NURSE-PHYSICIAN CONFLICT AND

ITS MANAGEMENT

Dr. Krupesh Thacker

INTRODUCTIONDEFINITION

“Conflict is a process that begins when

an individual or group perceives differences and opposition between

him- or herself and another individual

or group about interests, beliefs, or values that matter to him or her.”

(De Dreu, Harinck, & Van, 1999; Wall & Callister, 1995)

INTRO CONT…

Conflicts occurs in routine lifeDifferent person different personalityChanging health care system – increased interaction- more chances of conflictsEffects-positive& negative

PHYSICIAN-NURSE CONFLICT

Increased education of nursesMore rights/responsibilities in patient’s treatmentDifficult for physicians to accept such autonomyMay find difficulties to trust diagnosis by nursesNurses feel stress and job dissatisfactionAffect the nurse-physician relationship Conflict may occur

CONFLICT ASSESSMENT

Framework for the assessment of conflict

The components are PEPRS: Parties involved Events/issues (goals, behavior) Power Regulation of conflict(limiting factors, solution used) Style of management

Types of conflict

FORTE (1997) JEHN (1995)

Interpersonal

Intrapersonal

Inter group

Intra group

Task content

Emotional

Administrative

STAGE OF CONFLICT

Latent conflict : conditions present; but not recognizedPerceived conflict : perceive the occurrence Felt conflict : take matter seriously, but will not react openlyManifest conflict : reflects emotions in the behaviorConflict aftermath : solved and a new working relationship is established

CAUSES OF CONFLICT

Individual characteristics

values, education, age, demography Interpersonal factors

trust, respect, communication Organizational factors

interdependence

EFFECT OF CONFLICTNEGATIVE

Job stress Negative EmotionsAbsenteeism Intent to leaveMedical Errors Reduced productivityPatient’s safety AvoidanceJob dissatisfaction

EFFECT OF CONFLICTPOSITIVE

“Conflicts are cracks in a broken system, but they can also be source of creativity”

Strong relationships New better ways Decrease stress Increase work capacity Increase productivity

CONFLICT MANAGEMENT

AvoidanceFrequently used by nurse & physician

Positive Negative

Postpone the matter

Delayed decision

Save time Patient’s safety

To withdraw Interpersonal relations

Diplomatic Communication lack

Managerial Implications

Emotional type of conflict Save time and let both of them

(physician-nurse) handle the problem Should judge the exact time to interfere

in the matter, if required

CONFLICT MANAGEMENT

Pressing

Power difference Overestimate self/other’s power Underestimate self/other’s powerNurses feel insulted, mental stress, job dissatisfaction, negative emotions

Managerial Implications

To deal with emotional type of conflict Keep a close watch , so whenever

required he/she can settle the issue

CONFLICT MANAGEMENT

AccommodationMore importance to other’s wish To avoid unpleasant disputesIn past nurses used more frequently Study on 354 professional nurses in

Thailand in 2000

41.2% used accommodation

29.2% used compromising approach

Managerial Implications

Often uses this method Give physicians what they want Maintain good relations May become avoidance or pressing for

the nurses due to accommodation between manager and physicians

CONFLICT MANAGEMENT

Compromising Both should compromise Good interpersonal relations

According to the study on 126 nursing students, undergraduate and graduate students used compromising approach followed by avoidance

CONFLICT MANAGEMENT

Collaboration

“Nurses and physician working together cooperatively to achieve shared problem solving, conflict resolution, decision making, communication and coordination”

CONFLICT MANAGEMENT

Collaboration

New better wayNo compromiseMutual respect SatisfactionCo-operative attitude Increase work capacityImprove patient’s safety

CONT…

Study : in 5 hospitals on 75 physician & 54 head nurses; collaborating method is

chosen more frequently by nurses & least frequently by physicians

Improving collaborative communication has benefits of increasing patient

survival, shortening length of hospital stay, enhancing professional

relationships, staff satisfaction.

CONT…Patient’s safety is directly proportional to the physician-nurse communication that decreases medical errors

Must understand the severity of the effect of their conflict on patient’s life as well as hospital’s productivity

Managerial Implications

Collaborative approach is beneficial for physicians, nurses as well as patients

Manager should try to use this approach to deal with physician-nurse conflict

CONCLUSION

Collaborative approach is the best Physician should understand

& accept the changeAttain conflict resolution training program Training improves conflict management skills

in professional as well as personal life