Richard Burnell, who works in the NHS as a specialist in conflict and mediation, shares his tips for nurses on dealing with clashes on the job whether with patients or colleagues.
Conflict is an inevitable part of life, whether at home or at work, with patients or with colleagues; it is at the heart of all human interaction. When people are asked if they agree with the phrase ‘I don’t like conflict,’ the answer is always overwhelmingly yes. The overriding belief many of us have is that conflict is scary and should be avoided wherever possible.
However, how often do any of us pause to think about the meaning of conflict? When it comes to this topic, we are often guilty of practicing something called black and white thinking: we imagine life can only be split in to two states, either where conflict is present and we are in a highly stressful environment or where conflict is not present and we live in a state of relaxed calmness.
In reality, conflict at work can range from a discussion between two colleagues about changes to a patient’s treatment, to being threatened with physical violence inside a patient’s home. It comes in many shapes and sizes, most of which are at the lower end of the spectrum and easily managed once we have the right approach.
It’s not personal
To help better manage conflict in your professional life, it is vital to comprehend the difference between frustrated and abusive behaviour. As carers, most of us recognise that frustration is a natural and perfectly acceptable emotion for patients to feel and express. However, when we encounter it in practice, we often incorrectly consider frustration to be unacceptable and seek to challenge it, thus inflaming a situation.
Take a scenario in which an apparently healthy man in his sixties suddenly has a stroke. His family are unhappy with the acute care that he has received and after discharge, it is apparent he will need support in his home. When the community nursing team make telephone contact with the family to arrange a visit, they are told they are ‘useless’ and ‘shouldn’t be allowed to call themselves nurses after the way they treated dad in the hospital.’
It is easy to become indignant at this. After all, the community team aren’t to blame for the acute care and surely the family have no right to tell them they are ‘useless’. This seems intuitive until we start to think about the deeper principles of conflict management. Ask yourself:
- Are the patient’s family allowed to believe that nurses are useless? Unquestionably, yes. What sort of dictatorship would we live in if we tried to ban people from believing healthcare professionals were useless?
- Are the patient’s family allowed to express the view that healthcare professionals are useless? Yes, they are. How arrogant would the NHS be if it tried to ban families from having zero confidence in its staff?
- Should we silence people who believe we can’t do our jobs? We might not like the word ‘useless’, but it is not an abusive term. We might find their opinion unfair, but this doesn’t make it abusive either.
The mistake many of us make is to interpret this type of frustrated behaviour from the family as a personal insult, which is why the first rule of managing conflict is ‘It’s Not Personal’ (INP).
The family have lost trust in healthcare staff, whether rationally or irrationally. Our job as care professionals is to restore that trust. If we take their frustrated response personally, we lose sight of this and enter a win-lose conflict where we want to correct the family about their assumptions and challenge them. But if we take our ego away and depersonalise (INP), we see the word ‘useless’ for what it really is: a symbol of distrust and a barrier that requires compassionate communication to overcome it.
The above scenario doesn’t mean all conflict will only exist at the frustrated level. If the family had instead threatened any healthcare professional who came to visit their dad with physical violence, this would move into the category of ‘abusive’ behaviour, which is not acceptable.
We can recognise abusive behaviour where one of the following is present:
Harm or damage caused to people or property
Abusive language (racism, mocking physical appearance etc.)
However, it is vital that we don’t call patients who criticise or hold strong negative opinions about us abusive simply because we find their opinions unjust or unreasonable.
Focus on giving
In professional mediated conversations, a repeat problem is that feuding colleagues tend to interpret neutral actions as personal sleights; this also ultimately boils down to a lack of trust. The skill of a mediator is to restore that trust between two parties. However, this can be done without professional assistance if staff members are self-aware.
For example, a staff member who says ‘good morning’ to the team but thinks they are ignored by one colleague may choose to see this as a personal issue. It may be that the colleague holds a personal dislike – but equally, it may be that they didn’t hear, were highly stressed or did reply but only quietly. Here, we are in danger of practicing ‘Unconditional Negative Regard’ (UNR), which will create a long-term conflict. We choose to see the worst motive possible for someone else’s behaviour at the earliest available opportunity, then we choose to keep interpreting each subsequent behaviour accordingly. We might think: ‘Amandeep didn’t say good morning to me earlier, then the phone was ringing and she left it for me to answer. She is deliberately trying to annoy me.’ Once we think like this, we start to filter each of Amandeep’s behaviours through our UNR machine and the conflict will continue.
To solve this problem, we firstly have our INP skillset. Instead of making Amandeep’s behaviour about us and potentially interpreting it with bias, we can try to view it through a compassionate filter that evaluates what she is thinking, feeling and a how she is truly behaving. This removes ourself from the emotional equation and helps us to achieve greater objectivity.
The second skill to implement is the ‘Focus on Giving’ (FOG) mindset. Do you only say good morning to your colleagues because you want to feel accepted - or do you do it because it’s a kind way to start the day? Instead of fixating on what you might not get back from our colleagues, why not take pride in what we put into the team? In an additional example, when you are in your car, allow another driver to pull out and they don’t say thank you, how do you feel? Many of us feel angry or frustration with this ‘rudeness’. But now think about this: Have you done a kind thing? Have you helped someone in their journey and reduced the queue? Does the kindness you have just shown help keep the roads moving? Yes, to all those questions.
However, we often choose to turn our kindness into anger. The only person who can destroy our kind deeds is ourselves when we become upset that we didn’t receive the thanks we felt entitled to. Once you start to use the FOG principle, conflict is much harder to come by because the small seeds that conflict grows from within teams never have chance to germinate.
If you can practice the skills of depersonalisation, avoid slipping into the ‘Unconditional Negative Regard’ trap and practice the ‘Focus on Giving’ principle, managing conflict with patients and within teams ceases to become something stressful or scary. It simply becomes an everyday part of your professional life and can have an extraordinary impact on your wellbeing at work.
Managing conflict starts with a mindset – and once you have that right, you realise you aren’t really managing conflict at all. You are just practising the core values of communication, consideration and empathy that run through the heart of all compassionate nurses.