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Hone your skills as a nurse mediator to manage staff conflict


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Your professional title might be nurse manager, but sometimes it could just as easily be nurse mediator.

Staff members are bound to hold different values, beliefs, and interests, and thus some conflict is almost unavoidable. But nurse managers often are not aware of how to best address these clashes when they occur.

"There usually isn't a lot of time and energy focused on learning leadership skills to resolve conflict," says Kelly Smith Papa, RN, MSN, director of education, research and dementia care consulting in the Alzheimer's Resource Center of Connecticut in Plantsville, who spent years in various nurse leadership roles. "But if you ignore conflict, it festers and infects the entire [department's] culture."

Invisible sources of conflict

Conflict may arise from a variety of sources in healthcare facilities, but some are not always so apparent to the busy nurse manager.

"In my experience, most staff conflicts are based on a lack of communication and a perception of what someone else may or may not be doing," says Papa.

Judi Williams, RN, MHA, NE-BC, director of organizational development and ANCC Magnet Recognition Program® director at the Medical Center (TX) of Arlington adds covert behavior as another source of conflict, such as a staff member talking behind another's back, not helping out another nurse when it is busy, and leaving tasks for nurses on the oncoming shift to complete.

"These passive aggressive behaviors can cause great distress to a nurse who is experiencing them, but often fly under the radar of the nurse manager because they are somewhat invisible," Williams says.

Nurse mediator mistakes

Still, when conflict arises, nurse managers are frequently compelled to sort them out so they do not escalate into more serious situations. Identifying an equitable resolution can be a struggle.

"Nurses by nature are 'fixers' and in general, our personalities lead us to be conflict avoiders," says Williams. "While this is beginning to change, in that nurses are taught to advocate for patients, we still have a hard time doing this for ourselves or our staff."

Williams says some of the biggest slip-ups nurse managers can make are:

  • Trying to fix the problem themselves, instead of requiring the involved individuals to sit down, discuss the problem, and devise a solution
  • Taking a staff member's word and taking action without fully investigating the complaint

"Managers who are not skilled in conflict management may jump to conclusions and write up the other nurse without discussing the situation and [hearing] their side of the story," Williams says.

Hash out the clashes

Nurse managers can begin settling a staff dispute by assessing the nature of the problem. Taking a step back from the situation before reacting allows time for managers to separate themselves from high emotions.

Consider the following questions before taking action:

  • Is this the first time this situation has occurred with this employee?
  • Did I do or not do something that led to this scenario?
  • Am I judging either the employee or the behavior?
  • Am I clear on what the issue really is? What options do I have to resolve or manage the situation?
  • Am I willing to hold the employee accountable, if necessary? (Cohen 2004)


Papa suggests managers first sit with the involved staff members separately to listen to both parties' perceptions of what happened. Then, give them time for reflection.

In a second meeting, Papa listens to staff members' reflections. "I want them to tell me what words they could have used to relay their opinions differently," says Papa.

Papa brings resources to the meeting that staff can take with them to sharpen their communication skills and enhance teambuilding.

"I ask staff to reflect on someone they work well with, whether this be a supervisor or peer," says Papa. A manager's next move should be having staff identify why they work well with that person and if any of those same elements can help them collaborate with other staff.

During a third session, Papa asks staff to educate her about how they are going to approach the situation differently the next time around.

Peer-to-peer accountability can also help managers when addressing conflict, which requires a nurse to discuss behavioral concerns with the nurse involved to reach a mutual solution to the conflict.

"In order for the process to work effectively, staff need training on communication skills and conflict management, and they need to be empowered by facility leadership to hold each other accountable," says Williams. "Leadership needs to set the expectation and they need to follow up and follow through [with] these actions."

Reference
Cohen, S., et al. (2004). Core Skills for Nurse Managers: A Training Toolkit. Marblehead: HCPro, Inc.