamics of manipulative behavior and developing effective responses allow harmony with reduced tension. These strategies many not apply to all settings. Each situation and event is different and unique. Individual staff members need to be understood for who they are, acknowledged in that way, and valued for who they are. There are no "cookbook" resolutions in the workplace.

Ongoing unit assessment is requisite to proactive management through change, as are visibility, active listening, confrontation, participation, and interaction. There is no room for destructive manipulation by staff members' in today's health care climate.

Quick Guide to Self-Defense

As a manager, when you are faced with a conflict in the work environment, you often have three choices. You can stay out of it, attempt to arbitrate it, or participate in it. Leonard Greenhalgh describes the three approaches below:

Staying out

If you want to stay out, you can avoid being sucked into the conflict by taking the following steps:

ü Be available. But do not isolate yourself so that you do not know what is going on in your unit or your organization. Make a point of having times and places for talking with staff members away from the unit, perhaps by having coffee, in turn, with each of the staff members that you interact with. Keep tabs on social sentiment so you will have up-to-date information on feelings.

ü Interact with people outside of your immediate department. This will give you a better perspective on what is really going on in your department, plus additional information! It will also give you a support group, if you ever are "attacked." Consider not only interacting with the "big shots." The "little people" are important too, and if you slight one of them by ignoring him or her, you will have an enemy. Often too, it is the "little people" that have subordinate power in a group or an organization.

ü Allow staff members to express themselves openly without fear of reprisals, but do not be afraid to disagree. Be sincere, but firm. Let staff members know where you, and they, stand on issues. The reputation for being a fair and honest manager is one of the greatest strengths you can have when the chips are down.

ü Cultivate a social climate such that staff members will rush to your support, if someone attacks you. Be open, and above all, be yourself. Do not try to effect a style that does not fit you. Staff members will see right through the disguise, and condemn you for your attempt to deceive.

ü Punish well and reward well. Be fair, but firm. If you do not "have the heart" to punish or discipline someone when necessary, you should consider something other than a managerial position.

ü Tell staff members what is expected of them. Explain what their roles are to be, and what authority and responsibilities they have. Specify what you intend to do if they step out of bounds or what subsequent management techniques will be implemented. Make sure you follow through, if limits are exceeded.

Deciding on involvement

If you are not able to stay out of the conflict, here is what you can do to help you decide exactly how you should be involved.

ü Do not back into a confrontation. Do not be pushed into a defensive position. You make the decision when, where, and how you will intervene.

ü Get information quickly on how the conflict is shaping up, using your information network. Find out whether the conflict is confinable or expanding. How fast is it moving? How mush time do you have before you have to act?

Arbitrating

When you have enough information, you may decide the best course of action is to arbitrate. To accomplish this, you may want to choose one or more of the following options:

ü Negotiate a compromise that will cool down a conflict.

ü Create a balance-of-power situation so that the person pressing the conflict will see that she or he can lose.

ü Remember that any step in the right direction is better than none, if the conflict involves several issues. Resolve the rational issues that you can do something with first, then try to neutralize the irrational issues as best you can. This will sometimes release just enough pressure to get things back to a manageable level.

ü Allow staff members to withdraw gracefully. Remember how important a person's pride is.

Participation

Sometimes you will find yourself backed into a corner. Even though you have done your best, there is no way you can avoid the conflict. At such times, you must defend yourself well. There is nothing noble about giving in to an unscrupulous opponent who is out to get you. You owe it to yourself and your department not to buckle in.

Here are a few guidelines you can use to defend yourself well:

ü Go into the conflict positively. Be psychologically convinced that you are in the right, and have done all you can to avoid the battle.

ü Keep the initiative. Do not fight on your opponent's battleground, unless you are convinced that you will win anyway.

ü Plan all of your moves intelligently. This means weighing all the advantages and disadvantages of all possible moves, and anticipating your opponent's possible reaction.

ü Explain the facts of what is going on to your higher ups or superiors. This will prevent your opponent from attacking you by going over your head to damage their perception of you.

ü Do not take a position that you cannot back away from. The circumstances might change and you may want to choose a different position. Stay flexible. Do not be afraid to retreat if you have to. You may have to handle defeat with dignity.

ü Don't tackle a conflict that you cannot win or tie. If you are faced with such a conflict, discuss it with your superiors or a mentor.

ü If you make an offensive move against your opponent, make sure it will not fail. For example, if you have to fire a nurse, make sure your decision will not be overruled by someone higher, or someone in the human resources department. Otherwise that nurse will spend the rest of his or her nursing career waiting for an opportunity to get back at you.

ü Lose only if it is advantageous, such as for the purpose of getting a stronger position on a bigger problem. Remember the old adage about losing a battle, but winning the war.

ü Finally, remember that you can be destroyed by a ruthless enemy, even if you have always done what is right and fair. If you get into a position where you have to use serious strategy against a very formidable opponent, do not expose your strategies. Set up false moves. Plant rumors to confuse your opponent, but avoid doing anything that will put you in a bad light. Whenever possible, let others administer punishments. Get your allies to commit themselves and put pressure on your opponent to stop attacking you.