Running head: CONFLICT IN NURSING

Conflict in Nursing: A Student Experience

Courtney Fontana, Caitlin Martinez, Paige Nicolosi, & Megan Rocha
California State University, Stanislaus
December 2, 2014
Conflict in Nursing: A Student Experience
Imagine a world where everyone got along. Its almost impossible to do, because
humanity is sensitized to conflict and chaos. Whether it is at home, school, within the
community, or at work, individuals experience some form of conflict in many corners of their
lives (Losa Iglesias & Becerro De Bengoa Vallejo, 2012). Clashes of ideals, knowledge
competitions, and rivalries over differing perspectives can take place in even the noblest of
professions, including nursing. One study of nurses, conducted by Nayeri, Negarandeh,
Barhrani, and Asl (2010), showed that 85% had experienced conflict at one point in their career.
This startling statistic did not stop four students from California State University, Stanislaus from
pursuing their dreams of becoming baccalaureate level nurses. Neither did the conflict that one
of them experienced at Childrens Hospital of Central California.
Conflict Definition & Types

In order to understand the dynamics of a specific conflict, one must first know what
conflict means in general. Conflict is an explicit struggle between two or more interdependent
factions (Wilmot & Hocker, 1978). These parties perceive their goals as incompatible, believe
resources are scarce, and think that others are interfering with their ability to achieve expressed
goals. Conflicts exist whenever incompatible activities occur.
There are a multitude of conflict types and styles. The conflict style relating directly to
differing opinions about the activity or task at hand is known as a substantive conflict (Jehn,
1997). A conflict in interpersonal relations is referred to as an affective conflict. A conflict of
feelings is known as a personality conflict. A conflict of ideas is called a formulation conflict. A
conflict within oneself is known as an intrapersonal conflict (Jehn, 1997). Other styles of
conflict include compromising, competing, avoiding, and accommodating (Losa Iglesias &
Becerro De Bengoa Vallejo, 2012).
Team Conflict Resolution Styles & Importance of Winning
Just as there is diversity in conflict type, there are also many styles of conflict resolution.
Author A tries to avoid negative feelings by using a collaborating style (Adkins, 2006). She
resolves conflict by optimizing the results for all involved. The satisfaction with the end result
by all parties is more important to Author A than winning.
Author B is a bit more competitive than Author A. She is less concerned with breeding
hostility and is more focused on solving the problem quickly (Adkins, 2006). She utilizes a
competing style and an authoritarian approach, so she can redirect her energy back to the initial
goal. Author B only feels fulfilled if she wins.
Author C despises conflict. She avoids it at all costs and utilizes a non-confrontational
approach (Adkins, 2006). Her avoiding style helps to keep conflict from escalating, but many
times leaves problems unresolved. In the end, the unaddressed problems tend to fester and

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Author C is left with a bigger conflict than she started with. As one would assume, winning is
the farthest thing from her mind.
Author D aims to find the middle ground during a conflict (Adkins, 2006). She leans
towards a compromising style and shares the power of decision making with her rivals. Author
D understands that by compromising, she might have to split the difference in the end, and
acknowledges that neither party will be fully satisfied. Winning is only important to her half of
the time.
Common Sources of Conflict Among Nurses
Conflict within healthcare dates back to the early 1900s when hospitals expanded and
doctors and nurses began professionalizing their practices and pursing extensive education
(Arndt, 2009). Nurses, specifically, began to take on a variety of roles within the hospitals.
They became superintendents and administrators, but also cared for patients and supervised
newly established nursing schools. Their roles were overlapping as they were beginning to take
on multiple social identities. Often times, this led to role conflict, which is one of the main
sources of conflicts that nurses still experience today (Arndt, 2009).
According to Brinkert (2010), when nurses have multiple professional roles, conflicts
develop regarding ethical obligations to various parties (p. 147). Nurses are not only expected
to be patient advocates, but are also required to be ethically competent. They are expected to
follow hospital protocols, even if they conflict with a patient or a patients familys wishes. In
addition, nurses experience conflicts with physicians regarding their roles too. Traditionally,
nurses complied with doctors orders without question. In a way, doctors were in charge of the
nurses role by telling them what to do. However, nurses now reject the traditional paradigm of
doctor dominance and nurse deference (Vivar, 2006, p. 201) and have greater decision-making
power, which has caused conflict between nurses and doctors.

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In addition, nurses work, communicate, and collaborate with many other healthcare
workers every day in order to make decisions and provide their patients with the best care
possible. This regular collaboration results in inevitable conflict resulting from differing
perceptions and opinions (Leever et al., 2010). When collaborating, people must communicate
with one another and explore their differing views in order to come to together and find a
solution (Leever et al., 2010). Inability to agree or come to a conclusion causes conflict, which
is likely a result of poor communication and conflict management skills. Moreover, poor
interpersonal relationships between staff members can stem from these poor communication
skills and contribute to a negative work environment. Bullying, or horizontal violence, among
nurses is a common occurrence in the workplace (Brinkert, 2010). Since nurses are often
thought to be gentle and kind, they try to uphold these characteristics and avoid confronting
inappropriate behavior from their colleagues (Brinkert, 2010). This creates a hostile work
environment that contributes to absenteeism and poor patient outcomes (Kelly, 2006).
Conflict among nurses of different generations has also been a long-standing problem
(Murray, 2013). Simple generational differences between nurses can cause conflicts and these
conflicts present a challenge for nurse managers. Currently, four generations are working
together in nursing and this has created the widest age-range of employees. Each generation has
different expectations of their work environment, values, and work ethic. Often times,
generations misunderstand one another or have stereotypes about one another, leading to
assumptions that cause conflict. Older generations may believe that the younger generations lack
respect and professionalism, while younger generations view the older generations as old
fashioned and technologically incompetent. Nurses must take responsibility for fostering a
positive work environment based on mutual respect and understanding, otherwise patient safety
and patient outcomes are at risk (Murray, 2013).

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Conflict Management Methods Used by Nurses

Health care professionals work in stressful positions and difficult environments. This
makes them vulnerable to conflict (Kelly, 2006). Because of this, conflict management is a
crucial aspect in maintaining a positive work environment. However, conflict creates added
stress for nurses and is evidenced as draining energy, reducing focus, and causing discomfort
and hostility (Kelly, 2006). This is why avoidance is the most common method of conflict
management. Avoidance does not confront, or even acknowledge the issues contributing to the
conflict; it postpones the conflict, so that it can be dealt with at a later time. This may be a
successful short-term solution for conflict if a nurse is in a very high stress situation and cannot
deal with the conflict at that moment, but is unsuccessful otherwise. Many stereotypical
expectations of nurses have paved the way for avoidance as a method of conflict management.
Historically, nurses have been perceived as compassionate, warm, and nurturing; they certainly
do not engage in conflict. This stereotype has caused nurses to avoid conflict in an attempt to
uphold this perception. However, this is not effective and just permits conflict and the issues
surrounding the conflict (Kelly, 2006).
Currently, compromising has been the method of conflict management chosen most
frequently by nurses and physicians in the health care workforce (Leever, 2010). Compromising
shows concern for both sides of an issue and leads participants to a solution through negotiation.
It satisfies the needs of both parties through the use of assertiveness and cooperation (Leever,
2010). This is a more effective way for nurses to approach conflict because it allows a
discussion to take place between the parties. Discussions allow people to take into consideration
the experiences of others while avoiding direct confrontation (Leever, 2010). A conflict can be
brought up at a meeting or brought to the attention of a nurse manager. Talking through issues
allows compromise to occur and a solution to be formed.

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A Personal Experience with Conflict

The stress and conflict health care workers experience is heightened for newly graduated
nurses and nursing students, as they often become targets of unwelcoming behaviors (Magnavita
& Heponiemi, 2011). The authors are students of the California State University, Stanislaus
nursing program and during a portion of their schooling, are assigned to travel for a three-day
clinical experience to one of the areas pediatric specialty hospitals (C. Fontana, personal
communication, December 6, 2013).
During this trip, one of the authors and two of her colleagues were assigned to care for
patients on the Oncology floor. They were excited for such an experience because no other
hospital had offered exposure to such rare cases. Upon arrival, the students were instructed to
report to their assigned floors and select a patient to care for during their rotation. As the three
students arrived on the floor, the charge nurse confronted them with a significant amount of
hostility, as she did not feel it was appropriate for more than two students to be assigned to that
particular floor. The students relayed to the nurse that this was the unit they were assigned to by
their clinical coordinator. One of the students further shared that she would be happy to call the
instructor if having the students up there presented a problem. The disgruntled charge nurse
demanded that the students wait in the break room for the instructor, so they were not in
anyones way. The students did as they were asked (C. Fontana, personal communication,
December 6, 2013).
Their instructor spoke with the education coordinator of the hospital and was able to
arrange for one of the students to be moved to a different unit. Although the charge nurses wish
was granted, she continued to be unwelcoming to the students and instructed them to collect their
information away from everyone else. She found the students to be distracting. The author and
her peer appeased the charge nurse and left the unit as soon as they were finished. The following

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day, the charge nurse was not present. Upon hearing what had occurred the previous day, the
other nurses were extremely apologetic and helpful for the remainder of the rotation (C. Fontana,
personal communication, December 6, 2013).
In this instance, the conflict resulted from miscommunication and differing individual
needs of the particular unit and clinical coordinators, which are two of the most common sources
of workplace conflict (Fight or flight?, 2013). The strategies used to resolve the professional
conflict experienced by the author, her peers, and clinical instructor, were accommodating
because they rearranged placements, and later avoidance, because they stayed out of the nurses
way while obtaining information needed for patient care.

Professional Versus Personal Conflict Resolution

Conflict, like in the example above, is the result of differences between opinions, goals,
ideas, behaviors, needs, or attitudes, and is as certain to occur as death, and taxes, at some point
in any personal or professional relationship (Okafor & Osakinle, 2014). The manner by which a
conflict is resolved impacts whether the conflict was positive, and used as a growing experience,
or negative, forming a grudge or barrier between those involved. In personal relationships,
conflict is often a result of poor communication (Okafor & Osakinle, 2014). For this reason,
effective communication is essential to correct misunderstandings and resolve conflicts.
Collaboration is the best solution for personal conflict, as it encompasses a willingness of
the parties involved to learn from, give to, and trust each other (Eliason, 2014). Professional
relationships are generally more casual and involve less emotional investment, thus the causes of
conflict are slightly different. Professional conflict generally results from unclear information,
scarce resources, differing procedures, assumptions, differing perceptions, individual desires,

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goals, and differing communication styles (Fight or Flight?, 2013). While the cause of conflict
is different in personal and professional relationships, research shows that being a collaborator in
the professional sphere is usually the most positive option (Fight or Flight?, 2013). It seems
that no matter the conflict, collaboration is the best resolution strategy.
Ways to Resolve Conflict
If conflicts in the workplace are ignored, or handled in an inappropriate manor, many
negative repercussions can develop (Losa Iglesias & Becerro De Bengoa Vallejo, 2012). For
example, if unacceptable behaviors in the workplace persist, there can be a decrease in employee
morale, an increase in employee turnover rates, and even an increase in lawsuits against the
hospital for allowing a harmful work environment. Many people have different ways in which
they define conflict (Taylor, 2014). As a result, conflicts can be difficult to resolve. According
to Losa Iglesias and Becerro De Bengoa Vallejo (2012), there are four common ways in which
nurses resolve conflict in both the academic and clinical settings: they compromise with each
other, compete against each other, entirely avoid the situation, or accommodate the person
causing the conflict. If conflicts can be resolved in an appropriate and timely manor, there will
be an increase in work place effectiveness, and trust and openness between peers (Kelly, 2006).
As stated above, the author and her peers chose to use accommodation to solve the
conflict they were presented with during one of their clinical rotations. This was a rare choice
because many nurses try to avoid new conflicts with the hopes of strengthening peer
relationships and preventing further escalation of the conflict at hand (Kelly, 2006). However,
this is not always a wise choice, for constantly taking on a passive role can promote low morale
between employees and can have negative effects on patient care. Instead, Kelly (2006) suggests
that one should approach a similar situation with an assertive behavior because being confident
and self-assured allows a nurse to express his or her honest feelings about a situation in a direct,

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straightforward manor. This type of behavior promotes better communication between peers,
which will in turn increase the effectiveness of patient care (Kelly, 2006).
An Assertive Approach to Resolving Conflict
If the author and her peers had decided to use an assertive approach to solve the abovementioned conflict, instead of an accommodating approach, they would have suggested to the
charge nurse that her negativity towards them was interrupting their learning experience. These
students would have demanded that they be allowed to remain on the Oncology floor because
that was the floor that had previously been assigned to them, by their instructor. The author and
her peers would have acted in this way, because they would have truly believed that their
learning was being affected in a negative manner. Unfortunately, because the author and her
peers are students, this type of behavior would not have been well received by the charge nurse
on duty. Instead, it would have been appropriate for the student nurses to explain to the charge
nurse why they wanted to be placed on the Oncology floor, and how it would benefit their
learning experience. By doing so, the author and her peers would have still been assertive, but in
a more appropriate and forthcoming way.
Ways to Improve Team Conflict Resolution Styles
Authors A, B, C, and D, all have different ways in which they choose to resolve conflict.
When comparing these different resolution styles, it is obvious that Author B depicts more
assertive qualities, than Authors A, C, and D, because she uses authoritative techniques and is
concerned with finding prompt resolutions. As stated above, being assertive is the best way to
resolve conflict (Kelly, 2006). As a result, it is the authors goal to improve their resolution
styles to fit this idea.
To become more assertive, the authors propose that Author A needs to be more focused
on winning. It is suggested, that Author A stand behind her personal opinions, and beliefs, when

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faced with conflict, instead of focusing on pleasing all persons involved. In doing so, Author A
may make enemies, but she will find satisfaction in the success of her character.
Next, the authors recommend that Author C face conflicts head on, instead of being
intimidated by them. If Author C is less passive, she will decrease the chance of conflicts going
unresolved, and will in turn be pleased with the resolution of conflicts. Finally, the authors
advise that, in order for Author D to become more assertive, she needs to focus on choosing a
side when faced with conflict. If Author D can achieve this, she will have an opinion to fight for,
and a belief to stand behind.
Despite the difficulty of it all, finding a personalized and individual approach to conflict
management is vital for everyone. Clashes of ideals, competitions about knowledge, and
rivalries over differing perspectives can take place in many aspects of life, including the
professional arena. This is extremely important because it will help nursing staff avoid excess
stress, steer clear of problematic situations, and increase overall morale. Furthermore, it is
imperative for nurses to find and maintain an effective conflict resolution style, so that they are
able to follow hospital policy and procedure, deliver efficient nursing care, and above all else,
keep their patients safe.

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