Conflict Resolution in Healthcare Settings

Conflict Resolution in Healthcare Settings Chapter 2 Literature Review Psychologists and sociologists note that conflict is a natural and unavoidable part of human life. Every person experiences conflict at a certain point in life. The level of conflict, however, differs significantly across different settings. At home, family members engage in conflicts that older members help easily and quickly resolve to avoid family disintegration. In professional settings, conflicts may arise between individuals and coworkers, and clients.

Resolving conflicts creates a platform for enhanced interactions between different parties. In line with the Karl Marx Conflict Theory, an unavoidable conflict between different parties is the key driver behind the social change. People initiate social change to address the needs and interests of specific parties within their social circle.

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In healthcare settings, conflicts occur between professionals in different specialties. For instance, as pointed out by Alshammari and Dayrit (2017), conflicts between medical and nursing professionals occur frequently. These professionals, as highlighted by Eriksson and Müllern (2017), undergo extensive training and preparation to deal with challenges that occur during practice. Unfortunately, extensive training may enhance conflict management but does not prevent conflicts from arising. The failure to acknowledge the role played by nurses in the healthcare system is the major cause of problems between nurses and physicians. Jasemi, Hassankhani, and Zamanzadeh (2017) noted that recognizing nursing roles, establishing effective communication mechanisms, and supporting interprofessional collaboration can eliminate communication problems and other conflicts between nurses and physicians. The researchers also noted that improving professional communication also guarantees the quality of professional services offered to patients.

Traditionally, people perceive nursing as “carative” and medicine “curative” despite both are healing disciplines that integrate art and science. Jasemi, Hassankhani, and Zamanzadeh (2017) argued that curative and caring functions do not occur independently. They are joined together by common philosophical goals and health care objectives. Jasemi, Hassankhani, and Zamanzadeh (2017) noted that although nursing and medicine have traversed complex evolutionary paths dating hundreds of years, the collaborative relationship between these professions is a relatively recent phenomenon originating from hospital nursing reforms initiated

by Florence nightingale in the late 19th century. Jasemi, Hassankhani, and Zamanzadeh (2017) described the interprofessional collaboration between Medicine and Nursing as the sharing of

ideas, and decisions, working together to resolve practice and social issues, and formulating care plans to address critical patients’ needs.

The key elements of interprofessional relationships, as pointed out by Tan, Zhou, and Kelly (2017), are communication, cohesion, interactions, coordination, and relations between physicians and nurses. These elements are integral to healthcare delivery and practice. Nurse leaders strive to achieve interprofessional collaborations by integrating these elements into healthcare processes.

Tan, Zhou, and Kelly (2017) also noted that the output of the collaboration between nurses and physicians represents the actual outcomes of team performance. The objective results of nurse-physician collaboration include enhanced patient outcomes and efficiency, whereas the subjective results include patient satisfaction and improved well-being. Nurse-physician collaboration improves the psychological health of nurses, thus, improving their capacity to deliver quality care (Tan, Zhou, & Kelly, 2017). Importantly, it enhances knowledge sharing between these parties subsequently improving the quality of services offered to clients.

Collaboration could, therefore, resolve various health care problems, including nursing shortage, lack of skills, and job satisfaction.

Unfortunately, nurse-physician collaboration is not a flawless process. Interactions between these parties are marred by complex challenges that threaten to cripple the medical and nursing progress gained over the years. Physicians tend to undermine nursing roles despite being pillars of the healthcare system. Nurses, on the other hand, dislike the authority exemplified by physicians during practice. These relationship challenges coupled with stress and work overload doubtlessly trigger conflicts between nurses and physicians at all levels of practice.

Physician-Nurse Conflicts

Nursing and medical professionals play a huge role in health care delivery and patient management practices. They collaborate and consult with other professionals to determine the most fitting interventions to treat individual patients. Despite working together in multidisciplinary teams, sometimes challenges mar these interactions. Mahmoodi and Tahrekhani (2018) cited physician-nurses conflict as the greatest contributor to stress, burnout, and job dissatisfaction for nurses. However, tension and conflict do not reflect all relations between physicians and nurses or nurses and other professionals. In many healthcare settings, these professionals communicate and work together to deliver quality care and accomplish core health objectives. Conflicts arise when nurses believe that physicians are treating them inappropriately relative to other care providers. Some nurses may fail to report discrimination incidences due to fear of reprisal. This problem may grow out of proportion if the organization does not implement appropriate measures to address it.

Irrefutably, nurses and physicians are integral entities of health care teams. These teams comprise individuals from different specialties. Education, training, and preparation differ from one specialty to another. Therefore, during practice, care providers may give contradictory recommendations and approaches to patient care creating conflicts. For instance, professionals from different disciplines may advocate for their assessment of the patient. Such a move may create tension with other professionals, who may have already completed the assessment process.

The tension may be higher if the request for further assessment by nurses and other junior professionals contradicts the physician’s recommended approach to care.

Further, as pointed out by Rovithis et al. (2017), conflicts may occur if nurses and physicians view the same issue from different perspectives. The physician may perceive a particular situation to be less of a problem than nurses do. Nurses, on the other hand, may

perceive a certain health issue to be more serious than physicians do. Nurses may also feel that they know patients better than physicians do; hence they have a right to determine a suitable treatment plan (Tan, Zhou & Kelly, 2017). Therefore, they become frustrated when physicians fail to include them in decision-making processes or when some crucial care processes are ignored.

Frustrations also arise when nurses call physicians to seek clarification on certain treatment issues, but physicians are not receptive. On the other hand, physicians may grow impatient when nurses fail to present accurate information about the patient. Such incidences, as denoted by Wang et al. (2018), hinder decision-making and further damage the already strained relationship between nurses and physicians.

Sources of conflict Notably, interpersonal conflicts are aggravated by negative personalities presented by some people. Conflicts frequently occur while interacting with less friendly and impatient persons than others. The same case applies to nurses and physicians. However, the widespread nature of physician-nurse conflicts indicates they are more than just consequences of negative personalities. These conflicts are associated with complex factors that require organizational involvement to resolve. Existing literature explores the primary reasons why conflicts occur between nurses and physicians in hospital settings. Some identified reasons include poor communication, power imbalance, ambiguous roles, separate education, unmet expectations, limited resources, incompatibility, and misunderstanding. Literature also discloses that differences in individual beliefs, discrimination, and differences in functional understanding between these parties may also trigger interprofessional conflicts.

House and Havens (2017) revealed that organizational issues are the most complex causes of nurse/physician conflicts. The researchers noted that in most hospital settings, nurses are supervised by physicians. The presence of more than one supervisor giving unclear directions confuses the nurses. Unclear job descriptions and insufficient distribution of resources between these professions further affect their relationships.

The power imbalance is a significant contributor to physician-nurse conflict. Undeniably, physicians experience high respect, prestige, financial success, and authority than other healthcare providers. Their training and education also rank the highest in any society.

Physicians also hold the primary legal responsibility for patients. They make medical decisions and give orders to nurses on what they should do to patients. In hospitals with dual management, the physician hierarchy enjoys more power than administrative and nursing management.

On the contrary, nursing professionals do not experience such respect and financial compensation. Their education and training are not as extensive as physicians. In all healthcare contexts, nurses have lesser authority than physicians. Therefore, as highlighted by Alshammari and Dayrit (2017), nurses perceive their roles to be subservient to that of physicians. This power imbalance creates the perception among nursing professionals that their roles and views in the healthcare context are of lesser value than physicians. Nurses’ views are often overruled and overridden by physicians, thus, creating frustration and tension among these professionals.

Although interprofessional collaboration between nurses and physicians is integral to establishing a competent health care platform, these professionals may express varying interests in practice leading to conflicts (Grubaugh & Flynn 2018). Traditionally, nurses are viewed as doctors’ helpers. However, nursing theorists claim that these views are typical misconceptions of the right role of nursing. One way of characterizing the different interests between nurses and

physicians is that physicians are focused on treating and curing patients of diseases. In contrast, nurses are focused on delivering personalized care to patients (Tan, Zhou & Kelly, 2017). The differing interests may create conflicts between these parties. Nurses believe they have a larger say in the patient care processes since they focus on their state and wellbeing. Moreover, since physicians attend to patients less often than nurses assigned to their care, nurses feel they understand their needs better than physicians. Nurses feel that they deserve more authority and responsibility for patients than stipulated in the current healthcare system.

Poor nurse-physician communication also escalates conflicts and tension between these parties. Some common communication problems associated with nurse-physician conflicts include minimal communication opportunities, objectionable behavior, inappropriate modes of communication, language and cultural barriers, insufficient information, preference for autonomy, and selective communication partners (Tan, Zhou & Kelly, 2017). Limited opportunities for face-to-face communication between nurses and physicians hinder dispute resolution. Communication opportunities are further dwindled by undervaluing of nurses’ presence and input in healthcare plans. Tan, Zhou and Kelly (2017) further noted that physicians’ objectionable behavior and preference for autonomy affects interactions with nurses.

These behaviors exemplify the physicians’ unwillingness to interact with nurses at any level.

Research shows that gender-based issues are also significant contributors to physiciannurse conflict. In the past, nursing practice was a female-dominated profession, whereas medical practice was male-dominated. However, the transformations of these professionals have seen more men and women taking up each of these professions. However, women still make the largest proportion of the nursing profession. Some people believe that physician-nurse conflicts are caused by gender variation, which reflects the conflict between men and women in society.

Nurse theorists believe that the historical oppression of women in other social sectors has infiltrated the health system. Physicians likely see nurses from a male dominance perspective due to the subservient nature of females in society (Akel & Elazeem, 2015). These factors and the culminating tension and stress could make nurses feel disrespected, disempowered, disvalued, and denigrated. They, therefore, deserve consideration as potential causes of physician-nurse conflict.

The impact of physician-nurse conflict on practice Physician-nurse conflicts have far-reaching consequences. They affect almost all aspects of nursing, including the safety and well-being of professionals, patients, and other stakeholders.

Siedlecki and Hixson (2015) noted that the quality of practice environment influences patients' quality of care. Thus, patients are more likely to receive evidence-based care in environments typified by interprofessional collaboration. Conversely, in environments typified by physiciannurse conflict, patients rarely receive fitting care. This view aligns with Higazee (2015), who noted that physician behaviors and attitudes towards nurses directly impact patient care and patient outcomes.

Conflicts also affect healthcare professionals’ ability to accommodate divergent views and participate in quality improvement initiatives. In a conflict-laden environment, physicians and nurses frame quality improvement interventions in ways that view the other party as sources of the problem rather than partners in developing sustainable solutions (Siedlecki & Hixson, 2015).

Cullati et al. (2019) noted that all healthcare teams comprise physicians and nurses.

These professionals participate in the evidence-based decision-making process to determine the intervention that suits clients' health needs best. However, physician-nurse conflicts hinder the

flawless interactions between these professionals. Physicians may undermine and overlook nurse’s contributions leading to conflicts. Such actions contribute to low self-esteem among nurses. These professionals feel intimidated hence avoid contributing to decision-making.

Disrespected nurses are less inclined to point out errors made by physicians (Cullati et al., 2019).

Nurses may witness and keep quiet while inappropriate interventions are being implemented in certain patient cases to ensure the blame lies squarely on the physician involved. Unfortunately, patients are the greatest losers when physicians and nurses engage in such conflicts. Poor patient outcomes further affect patient satisfaction.

Physician-nurse conflict negatively affects nurses’ job satisfaction and willingness to participate in patent care processes. Higazee (2015) noted that intent to leave the profession is greatest among nurses, who are unappreciated, poorly compensated, and rarely engaged in decision-making. Therefore, conflicts increase nurse turnover rates further affecting the basic structure of the healthcare system. Importantly, physician-nurse conflicts affect the perception of professionalism. The strained relationship between nurses and physicians lowers the nurses’ desire to be associated with their profession (Higazee (2015).

A study aimed to explore the type and frequency of physician-nurse conflicts, the consequences of these incidences, and the best interventions, as exemplified by Higazee (2015), revealed that nurses within their first year of practice experience the greatest level of conflicts.

Physicians rarely give these nurses a chance to suggest interventions to integrate into the treatment plan. Conflicts at this level result in a higher rate of absenteeism and increased desire to leave the profession.

Undeniably, new nurses learn by interacting with physicians, experienced nurses, and other healthcare team members. Physician-nurse conflicts, however, disrupt these interactions

and affect continuous learning. Conflicts between a physician and a nurse in the same team may have negative impactions on other members. Other nurses for instance, may feel demoralized by the inappropriate treatment of their colleagues. Therefore, healthcare leaders need to implement effective interventions to arrest physician-nurse conflicts and promote the safety of these professionals and their clients. Higazee (2015) argued that the selected interventions should support collaboration between these professionals and establish a healthier and more productive work environment.

Resolving physician-nurse conflict Despite many suggestions made by professionals, the key to physician-nurse conflicts and resultant problems is not fully clear. Tan, Zhou, and Kelly (2017) recommended improving communication between these professionals to support decision-making and resolve tensions.

The researchers noted that poor communication leads to unmet expectations, which frustrate nurses and affect working relationships. Although improved communication would address certain aspects of physician-nurse conflicts, it alone would not solve the complex issues of power imbalance, ambiguous roles, incompatibility and inadequate resources (Lee & Lai, 2015).

Specific recommendations are, thus, needed on how to resolve communication and other intricate issues.

Another proposal is implementing an optimal conflict resolution method. Most nurses tend to avoid conflicts or become resigned to them. Avoidance creates a base for continued tension rather than resolving existing problems. Some conflict resolution tactics, which foster cooperation and collaboration, might help avert these problems and attain better overall results.

Despite the potential benefits of this suggestion, it is unclear if physicians, who are contented with the status quo, would participate in such conflict resolution practices.

Alilyyani, Wong, and Cummings (2018) stressed the need for healthcare organizations to find a way to manage conflicts and develop effective working relationships between physicians and nurses. The researchers noted that these relationships are essential for establishing healthy working environments. Unresolved conflicts have devastating implications on patient outcomes, organizational management, workforce productivity, and resource management (Alilyyani, Wong & Cummings, 2018). The challenges revolving around critical care services’ delivery complicate conflict resolution. Therefore, identifying and implementing an effective conflict resolution strategy is vital for enhanced interprofessional relationships in health care settings.

Nurse theorists propose mediation as the best intervention for interprofessional conflict in health care settings. Mediation is a disagreement resolution technique facilitated by an impartial third party. The mediator creates a favorable environment for physicians and nurses to air their grievances, negotiate, and settle on fitting decisions. Mediation, as highlighted by Lee and Lai (2015), employs a confidential and non-adversarial approach to disputes besides employing skills and practices applicable to clinical practice to facilitate bioethical decision-making and dispute resolution. Lee and Lai (2015) noted that mediation achieves better outcomes than litigation and other dispute resolution methods.

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