Learning Objectives

Chapter 4: Decision Making and Conflict Management

After completing this chapter, the reader should be able to: 1. Define the decision-making process. 2. List the elements of the decision-making process. 3. Analyze the relationship between decision making and leadership. 4. Define conflict. 5. Differentiate conflict management from decision making. 6. Identify categories of potential conflict. 7. List conflict management strategies. 8. Analyze the relationship between leadership and the management of conflict.

Putting it All Together

Remember that you, the new nurse, have been making clinical decisions for your patients throughout your education. Each step of the way, you needed less and less guidance to decide a nursing course of action. That same process will be applied to decisions you will make within the organization context. You will consult with others as necessary to test out your course of action, modify your plan, and learn from both good and weak decisions. You have many skills to build on right now, and those skills will only become more effective as you practice them in new situations such as making assignments and delegating nursing activities. All of these activities will enhance your critical-thinking and communications skills. Conflict, on the other hand, will be a more challenging experience. This is one activity where you should stop before you speak and use your knowledge before simply reacting. Most conflict stems from misunderstandings and differing expectations among the parties. It is less a personal attack on you and more a reaction to a perceived inequality or problem. You can stay calm and reasonable by keeping your own emotions in check. This can be done by using the VENT technique: Validate that this is a real difference of opinion or view. Express emotions in a healthy way. Anger is a powerful emotion and, like all emotions, has a physiologic dimension. It has been suggested that expressing emotions often dissipates some of the intensity. In the workplace, drop a pencil on the desk or crumple a piece of paper. These psychomotor actions discharge emotional energy. Negotiate the conflict situation either immediately or later, and preferably in private. Trust yourself and your actions.

In addition, simply follow the basic principles of dealing with any kind of conflict. They are: 1. Listen actively to the parties involved and do not interrupt. 2. Reiterate the other's viewpoint. 3. Request suggestions for a resolution. 4. Consider the options, but remember that you may not necessarily agree, and you may have to make a unilateral decision. Management of conflict is a necessary skill that takes time and effort but is well worth the rewards. 5. Jointly, if possible, make a decision when emotions are cool.

Chapter Summary
In this chapter, decision making and management of conflict are discussed. Effective communication improves understanding between parties in complex work settings, and healthy group dynamics facilitate decision making. In turn, quality decision making fosters effective management of conflict. Not all conflicts are detrimental, but those that are must be managed and brought under control. Some conflict is growth producing and leads to a revitalization of efforts. Experience in decision making and conflict management leads to heightened precision in communication and improved group relations. Outcomes of both are good or bad, depending on the willingness of participants to work toward success and on improving their skill level. Process models of decision making and conflict resolution are offered. 1. The nurse manager is creating a group that will be tasked to redesign the nurses station. How should the nurse manager determine who will be represented in this group? Your Answer: Place a sign-up sheet in the locker room and ask for volunteers. Correct Answer: Select representatives from all levels of staff who work on the unit. Rationale: The configuration of the group charged with formulating a decision should have adequate representation of all who are going to be directly affected by it. Therefore, the nurse manager should select representatives from all levels of staff who work on the unit to participate in the redesign of the nurses station. Arbitrary assignment of individuals, such as pulling names from a hat, should be avoided since the outcome may not be of the highest quality. Interest alone, such as asking for

volunteers with a sign-up sheet, is insufficient because those who are interested might not be the best decision makers. Choosing nurses with more than 5 years of experience also may be considered arbitrary and is not the ideal approach to develop this group. Nursing Process: Planning Client Need: Safe, Effective Care Environment Cognitive Level: Application

2.

The nurse manager is planning to use brainstorming to facilitate the implementation of a computerized documentation system. Which of the following should the manager counsel the staff prior to starting the brainstorming session? Your Answer: Think the idea completely through to the end before offering it as a suggestion. Correct Answer: Remember that there is no such thing as a bad idea, so letting the mind wander is completely acceptable. Rationale: There are four principles to brainstorming: dont judge ideas; let the mind wander; aim for quality; and hitchhike on previous ideas. With these principles in mind, the correct direction the manager should provide to the staff prior to the brainstorming session would be there is no such thing as a bad idea, so letting the mind wander is completely acceptable. Thinking the idea through to the end would be judging the idea. Letting all ideas remain free-standing would not permit hitchhiking of ideas. Staying focused on the number of people to be trained could compromise quality. Nursing Process: Planning Client Need: Safe, Effective Care Environment Cognitive Level: Application

3.

The nurse manager is angry upon learning that the computerized documentation system go-live date has been moved ahead by one week, which will affect staff training and client care. How can the managers anger be directed toward a positive outcome? Your Answer: Analyze available resources, call a staff meeting, and discuss ways in which all staff can be trained while ensuring client care needs are met. Rationale: The nurse is experiencing situational anger, which can be

energizing, constructive, and arises when realistic expectations cannot be met. The movement of the implementation date of the computerized documentation system is an expectation that cannot be met. The way in which the nurse manager can direct the anger toward a positive outcome would be to analyze available resources, call a staff meeting, and discuss ways in which all staff can be trained while ensuring client care needs are met. The other choices would not lead to a positive outcome and should not be done by the nurse manager. Nursing Process: Planning Client Need: Safe, Effective Care Environment Cognitive Level: Application

4.

The nurse has learned that 8-hour shifts have been eliminated and staff will be scheduled to work 12-hour shifts, and is concerned about working while maintaining her familys needs. This nurse is experiencing which of the following types of conflict? Your Answer: Competing role Rationale: Competing role conflicts occur when the same person fills the roles of nurse, student, spouse, and parent, all of which place demands on that individuals time, energy, and attention. Profession/bureaucratic conflicts are an incompatibility between the system expectations and professional responsibilities. Nurse/nurse conflicts occur when differing values about the philosophy of nursing are held by nurses who work together. Personal competency gap conflicts occur when nurses skill levels interfere with their own expectations of standards of practice for themselves. Nursing Process: Assessment Client Need: Safe, Effective Care Environment Cognitive Level: Analysis

5.

After attending a volatile committee meeting, the nurse wants to inform the manager of the content and outcomes. Which of the following should the nurse say to share the committee information in a positive way? Your Answer: Time was spent explaining why a decision was made, which was very helpful to all present. Rationale: Conceptualizing conflict using positive terms can lead to a

positive outcome. Terms that are considered positive include exciting, creative, helpful, stimulating, and growth-producing. The response time was spent explaining why a decision was made, which was very helpful to all present uses positive terms and will most likely lead to a positive outcome. If conflict is described using negative terms, negative outcomes can occur. Examples of negative terms include anxiety, hostile, anger, and confrontation. The other choices, which are incorrect, use these terms in the description and would not be considered as being a positive way to explain the committee meeting. Nursing Process: Implementation Client Need: Safe, Effective Care Environment Cognitive Level: Application

6.

While determining if overtime could be approved, the nurse manager learns that an immediate family member is critically ill. The manager tells the charge nurse to approve all nursing staff overtime until further notice. Once the managers stress level has decreased, which of the following should be done? Your Answer: Analyze the amount of overtime and determine when it will cease Rationale: The nurse manager received news that caused an immediate panic level of anxiety. Because of the level of anxiety, the manager had a distorted perception about the overtime and made a blanket approval of all overtime until further notice. Once the anxiety level has decreased, the nurse manager should reanalyze the decision made regarding the overtime and determine when it will cease. The nurse manager should not rescind all overtime the charge nurse approved nor continue with the approval of overtime until the next budget cycle. Moving budget dollars to cover the overtime may or may not be feasible, depending upon the amount of money needed to cover the overtime budget. Nursing Process: Implementation Client Need: Safe, Effective Care Environment Cognitive Level: Analysis

7.

The nurse manager is working through predicting outcomes in the decision-making process. Which of the following activities will the manager conduct during this step of the process? (Select all that apply.)

Your Answers: Use fact-finding techniques Search for variations in ideas Be honest about pros and cons Correct Answers: Remove alternatives with undesirable outcomes Concentrate on quality Rationale: 1. Be honest about pros and cons. This is an activity conducting during the plan for managing consequences step. 2. Concentrate on quality. This is an activity conducted during the predicting outcomes step of the process. 3. Remove alternatives with undesirable results. This is an activity conducted during the predicting outcomes step of the process. 4. Search for variations in ideas. This is an activity conducted during the generation of alternative decisions step of the process. 5. Use fact-finding techniques. This is an activity conducted during the gathering of pertinent facts step of the process. Nursing Process: Implementation Client Need: Safe, Effective Care Environment Cognitive Level: Application

8.

A meeting is planned to discuss a conflict between the nursing staff and the physical therapy staff regarding times for clients therapies. Which of the following techniques can be employed before the meeting to enhance the outcome? Your Answer: Think tanks Correct Answer: Centering Rationale: Centering is a technique used to enhance collaboration by controlling stress during conflict resolution efforts. Centering relaxes the body, opens the mind, and produces stability that affects the environment. Brainstorming, forced association, and think tanks are all techniques used to generate ideas. They are typically used within the meeting and not before the meeting. Nursing Process: Planning Client Need: Safe, Effective Care Environment

Cognitive Level: Application

9.

The medical resident is overheard telling a group of new interns that their teacher for the next 3 months will not be the resident but rather the nursing staff. The nurse manager realizes the resident is explaining a(n): Your Answer: Personal competency gap conflict. Correct Answer: Collegial relationship between the medical and nursing staff. Rationale: The medical resident is explaining the value of the nursing staff as teachers to the new medical residents. This is a collegial relationship between the medical and nursing staff that is instrumental to avoiding the nurse/doctor conflict. Professional/bureaucratic conflicts arise from an incompatibility of expectations produced by the system and perceived professional standards and responsibilities, and an imbalance of power is often at the root of such conflicts. Personal competency gap conflicts occur when nurses skill levels interfere with their own expectations of standards of practice for themselves. This type of conflict occurs when nurses are expected to provide client care in areas in which they are unfamiliar, Expressive/instrumental conflicts occur when nurses are torn between technical care demands and the human or expressive needs of patients. Ethical issues, legal issues, patient and family requests, personal values, and the philosophy of the nurse are elements in this type of conflict. Nursing Process: Assessment Client Need: Safe, Effective Care Environment Cognitive Level: Analysis

10.

Which of the following techniques can the nurse manager use to achieve a successful situation between two conflicting groups of nursing staff? (Select all that apply.) Your Answer: Bargaining Correct Answers: Confrontation Bargaining Rationale: 1. Smoothing. This technique minimizes the importance of

2. 3.

4. 5.

differences so that they are not acknowledged and/or respected, and therefore no solution is found. All parties lose, and in time the problem presents itself again. Avoidance. This is a no-win technique that sweeps differences off to the side where they will not go away but rather get worse. Unilateral action. This technique implies active involvement by one party while the other party avoids action or is powerless to act. This leads to a win-lose outcome. Confrontation. This technique brings problems out into the open and, when successful, leads to a win-win situation. Bargaining. This technique implies that if one party is given something, something will be given in return. It can be time consuming but can lead to a win-win situation.

Nursing Process: Implementation Client Need: Safe, Effective Care Environment Cognitive Level: Application

Chapter 4 Key Terms

Analysis is a critical function essential to sound decision making. is a form of body relaxation that allows the harnessing of energy to overcome conflict by strengthening one's psychophysiological state and producing physical and emotional stability when confronted with conflict. is an unsettling condition that causes a clash of ideas about what is expected or established. Conflict can be friendly or hostile. is a human quality needed to generate ideas in decision making. is a process of arriving at a conclusion after an analysis of units of related information. It is purposeful and goal directed. are a complex conclusion derived from a set of premises that relate to a situation. is the dynamic socioemotional milieu that establishes the harmony/conflict ratio among people. is a force within people that shapes the way in which others can function. Two types of power are described in this chapter: (1) directive power, a negative force that exploits others by advancing the power wielder's interest, and (2) synergic power, a positive force that cherishes others by incorporating their values.

Centering

Conflict Creativity Decision-Making Process Decisions

Internal Climate

Power

Predicting

is an identification of the likely outcomes of a decision, given consideration of all known facts about a situation. It is a critical part of selecting a decision. are propositions about something that serve as bases for decisions. A premise can be correct or incorrect and serves as the unit of analysis when evaluating decisions. results when a legitimate expectation has not been met. It differs from chronic anger and can be energizing and constructive.

Premises

Situational Anger