Conflict Transformation – A Nurse Managers Experience Dealing With Confrontational Situations

Seven years ago I would describe myself as being the type of person who always steered clear of confrontational situations and conflict with other people. As a child I was bullied at school because I was overweight, so became a shy quiet child who didn’t mix with other children and kept myself to myself. In my teenage years I lost my weight and with that loss grew confidence in my looks and in my personality. By the time I qualified as a nurse I was a confident individual who still disliked confrontational situations and I would try anything rather than find myself in a heated conversation or situation.

In 2000 I joined Wirral Hospital NHS Trust as a Hospital Clinical Co-ordinator who was responsible for the out of hours site management of the trust. I was soon to find out that confrontational situations that would bring about conflict on nearly every shift would become part of my everyday life. Conflict is the interaction of interdependent people who perceive incompatible goals and interface from each other in achieving those goals. Folger et al (1997). The following assignment will focus on events that have taken place in my earlier career and how I have developed and channelled my experiences recognising the need for change in my thoughts and behaviour.

On commencement of the role of Hospital Co-ordinator I was overwhelmed when observing the other Co-ordinators in practice. I was initially to be mentored by my colleagues for eight weeks to allow myself to see how the role operates and the decision process required when making decisions when moving staff, sorting out beds for patients and dealing with any crisis situation that came your way. I recall thinking that I had made a huge mistake undertaking the role especially when I could see colleagues having to argue and take authority over situations involving staff and at times the general public. I tried to follow my colleague’s way of handling situations but then realised every individual had different ways of dealing with things some that seemed to work and some that didn’t.

In the first year of my role as Hospital Co-ordinator I slowly developed my confidence when handling difficult situations but also on reflection managed to gain not only confidence but also an attitude. Sunday late shifts are renowned for being busy. With a high number of patient admissions that gradually increase over the weekend and a decrease in bed capacity the role of the Co-ordinator can be extremely busy. Adding clinical duties assisting the junior doctors and any possible crisis that could happen at any given time I often found myself highly stressed. This high level of stress often brought out an argumentative person who on reflection was calm and friendly when things were going right and people co-operated with tasks asked of them but when crossed became bossy wanting to press onto others the authority given with the title of my role. Scott (2007) describes this behaviour as self sabotage adding that when an individual is found in a stressful situation they can often become impatient, taking out frustrations on innocent bystanders, or causing unnecessary conflicts and mental stress because stress is clouding their judgement. She goes on to describe my reactions as being poor conflict resolution skills when someone tends to act aggressively with people when simple assertiveness will work better. At that time in my career I was struggling to come to terms with my role and the authority I had been given and therefore found it difficult to challenge others decisions without being perceived as aggressive.

From the number of duties asked of the Hospital Co-ordinator often all together, I had to learn how to prioritise my duties and understand it was acceptable to say no to tasks asked of me that other people could carry out. I had to quickly understand that my role was that of a co-ordinator for the trust, advising others on what to do and the best person to contact. Sunday late shifts produced a high number of bleeps, with staff wanting advice and clinical support. This clinical support could be delivered from not only the Hospital Co-ordinator but also by the junior doctors and by a high number of ward staff. It was the teams and my own experience at that time that ward nurses often didn’t attempt to carry out the clinical duties although capable of taking blood, and inserting intravenous lines for fluids and antibiotics. It became a regular occurrence that ward nurses would bleep the Co-ordinator instead of carrying out the duty themselves, which soon became the same for the junior medical staff. What both the nursing staff and medical staff didn’t realise was the change in staff numbers from night shift to day. Overnight there were three Co-ordinators to assist with clinical duties but on a Sunday late there was only one member of staff for everything. Over time this aggravated our team and especially me. Even before a member of staff could explain the reason for bleeping me and asking for assistance or advice I would feel annoyed and bad tempered. Heitler (1993) captures my conflictual worklife and personality. She believes that some people whatever happens in their lives, good and bad, these people are more likely to react with criticism, self-criticism, blame, and self blame. The more they react with negativity, defensiveness, irritability or selfishness towards challenges that confront them in daily living, the more their lives become conflictual. These attitudes invite negativity from others, “bad luck,” and more upsetting interactions.

I recall that on the particular shift in question I had to deal with a number of staffing issues. This included moving nurses from ward to ward to make areas safe whilst upsetting the nursing staff in the process. That alongside a busy Accident and Emergency Department and little number of beds to admit patients into equalled a highly stressed and tired Co-ordinator. My bad temper had gradually grown throughout the day, therefore in order to release some of my tension and to take a break from the hectic shift I was having I decided to visit a nurse on one of the surgical wards that I often chatted with. Our chats were usually about where we had been out socialising and our latest shopping experience and I needed to take five minutes of “normality” before I resumed to my duties. When I arrived on the ward I was met with a smiling faces of all the nursing staff sitting behind a desk drinking tea. I was offered a drink which I refused, as I knew I could only spare minutes of my time. I remember thinking how well staffed the ward was with not just nurses but senior nurses, three in total were most wards were lucky to have one on duty and how quiet having only earlier been running around trying to staff wards who had the bare minimum of nurses. Whilst beginning my informal chat with the nurse I knew another of the senior nurses who I have to say I didn’t know but immediately didn’t like raised her voice to speak to me to demand that I carried out a clinical procedure that the staff there could do themselves. As Umbriet (1997) observes that when people become embroiled in conflict, it is common for them to communicate and interact in dysfunctional ways. The careless expression of intense anger and bitterness, along with the inability to listen to the other party or effectively communicate their own needs, can mask many strengths that they may have.

Only on reflecting on my previous experiences and reactions to incidents can I now understand that depending on how I react to situations of conflict can now actually strengthen relationships instead of adding further mental stress. I also can now see that my “ego” also had a part to play in the way I dealt with confrontational situations. Tolle (2005) describes my insecurities in my ability to make decisions and act in a professional manner as having an ego that is threatened if someone has more, knows more or can do more than i. This would result in my ego feeling insecure because the feeling of “less” diminishes its imagined sense of self relative to other. By having these insecurities I would then retaliate by trying to restore my ego by somehow diminishing, criticising, or belittling the value of the other person’s possessions, knowledge or abilities.

My response to the nurse was abrupt and quite rude. I recall telling her that I was far too busy to carry out such a procedure especially when they were obviously one of the best staffed wards I had seen that day. By responding in such a short blunt way I then only provoked the nurse with an equally abrupt response. Only now can I see that I was too quick to want to respond with a negative answer than to see if there was a valid reason for her needing my help. As Roberts (2005) highlights the ability to express thoughts and feelings in a direct and non threatening manner is important, however effective listening skills are crucial in the introduction of problematic topics. The conversation continued with this nurse stating she had heard how “intimidating” I could be and that I didn’t intimidate her. I was extremely shocked by her response and ended the conversation by asking for her name and saying that I would be reporting her to her seniors. I left the ward that day shocked and deep down hurt by her accusation. Roberts goes on to capture this catalyst for conflict as a pattern of distortion. He states some of the blocks to our well being are the Patterns of Distortion that rise up within us, and distort the way we think and feel about a situation or person. These distortions can cause profound disconnection’s that cause or reinforce conflicts and reduce our happiness, confidence and productivity.

I never imagined myself as being intimidating to anyone and was concerned to find out that according to this nurse many people also felt this way about me. When I came away from playing the role of Hospital Co-ordinator I was a different person, often insecure wanting others to like me and often looking for reassurance. By using the word intimidating I was left worried and sought the opinion of my family when I returned home that day to try and console myself that I was a nice person who was loving and warm and not that of a bully.

I think that day changed my thoughts and ideas and therefore the way in which I interacted with others within the workplace. I recognised the need for change, as inevitably I wanted to be recognised for my achievements by being perceived by others as someone who is approachable and fair when having to deal with confrontational situations. I didn’t want to respond to people when in a confrontational situation in an aggressive matter and wanted to be able to diffuse situations not create further problems. The transformative theory of conflict starts by offering its own answer to the foundational question of what conflict means to the people involved. According to transformative theory, what people find most significant about conflict is not that it frustrates their satisfaction of some right, interest, or pursuit, no matter how important, but that it leads and even forces them to behave towards themselves and others in ways that they find uncomfortable and even repellent. Bush & Folger (2005).

From that day on I still see the nurse who I had this confrontation with and although we don’t speak to each other I am often reminded of my behaviour and consequently feel embarrassed inside. I recall discussing the incident with some of my colleagues not painting an accurate picture of the events but distorting them to make my colleagues think I had the upper hand and had won the situation. I felt too embarrassed to admit that this person had challenged my authority and left me feeling belittled and sad. Byatt-Smith (2007) describes the distortion of truth as being a way of wanting to keep others happy, wanting to avoid punishment whilst covering up embarrassment or poor self-esteem. On reflection this incident changed me for the better and made me take responsibility for my actions and response to others instead of using my position of authority. I begun to take a step back when finding myself in similar situations taking time to think of response rather that answering quickly back in a negative manner. Although my role was often abused by staff to carry out clinical duties I decided that I would turn these incidents into positive learning ones.

From then on when a member of staff asked for a procedure to be done I would enquire if the nurse had attempted the duty first. If they had and couldn’t do it I would carry on and undertake the duty but if they hadn’t I would offer support and say to the nurse we would do it together to build that persons confidence when carrying out such tasks. Although this often added time onto my duties I realised that in future months staff would be less hasty to call upon my assistance unless they needed help and support. I then hoped I would be perceived as a supportive senior nurse who could be recognised as a manager but gain the respect of others by being supportive and knowledgeable rather than dictatory. From my experiences I had used my personal transformation to educate others. Smith (1984) states that nurses who experience personal transformation empower their clients by enabling them to recognise new possibilities through their experiences. As this transformation process unfolds, the nurse and client become mutually committed to a broader vision. Needless to say there were incidents along the way that involved conflict that I didn’t always handle well but I believe that I had started to change my behaviour and thoughts as I progressed and became more comfortable and confident with my role as Hospital Co-ordinator.

As years past I continued to carry out my role with confidence and as new members of staff were recruited into the role of Hospital Co-ordinator I found myself able to offer advice and support to my colleagues when dealing with confrontational situations. Davies and Kaufman (1994) describe that by supporting colleagues professionals can work together to understand better the dynamics underlying the conflict and how its transformation from conflict to a collaborative process of peace building can be achieved. I often saw my new colleagues copying my behaviour from years earlier and I felt strong enough to discuss with others my negative behaviour and how I made sense of what it was I really wanted to achieve. I hoped my colleagues would take advice from someone who had carried out the role for so long and as their confidence grew it could often cause tension within the team. On reflection there were too many egos fighting for authority and the need to be recognised. “Often the ego seeks to cause other people to suffer so that it can displace the hurt it finds so difficult to bear-which it often creates itself” (Tolle 2006). However by this point I had decided to take a step back from the negativity between some of the team members and concentrate on preparing myself for a new role which I hoped to achieve that of the teams manager.

I became the team’s manager in 2006 and found it a natural progression having prepared myself for the position for some time. I had stopped socialising with my colleagues for some time and never gave an opinion when others talked about colleagues and incidents wanting a negative response. Hazleton (2007) believes conflict is inevitable in any team environment. They bring together a variety of personality and skills, each perceiving tasks and actions in different ways. He also states that the best way to deal with situations when people are complaining about their colleagues is to stay out of the conflict, remaining neutral on issues. Interestingly no one else from the team applied for the manager’s position only myself as they stated to me that they naturally felt the position was mine and felt happy with that. My quiet period of confrontational situations and incidents was about to end as it soon became apparent that my decisions as manager were not always favourable with others and they were happy to express this unhappiness either themselves or through others.

The most memorable incident that I think introduced me to some of the negative aspects of my role was the Christmas off duty. It had always caused problems from when I first started as a Co-ordinator and I realised not everyone would be happy with what I presented to them. I decided the fairest way was to ask people to list their requests and leave it in an envelope for me. After collecting everyone’s request I then sat down with previous Christmas rotas to try and draft a fair and reasonable rota. In order to try and promote a positive environment I allowed the team to take two days holiday over the Christmas and New Year period if they wished which I would allocate. After collecting everyone’s request it soon became evident that no one wanted to work Christmas Eve or Christmas day so I therefore had a challenge on my hands.

After completing what I thought was a fair reasonable rota I presented it to the team at their monthly meeting. Everyone quickly glanced at there off duty and no one complained and said they were happy. I felt relieved and expected that I would hear nothing else about it. A week later I received a telephone from one of the team who stated she had been chosen to represent everyone to inform me everyone was unhappy with their rota and were unhappy with an individual in the teams rota saying I had given them nicer off duty than the rest. I remember feeling angry inside wanting to retaliate as I had once previously with aggression and negativity. I wanted the team to change what I believed were their perceptions about me and the decisions I made. De Mello (1990) believes that we are all to eager to want people to change so that we feel good but points out if they did change how would that really effect us. We would remain just as vulnerable as before, and as idiotic and as asleep. I managed to keep in my feelings and instead remained calm. I informed the caller that I would not be changing the rota and that if individuals had issues they were welcome to come to me themselves and I would look at individual concerns. I asked the caller if she was happy with her rota to which she replied yes and I ended the conversation informing my team member that if she was happy we had nothing else to discuss. I felt empowered and proud of myself when I replaced the receiver. I had overcome my inner feeling of anger and managed to present myself as a calm rationale individual who would not be intimidated by anyone in my team. Instead I have developed my understanding and skills acting as mediator rather than instigator. “The application of mediation consistently results in high levels of client satisfaction and perceptions of fairness, within families, among co-workers, in neighbourhoods, and in the criminal justice system” (Umbreit 1997).

As I continue to develop my knowledge and skills of being a manager to a team of fourteen senior nurses I have learnt alot about myself as an individual over the years. I cannot say I find being a manager an easy task and I often have times when I question my actions and worry about decisions made but as a whole I feel confident and competent in my role. I try to think rationally rather than making hasty decisions and I am honest with my team. When I am unhappy with an individual or a situation I would rather portray my feelings rather than let them build up inside me. I hope by promoting this culture my team will also be truthful and discuss their problems and issues that they have. “Good integration and an ability to resolve conflicts are popularly held to be valuable leadership skills and one might expect leadership to emerge clearly in such a situation”(Callaghan 2007).

At this point in my life I feel ready to take the knowledge and skill I have developed and take it further. I feel ready to move onto the next step of the career ladder and pursue my goal of being a matron. I know that when I achieve this post I will have another learning curve to go through but know that from past experiences and the knowledge I have gained I will be able to take a positive confident approach to confrontational situations rather than a negative one. I feel I have grown up a lot over the last five years and think I now have the interpersonal skills to be able to interact with people I meet. Not only these skills assisted in my daily work life but also in my personal life. I was always quick to respond to possible conflict situations wanting to get my opinion across first always wanting to be right, often taking my work persona and ego home with me. I now try to be more objective and although not perfect realise the people who are close to me are the most important part of my life and by instigating or being part of conflict only results in my own personal unhappiness. It has been far more effective for me to channel negative thoughts and feelings into energy to be lost through undertaking different sports. By clearing my mind through exercise I have been able to lose a lot of anxiety that often resulted in me being a part of confrontation and unhappiness. Scott (2007) describes the process I have undergone by saying that by using tools to become more aware of your inner voice, using positive affirmations and surrounding yourself with positive energy, you can turn things around for the better, and experience much less mental and emotional stress in your daily life. I have transformed my once negative thoughts into a positive ideas or changes that can be implemented into my own life and educated to others.

                       

Lisa Grant

I am a matron in a University Teaching Hospital in the UK. My reflective article looks back as my experiences dealing with confrontational situations as a young nurse who was promoted into a managerial position after a short period of time. It reflects on the journey I have been on… MORE >