8

Regardless of how you manage conflict, there are some practical issues that you should be aware of and tips you should use to become more effective at defusing conflict situations. Remember, also, to be aware of your behavior and speech and their effect on the behavior of the other person during a potential conflict.

Strategies That Work

ü Acknowledge the objection. Many conflicts can be defused if you just acknowledge the objection or problem of the other person. This does not require "giving in." It just assures the other party that you understand the other point of view.

ü Try the feel-felt-found method. Try defusing the conflict by saying, "I can see why you feel that way; other staff members have felt the same way in the past, but many of them have found that our approach addresses their concerns in the long run."

ü Apologize. Even if the other party is primarily at fault, try apologizing for your share of the problem. If staff members feel they have been "wronged," there is little you can do to neutralize the conflict until you apologize.

ü Agree whenever you can. Look for areas to agree. Don't concede your point, but focus attention on areas where you may already agree.

ü Know your hot buttons. We all have emotional "hot buttons" that set us off during a conflict. They may be subtle comments that we perceive as insults or challenges. Being aware of your hot buttons will help you stay in control when someone accidentally or purposely says something that triggers an emotional response. If you know that someone strategically uses hot buttons to annoy or aggravate, you may be able to prepare yourself psychologically to handle the situation without losing your cool.

ü Go slowly. Remember that you don't have to resolve all aspects of the conflict immediately. Break the problem into smaller chunks.

ü Pause and say nothing. You can use silence. Use it to allow the situation to settle and buy time to think.

ü Use calming and nonverbal behaviors. If your goal is to neutralize the conflict, you should use your nonverbal behavior to help the other staff member relax. Begin by gradually slowing and calming your posture, gestures, and the other party will calm down as well.

ü Use a calm voice. A calm voice will help keep you and the other party calm. Take a few deep breaths before you start so you can compose yourself and relax a little.

ü Keep an eye contact. Maintaining normal eye contact will hold your "connection" with the other person.

ü Call time out. If the situation gets too tense, call a time out. Basketball coaches do it just to change momentum. You can use the same strategy in conflict situations.

Listening Skills

A major part of good communication and resolving conflict is effective listening. It is important to remember that listening is an active process. It involves focusing, questioning, validating, and processing the information gained. Most people have neither the training nor the natural ability to listen adequately. Listening is a skill that needs to be developed.

For the staff nurse or supervisor, he or she needs to listen to what information is important in a conflict and how to obtain details and do follow-ups, if necessary.

Listed below are some attitudes that are necessary in the listening process:

„ Caring or concern. As a team player, even during a conflict, it is important to be interested and concerned with others and how they feel. The individual who pretends to listen will not fool others for long and eventually create feelings of mistrust and stress.

„ Assumption of worth. The effective listener assumes the other person is of worth. This assumes humans given a proper climate are good. The active listener assumes goodness is in the other person.

„ Acceptance. This quality divides the true listener from the poor listener. Some individuals think they have the right values and cannot accept anyone with a different set of values. In today's environment, it is essential to realize that human beings are unique and have their strengths and individual differences.

„ Empathy. In resolving conflict situations, the possession of empathy gives the individual the ability to see the world as others see it. It is the assumption that everyone has different experiences, feelings and emotions, and perceives situations differently.

„ Desire to learn from others. Wanting to learn from everyone you meet assumes that everyone you meet has something to offer. With this attitude, life is a continuing experience and conflict becomes easier to resolve.

Negotiations

Resolution of complicated conflicting issues in nursing arenas provides an optimal setting for colleagues, physicians, and administrators to use the skill of negotiation. John Kelly describes negotiation as a collaborative human process designed to achieve a mutually satisfying agreement in which all parties leave feeling they have gained something. During a conflict situation, the most successful negotiations are those resulting in a win/win outcome for all parties. In this scenario, mutual satisfaction of need and harmonious efforts of both parties work together to build trust among the parties.

[John Kelly, "Negotiating Skills for the Nursing Supervisor," Nursing Clinics of North America, 1994; 18: 427].

Roy Fisher and Robert Ury suggest that principled negotiation may be the most advantageous model to use. However, considering the potential for a "power play," the opposing parties must be willing to use this idea, otherwise the process becomes competitive. The principled negotiation framework for issue resolution has several characteristics that produce a win/win for both parties.

The focus of principled negotiation addresses mutual gains for each party rather than bargaining about discrepancies between opposing sides. Thus, the principled negotiation emphasizes building a foundation for future successful negotiations.

Principled negotiation addresses the following four principles: (1) people, (2) interests, (3) options, (4) criteria. Each of these is explored separately below:

ü Separate the people from the problem. Avoid placing blame. Assessment of blame may be particularly counterproductive to the negotiation effort. Stay focused and keep the emphasis on the issue resolution, not who "caused" the problem. Use the opponent of negotiation as a resource, rather than a cause. Try to envision the issue from your opponent's viewpoint.

ü Focus on interests, not positions. Rather than focusing the negotiation on two opposing positions, focus the interests of each side while analyzing the problem. Explore options for meeting the needs of all individuals.

ü Generate multiple possibilities before making a decision. Remember that there is no single answer to a problem. Therefore, both sides at the negotiation table must assist the process by formulating numerous possible alternatives. Decide which options are the most realistic and appropriate.

ü Maintain that the results be based on some objective standard. The proposed agreement should be based or measured using a variety of standards suggested by the negotiators. These standards could be viewed as process- or outcome-oriented. Some of the standards might be the benefits and constraints for both parties, the maximum supportive position and the least acceptable result. The maximum supportive position is the most that one can ask within reason, given the available resources. The least acceptable result is usually one's "bottom line."

[Roy Fisher and William Ury. Getting to Yes (Boston, Massachusetts: Houghton Muffin Publishers, 1981) 87].

During the negotiating process, several points may be beneficial in delineating the limits:

„ How important is the issue?

„ How important is the issue to your opponent?

„ What is the specific issue of the negotiation?

„ What will you do if an agreement is not reached?

„ What will your negotiating opponent do if an agreement is not reached?

The overall goal of principled negotiation is to achieve a wise agreement based on joint decision making. The principled negotiation model, developed by Roy Fisher and William Ury, divides the negotiation period into three stages that include analysis, planning, and discussion. Evaluation occurs at each step in the process and consists of referring to the overall goal. The three stages are:

¶ Analysis stage. Data are gathered, preferably based on appropriate inquiry. A fact-finding expedition to ascertain possible assumptions inherent to the process and supportive documentation of the "facts" in the case is essential for adequate analysis. Your interests, as well as those of your opponent, are considered. The key to this stage in the process is dealing with hostile emotions. It is equally important to remember that placing blame is essentially irrelevant and counterproductive to achieving one's goal.

¶ Planning stage. This stage deals with the same four elements of principled negotiation, i.e., people, interests, options, and criteria. During this stage, ways to manage unclear communications and deal with difficult personalities may be generated. This is also a time to prepare objectives and decide which interests of both parties are most important. Options for resolution are brainstormed and a criterion for evaluation is determined.

¶ Open discussion. It is helpful to begin this stage with a confident and positive attitude. A calm and deliberate approach may be instrumental. At this point in the negotiation process, both parties have an opportunity to identify common issues and explore numerous alternatives. Providing the disadvantages of one's proposal and suggestions for how such deterrents may be resolved, may also be helpful. Asking questions and clarifying issues on both sides is vital. Finally, each side seeks an agreement and evaluates the process.

Avoiding breakdowns in negotiations may be facilitated by an understanding of the characteristics of particular styles of individual negotiators. Thomas Warschaw identified six different negotiation styles as described below:

„ Win/win. Negotiators possess assets, such as the ability to be objective, nonjudgmental, open, and sensitive. Ideally, this negotiation style has no liabilities.

„ Competitive. This approach can be characterized by the "jungle fighters." Also known to be very creative, attentive and perceptive. However, liabilities of individuals with this style of negotiation may include aggressiveness, trustworthiness, and disloyalty.

„ Dictator approach. These individuals are noted as being aggressive, organized, and analytically efficient. They can also be very rigid, opinionated and obsessive.

„ Silhouette style. These individuals appear motivated, competent, discrete and trustworthy. Yet they may also be described as evasive, private and uncommunicative.

„ "Big Mamma/Big Daddy" style. This group appears caring, nurturing and calm. Liabilities include: manipulation and passive-aggressive behavior.

„ Soother approach. Appearing appreciative, helpful and gracious are characteristics of this group. Liabilities involve indecisiveness and evasiveness.

[Thomas Warchaw. Winning by Negotiation (New York: McGraw Hill Publishers, 1992) 80].

The opportunity to understand and become aware of different styles and approaches should prepare the health care worker with a better opportunity to anticipate counter responses.

Depending on the environment of the negotiation, staff members may use various strategies and tactics to facilitate the proceedings. No matter how successful the negotiation process may be between two parties, elements of conflict or potential barriers are likely to surface.

Perhaps the greatest barrier to any communication process is poor communication. This obstacle may be most easily avoided by adequate preparation, planning and organization. Another powerful tool for maintaining clear communication during deliberations is the use of questioning. The process of questioning encourages clarification. In addition, questions may serve to call a particular matter into attention and start the opponent thinking. Information may also be obtained or provided by questioning.

Maintaining an open style of communication may become difficult, especially when emotions rise and conflict exists. Stress is at an all-time high, with defensiveness and intimidation a possibility.

Selective listening, using loaded words and hidden messages or agendas also serve as barriers in the negotiation process. Although not always easy, remaining calm and self-assured and assertive rather than apologetic also facilitates the process successfully.

Strategies to further enhance the communication process include:

ü Be prepared. A successful negotiator is certain to have facts at hand. The worst time to learn new facts are when the negotiation is in progress. Never allow your opponent to be your only source of information.

ü Maintain focus on factual statements generated through appropriate inquiry and questioning.

ü Maintain a cooperative, rather than a competitive climate.

ü Pay particular attention to nonverbal communication.

ü You do not have to respond to statements you are not adequately prepared for. Rather, suggest they be discussed later.

ü Refrain from focusing on the personalities. Remain centered on the issues at hand.

ü Understand all your options. It may be time to change your approach or involve a resource person.

ü Use silence. Most people hate silence. Use this time to give yourself the information needed to move ahead.

ü Recognize the real agenda. Find out what the other person wants, even if it isn't put into words. Make it a win/win situation.

Once the negotiation has been completed, it is important to implement an evaluation process to promote a positive outcome. The following are five questions relevant to consider:

„ Did both parties communicate effectively?

„ Were questions used?

„ Were listening skills used effectively?

„ Did both parties react calmly to the deliberations, rather than attack the opposing parties' position?

„ Were a variety of options generated?

As a contrast, either/or solution generation, anxiety producing questioning, and escalating emotions may be used as a standard to judge a negotiation as a negative experience. Let's take a look at the following case study as an example of a positive negotiation, using the strategies of principled negotiation.

Case Study

Jan is a highly skilled ICU nurse who has extensive experience working with the postoperative cardiovascular patients. Jan has recently returned to school to complete her bachelor's degree and is the mother of two boys. Most of her evenings and weekends are spent playing "catch up" with school work, tending to home responsibilities and taking care of her sons.

For the past 8 years, Jan has been employed at the Regional Medical Center. Recently, the ICU supervisor met with the staff members to discuss changes in future scheduling. One of the changes to be implemented involved the staff members taking call for the unit every other weekend. Presently Jan works the day shift during the week with no call or weekend responsibilities. Jan decides she will have to seek employment elsewhere because these changes conflict with her current personal obligations, involving school and home.

Additionally, Jan is angry because she feels that her loyalty to the institution has been overlooked and that the proposed changes are too "rigid." Jan schedules a meeting with the supervisor to "vent" her feelings. At the meeting, the supervisor is surprised that such a change would influence Jan to resign her position. Therefore, the supervisor asks Jan to brainstorm some ideas and to return for a negotiation meeting next week. Jan agrees.

Discussion

Using the concept of principled negotiation, Jan begins to analyze the issue, using the four elements of people, interests, options and criteria. After several days she is less angry because she finds out that staffing mandates have come from the top executive level hospital administrators.

Nevertheless, she attempts to analyze the issue without placing blame. Jan considers another place of employment, but expects that she will not be able to work the day shift, at least initially. She also becomes aware that the supervisor must take steps to tighten staffing requirements, without adding additional staff members.

Following the analysis stage, Jan begins preparing for her negotiation meeting. Again, Jan returns to the analysis of the four elements of principled negotiation as a guide. The perceived "people problem" between Jan and her supervisor is recognized as only a perception. Trying to understand, Jan lists the interests of both the supervisor and herself. Then Jan brainstorms several options, including a "seniority exemption," hiring weekend personnel for call, and more slowly integrating the proposed change over the next 2 years.

After extensive analysis and preparation, Jan meets with the supervisor for the discussion stage of the negotiation. Jan uses numerous strategies during her presentation, including being confident and self-assured, actively listening, and asking questions. After presenting the supervisor with her findings and posing alternatives, Jan gives the supervisor an opportunity to present her views regarding the issue.

Communication between the two parties remains free and open. Collectively, both Jan and the supervisor formulate additional ideas that neither had brought to the negotiation table. By the end of the negotiation meeting, Jan and her supervisor had agreed that rotating call on a fixed schedule would meet both their needs. In this way, Jan would only take call one weekend each month and the supervisor would have all shifts covered without additional expenditures.

Evaluation of the negotiation showed that the process had definitely been positive. Each opponent communicated effectively and asked questions. The focus of the negotiation remained on the issue rather than personalities. In addition, a variety of plausible solutions were generated before each party reached agreement.

Numerous opportunities to cooperate with others for the good of the organization is possible with the strategies of negotiation. In today's climate of constant change, acquiring negotiation skills provides great potential for issue resolution among staff members.

Problem Ownership

Who owns the problem that produced the conflict? Is it you? Is it the other staff member or person? Maybe even the organization? It's important to determine the responsibility for the source of the conflict. Review the following dialogue:

Staff member: You don't seen to appreciate me because you haven't noticed that my work has improved.

Manager: You think it's important that I recognize your improvement and you feel disappointed because I haven't mentioned it.

In this example, the manager can assign ownership by either accepting responsibility if he or she has been remiss in encouraging the staff member, or remind the staff member that something was mentioned to him or her earlier that week about the positive work effort. Trying to remain rational when tense will help in determining ownership.

Often, when conflict is encountered, the usual response is to get defensive or accept too much of the responsibility for the problem. Neither is productive. It is more productive to attack the problem, not the person or staff member, even if they are irate or unreasonable. Try to focus on the core issue behind the emotion and address the issues. The staff member may feel neglected and expresses a need for more frequent feedback or attention. He or she may also be expressing an immature need for approval from authority.

"I messages"

The key to using "I messages" is to take responsibility, or "own" your feelings, reactions, or behaviors. "I messages" give information about you, they do not include judgments of others. In contrast, "you messages" usually put the other person on the defensive. "I messages" are perhaps most important to use when we are experiencing uncomfortable feelings we would rather ignore or get rid of. It is important to own all of our feelings, not just the happy, positive ones.

Using "I messages" helps keep communication open. They are often more difficult to use, because giving an "I message" forces you to be more open and vulnerable. However, using "I messages" also increases your sense of personal power and control. Not only do "you messages" often put the other person receiving the message on the defensive, but they can also reinforce feelings of helplessness in the person sending the message. Let's take a look at the communication exercise below:

Person A says:

I feel___________(feeling) about_____________(situation). And in order to help me _____________(your goal), I would like you to ______________________ (behavioral request.)

Person B says:

I understand_________________(what you think you heard the speaker say), and in the future I will___________________(state what you are willing to do).

Dealing With Anger

Anger. The very word makes us pause. Yet to be human is to know anger. Anger helps us defend our rights, in the workplace and in society. For all the positive aspects of anger, there are also destructive forms it can take, from physical and emotional violence to depression and illness.

Everyone gets angry, it's how you deal with it that matters. Irate nurses, doctors, pharmacists, social workers, patients and their families can all make us angry now and then. Angry individuals are a fact of life, although we wish we did not have to face them.

No matter how diligently we conduct our business, there are those who feel that they did not get what was promised, or the care or service they needed. When complaints and anger do arise, the issue of who is to blame should not be the major focus. What is really needed is a solution to the problem to cause patient, nurse or physician satisfaction.

Individuals go through distinct stages before anger strikes, and those phases are fairly easy to identify.

Disappointment is often voiced through such phrases as "perhaps you are not aware" or "maybe your department did not get the notice." Effective handling can usually solve the problem. Realize this is a signal, and take the problem seriously.  Seek a solution.

Frustration is often the next stage, and the shrill voice is often a clue. Anger is building. Do everything possible to head off the fury that may follow.

Anger is the third stage of this pattern, and at this point, the patient, doctor, pharmacist or nurse, is out of control.

First, hear the problem through, and avoid the impersonal approach. For example, you may need to help the family member fill out several forms about the patient, but take a minute first and let them know that you plan to help and are empathetic. Then help them get the requested information after explaining that it will be needed and why.

Let the angry person blow off steam. Like the hot air balloon, anger can only stay afloat as long as there is heat. After the pressure is released, you will be better able to handle the situation.

When dealing with angry people, it is important to use the conflict formula for angry people, as described by Elizabeth Kearney:

Conflict formula for angry people

ü Keep an open mind.

ü Listen to the problem.

ü Stay in the adult mode.

ü Gather the needed information.

ü Let others "vent" their frustrations.

ü Determine the "real" source of the conflict.

ü Evaluate the outcome to all concerned.

ü Remain objective and calm.

[Elizabeth Kearney. Everyone is a Customer (Los Angeles, California: Sterling Press Publishers, 1990) 75].

Another approach in dealing with anger in the workplace is to learn how to transform anger from a weapon that wounds not only yourself, but others, to a tool that promotes understanding and healthy change in relationships. Some of those tools are as follows:

n Identify the four constructive expressions of anger:

„ to communicate feelings of hurt,

„ to change the hurtful situation,

„ to prevent recurrence of the same hurt and

„ to improve the relationship and increase communication.

While many people may express anger in the four mentioned ways, they do not always adhere to the goals and display the following:

Passive anger. A situation where the individual does not admit to anger in the first place. They act like martyrs, breeding guilt in those around them. "Oh, don't worry about me," or "I'll take the double shift again."

Aggressive anger. A type of anger that can be physical, such as hitting, slamming doors, throwing things or being sarcastic.

Passive-aggressive anger. This description of anger looks passive on the surface but is, in fact, very aggressive. Often expressed in hidden, underhanded ways, passive-aggressive anger causes hurt and humiliation. In the work arena an example of passive-aggressive anger could be chronic lateness or having a feeling of "I'll get you," when dealing with a colleague that the individual thinks has wronged him or her.

Indirect anger. This type of anger can be expressed through avoiding responsibility. A very common form of indirect anger is the use of "triangles." Instead of leveling with the person the individual is angry at, the individual talks to a third party instead. Another description would be "A" talking to "B" about "C" instead of "A" going directly to "C." At their worst, triangles pull in other members of the work team, often unsuspectingly.

n Express your anger assertively. When anger is expressed assertively, the issues are stated clearly and firmly, without attacking the other person. Assertive anger sets limits and expresses needs, using, "I" rather than "you" statements. This type of expression is a method that communicates needs and feelings without violating the integrity of others.

n Clarify the real issue. Finding out what your anger is really about requires digging. One way to do that is to stop, take a deep breath, and ask yourself, "What am I thinking and feeling?" "What about this situation that makes me angry?" "What am I really angry about?"

n Give yourself time. Slow down. In the midst of anger, we often speak impulsively. Everything seems very urgent. Yet very few situations demand a decision or a resolution this moment unless, of course, it is a safety issue having to do with a patient. Slowing down helps to disengage and stay calm. Remaining calm, while continuing to assert your needs, is more likely to cause long-term change.

n Practice detachment. Detachment doesn't mean being cold or unfeeling, but rather recognizing that you and the person you're angry with are two separate individuals entitled to different feelings and needs. The more you remember this, the easier it will be to remain calm and maintain respect for the other person.

n Keep information flowing. In conflict resolution situations, some individuals tend to shut down. Withdrawing, pretending nothing is wrong, walking out of the room, or using the "silent treatment" are scenarios where the amount of information exchanged decreases or disappears altogether. Unfortunately, shutting down or leaving the scene only escalates the anger. If possible, agree to stay open and continue to engage.

If it appears that the anger is intensifying, you can jointly call time out, but agree on a time when you will return to the topic. Another way to keep information flowing when tension is high is to communicate feelings on paper, rather than in person.

As people, styles of anger and reactions to it will vary. Some resolve anger through a noisy, energetic argument. Others resolve it through a calm and thoughtful discussion. Not enough of us, probably, resolve anger through humor or a gentle laughter.

Successful negotiators can deal with angry people. It is also important to realize that you may need to let go of anger you can't control. Trying to change another person or circumstances over which you have no control leaves you frustrated and with reduced energy to exercise the power you do have.

Team Building

Team building activities become an important strategy in becoming not only the natural building blocks of organizational growth but also in developing problem solving skills and partnering with others to resolve conflict. As team members develop, feel ownership and see how they make a difference, the communication and decision making priorities will evolve. Trust among team members will allow them to honor commitments, maintain confidences and support one another.

Involvement by team members will assist in consensus building and motivation to seek mediation, collaboration and compromise in conflict management. In the development of teams, the team members need to have the abilities and attributes as outlined below:

ü Team members must have specific knowledge of the team building process.

ü Team members must understand the organization's vision, direction and competitive position.

ü Team members must be creative.

ü Team members must be adaptable.

ü Team members must be able to assimilate new ideas, responsibilities and roles.

ü Team members must be able to assess the rationale and value of a good work ethic.

ü Team members must be able to enjoy a challenge.

ü Team members must have high energy.

ü Team members must be able to function and contribute under pressure.

ü Team members must be willing to involve themselves in the change process.

Developing a "Positive Conflict Attitude"

Attitude. No other word can be more effective as a conflict reducing strategy than developing a positive attitude about resolving conflict. According to Michelle Polley, attitude is defined as the filter through which an individual sees the world. The conversations, issues and events become the perceptions and our attitude is the filter that colors those perceptions.

Have you ever known someone who is almost happy, confident and does not seem to be in the middle of a conflict situation? Someone who, even in the face of adversity, is able to find the positive aspects of the situation? The answer is obvious_ they have a positive attitude.

But a positive attitude is not something we are born with. Incidentally, neither are we born with a negative attitude. The development of an individual's attitude takes time and input. Indeed, for most of us, our attitude is a habit that we've developed over the years.

Attitudes definitely have outcomes, when it comes to conflict resolution and management. If you think it can be resolved and you focus on the positive, it will heighten your perception and ability to look at options and strategies to resolve conflict.

Developing a "positive conflict attitude" includes the following steps:

ü Make a conscious decision to change your attitude.

ü Determine which areas of your attitude need attention (attitude assessment).

ü Get rid of people around you with a negative influence.

ü Visualize a positive outcome.

ü Stating a positive affirmation (results oriented statement).

ü Be open to new explanations, experiences and rationale in conflict resolution.

[Michelle Polley. A Winning Attitude: How to Develop Your Most Important Asset (Mission, Kansas: SkillPath Publications, 1996) 142].

Dealing With Verbal Abuse

The following scenario describes a question and answer situation of verbal abuse with a surgeon, in an operating room setting, as reported by Dorothy Fogg. The strategies explored and discussed could be applied to any clinical setting.

Question: We have a surgeon in our operating room with whom it is very difficult to work. He constantly puts nurses down, calls them "stupid" and threatens to have them fired. He is sarcastic to the operating room staff members, especially the females, whom he calls "girls" or "chicks." What can be done about this type of behavior?

Answer: The best thing to do about a surgeon's abusive behavior is to confront the surgeon at the time the abuse occurs. This does not mean, however, that you should interrupt the surgical procedure. Immediately after the patient is out of the operating room, confront the surgeon and let him/her know that the displayed behavior was unacceptable and that you will not tolerate it. Tell the surgeon how the abusive behavior makes you feel. Offer a comment, such as:

When you berate me as you did during the surgical procedure, I feel very uncomfortable and distracted. This interferes with my ability to provide you the assistance you deserve.

Inform the surgeon that you will confront him/her immediately should another incidence of abusive behavior occur. Also inform your supervisor or immediate boss of the surgeon's behavior, your confrontation with the surgeon after the surgical procedure, and your plan for continued confrontation. If the surgeon's abusive behavior occurs again, continue to confront this behavior each time it occurs.

Consistency is essential. In addition, a formal complaint should be filed with the medical staff committee through appropriate channels in your facility or organization. Finally, if this does not stop the abusive behavior, as a last resort, you can press charges for slander and/or sexual harassment, if there are sexual overtones to the abuse.

In the meantime, set up a plan with other staff members and nurse managers in your department. Make them aware of each occassion you work with the particular surgeon, and if the surgeon becomes abusive, call a "Code Pink"(or similar word) for your room. When a "Code Pink" is called, all available operating room staff members should come into the room, look at the surgeon, and quietly stand with the person to whom the abuse was directed to defuse the intensity of the behavior.

After the surgeon realizes what is happening, he most likely will feel foolish and stop his/her abusive behavior. It is important that all available staff members participate in the plan.

The more people who gather, the greater the impact. If the surgeon asks you what is happening, tell him/her that you have assembled staff members for their support against the unwarranted verbal abuse. When the surgeon stops the abusive behavior, the support group should leave the room quietly. If the surgeon resumes his/her abusive behavior, call the code again and repeat the process. When the patient is out of the operating room, the abused staff member must confront the surgeon again.

[Dorothy Fogg, "Abusive Behaviors in the OR," Journal of the Association of Operating Room Nurses 1997; 3(77): 509].

Strategies That Don't Work

In resolving conflict there are some strategies that are guaranteed to fail and some strategies that probably won't work. James McCoy describes the types below.

Guaranteed to fail:

Deny the problem. Most of us will unconsciously deny the existence of a problem for as long as we can get away with it. Unfortunately, a denied problem can quickly develop into a conflict. Denial only allows the conflict to build more steam before it inevitably blows up in your face.

Ignore the problem. This is a worse strategy than denial. At least denial is unconscious. People who consciously ignore a problem are asking for a conflict.

Blame something or somebody else. This is often a tempting strategy for dealing with conflict, but in the long run it just doesn't work. Casting blame might temporarily deflect or postpone a conflict, but it won't resolve it. This strategy will also earn you a nomination for the least valuable player award in your organization.

Blame yourself. Blaming yourself may be appropriate, but it won't necessarily resolve the conflict. Some people are willing to accept blame as a preferred alternative to changing their behavior.

Five don'ts during conflict:

    Ò Don't get into a power struggle.

    Ò Don't become detached from conflict.

       Ò Don't let conflict establish your agenda.

    Ò Don't be caught awfulizing.

    Ò Don't be fooled by criticism.

Constructive conflict resolution has the ability to:

     Build winners.

     Declare a moratorium.

     Encourage equal partnership.

     Encourage active listening.

     Separate fact from opinion.

     Separate people from problems.

     Divide and conquer.

[James McCoy. Conflict and More Conflict (San Francisco: Bell and Sons Publishers 1996) 129].

Other strategies that probably won't work:

    q Criticize a participant in front of others.

    q Be critical of your opponent's other relationships.

    q Attack your opponent's motives.

    q Express doubts about your opponent's emotional well-being.

    q Attribute the divergent view of your opponent to personality or personal factors.

    q Talk about another participant behind his or her back.

    q Break confidences.