CONFLICT MANAGEMENT STYLES IN THE

HEALTH PROFESSIONS
SUSAN SPORTSMAN, PHD, RN,* AND PATTI HAMILTON, RN, PHDy

The purpose of the study was to determine prevalent conflict management styles chosen by
students in nursing and to contrast these styles with those chosen by students in allied health
professions. The associations among the level of professional health care education and the style
chosen were also determined. A convenience sample of 126 students in a comprehensive
university completed the Thomas–Kilmann Conflict Mode Instrument (TKI), which requires
respondents to choose behaviors most characteristic of their response to conflict and classifies
these behaviors as one of five styles.
There was no significant difference between the prevalent conflict management styles chosen by
graduate and undergraduate nursing students and those in allied health. Some of the students were
already licensed in their discipline; others had not yet taken a licensing exam. Licensure and
educational level were not associated with choice of styles. Women and men had similar
preferences. The prevalent style for nursing students was compromise, followed by avoidance. In
contrast, avoidance, followed by compromise and accommodation, was the prevalent style for
allied health students. When compared to the TKI norms, slightly more than one half of all
participants chose two or more conflict management styles, commonly avoidance and
accommodation at the 75th percentile or above. Only 9.8% of the participants chose collaboration
at that level. Implications for nurse educators, researchers, and administrators are discussed.
(Index words: Conflict management styles; Nurses; Allied health professionals; Collaboration;
Compromise; TKI) J Prof Nurs 23:157–66, 2007. A 2007 Elsevier Inc. All rights reserved.

Background skills, and personal accountability results in communica-

T HE U.S. HEALTH care delivery system is vulnerable
to the negative effects of conflict. The system is
complex and patient care is dependent upon multiple
disciplines working together. Yet working together is often
difficult because of miscommunication, compounded by
competing interests of various stakeholders. A large
national study of health care providers and administrators
found that the prevalent culture of poor communication
and collaboration among health professionals relates
significantly to continued medical errors and staff turn-
over. In addition, a lack of adequate support systems,
4Dean, College of Health Sciences and Human Services and Minnie
Rhea Wood Professor of Nursing, Midwestern State University,
Wichita Falls, TX.
yDirector of Research and Professor of Nursing, Texas Woman’s
University, Denton, TX.
Address correspondence and reprint requests to Dr. Sportsman:
Dean, College of Health Sciences and Human Services and Minnie
Rhea Wood Professor of Nursing, Midwestern State University,
Wichita Falls, TX 76308. E-mail: susan.sportsman@mwsu.edu
8755-7223/$ - see front matter
tion gaps that can cause harm to patients (Maxfield,
Grenny, McMillan, Patterson, & Switzier, 2005).
The Joint Commission on the Accreditation of
Health Care Organizations (JCAHO) suggests that poor
communication is a top contributor to sentinel events
reported to the JCAHO database (JCAHO, 2005). In
contrast, Bartol, Parrish, and McSweeney (2001) sug-
gest that increased positive interaction among health
care disciplines may positively influence patient out-
comes. Recently, bSilence Kills: The Seven Crucial
Conversations for Health CareQ reported that fewer
than 10% of approximately 17,000 nurses, physicians,
clinical care staff, and administrators surveyed
addressed problems they see in behavior of colleagues.
These behaviors include trouble following directions,
poor clinical judgment, or taking dangerous shortcuts
(Maxfield et al., 2005).
A first step in encouraging positive interaction among
health care providers, particularly in high-risk situa-
tions, is to support constructive conflict management as
part of a healthy working environment. For example,
the American Association of Critical Care Nurses

Journal of Professional Nursing, Vol 23, No 3 (May–June), 2007: pp 157–166 157

A 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.profnurs.2007.01.010
158
Table 1. Conflict Management Styles, Definitions, and Use
Style Definition
Competing Pursuit of own concerns at the
other person’s expense, using
whatever power seems appropriate to win.
Assertive and uncooperative.
Collaborating Attempting to work with the other
person to find a solution that fully
satisfies the concerns of both.
Assertive and cooperative.
Compromising The object is to find an expedient,
mutually acceptable solution that
partially satisfies both parties.
Intermediate in both assertiveness
and cooperativeness.
Avoiding One does not immediately pursue
own concerns or those of the
other person or address the conflict.
Unassertive and uncooperative.
Accommodating Neglecting own concerns to satisfy
concerns of the other person.
Unassertive and cooperative.
Note: Data from Thomas and Kilmann, 1978.
(AACN) has recently released standards for establishing
and sustaining healthy work environments (AACN,
2005). First among these standards is bNurses must be
as proficient in communication skills as they are in
clinical skills.Q Inherent in effective communication
skills in health care is the ability to positively manage
conflict, not only within a single discipline, but also
across disciplines.
This article describes a study designed to determine
prevalent conflict management styles of licensed and
unlicensed nursing students and other professionals
who must work together to deliver health care.
Understanding the way providers respond to conflict
is an important first step in being able to identify
effective strategies to help nurses constructively manage
inevitable conflicts in health care.
Purpose of the Study
The purpose of the study was to determine (1) prevalent
conflict management styles chosen by students in nursing
and to contrast these styles with those of students in
radiologic science and respiratory care and (2) whether
the level of professional health care education or gender
was associated with style. The following research ques-
tions were used to direct the study:
1. What are the prevalent conflict management
styles chosen by undergraduate and graduate
students in nursing, radiologic science, and
respiratory care?
2. Are there differences in the choice of prevalent
conflict management styles among undergrad-
uate and graduate nursing, radiologic science,
and respiratory care students?
3. Are there differences in the choice of prevalent
conflict management styles among associate
SPORTSMAN AND HAMILTON
Use
Use of competition might mean standing up
for your rights, defending a position you believe
is correct, or trying to win.
Use of collaboration might involve digging into
an issue to identify the underlying concerns of the
two individuals to find an alternative that meets
both sets of concerns.
Compromise might mean splitting the difference,
exchanging concessions, or seeking a quick
middle-ground position.
Avoidance might take the form of diplomatically
sidestepping an issue, postponing an issue until a better time,
or simply withdrawing from a threatening situation.
Use of accommodation might take the form of selfless
generosity or charity, obeying another person’s order when
you would prefer not to, or yielding to another’s point of view.
degree, baccalaureate, and master’s students in
designated health professions programs?
4. Are there differences in the choice of prevalent
conflict management styles between men and
women in the designated health professions?
Conceptual Framework
Conflict can be defined as an expressed struggle
between at least two interdependent parties who
perceive that incompatible goals, scarce resources, and
interference from others are preventing them from
achieving their goals (Wilmot & Hocker, 2001, p. 41).
The behavioral approaches used to resolve conflict are
referred to as conflict management styles. Used together
over time, these behaviors become a patterned response.
These behaviors are a result of both external conditions
and the person’s own approach to people and problems
(Friedman, Tidd, Currall, & Tsai, 2000) and are chosen
depending upon the relative importance of one’s
concern for self versus concern for others.
People tend to use the same patterns over and over
again in a wide range of conflicts. In some situations,
the patterned responses may effectively resolve the
conflict. However, in other circumstances, the same
pattern of behavior may only escalate it. To be effective
in conflict management, one must be able to consciously
choose the behaviors that best fit the circumstances,
rather than automatically using one style consistently
regardless of the situation (Sportsman, in press).
Three groups of researchers, Blake and Mouton
(1974), Thomas and Kilmann (1978), and Rahin and
Bonoma (1979) have described five behavioral patterns
or management styles that might be used in a conflict.
Despite multiple changes in individuals and organiza-
tional environments, these five styles are still used to
CONFLICT MANAGEMENT STYLES IN THE HEALTH PROFESSIONS
describe the variety of ways in which people respond to
conflict (Wilmot & Hocker, 2001). From a practical
perspective, the styles identified by the three groups
describe the same phenomena. Table 1 defines each of
the five conflict management styles in terms of the
underlying assertiveness or concern for self and coop-
erativeness (concern for others) of the behavioral
pattern and illustrates their possible use. The study
under consideration, like many other studies in health
care over the last 25 years, used the five conflict
management styles described by Thomas and Kilmann
as its conceptual framework.
Review of the Literature
Constructive conflict management requires an assess-
ment of the conflict situation, including the perceptions
of conflict participants. In fact, Wilmot and Hocker
(2001) noted that individual perceptions regarding
conflict serve as a blensQ through which the conflict is
analyzed. These perceptions, in turn, are influenced by
gender, educational background, and professional so-
cialization. Much of the research related to conflict,
particularly in nursing, between 1980 and 2000 centered
around factors that influence perceptions of the conflict.
Conflict and Gender
Gender is a powerful influence on perceptions, affecting
the interpretation of all situations. In the past, research
on conflict has frequently been carried out in industrial
and political organizations, primarily by male inves-
tigators, in male-dominated organizations, using men as
subjects. As a result, the primary findings regarding
conflict management can best be applied to men
(Valentine, 1995).
However, even with the possibility of gender bias
influencing data analysis, the study of conflict seems to
indicate that women may respond differently to conflict
than men (Valentine, 1995). For example, Rahim (1983)
studied the conflict management style used by 50 female
and 50 male managers in business and industry and
found that women were bmore integrating, avoiding and
compromising and less obliging than men.Q Unfortunate-
ly, the original instrument used in Rahim’s research was
developed and normed on 1,169 men and only 50
women, making conclusions about women difficult to
validate (Valentine, 1995). Research using the Thomas–
Kilmann Conflict Mode Instrument (TKI) has also
identified that men and women responded differently
to conflict (Thomas & Kilmann, 1974). Women were
more likely to take their partner’s interest into consid-
eration, preferring more compromising and tactful
strategies, whereas men prefer competitive, unyielding,
and aggressive strategies (Valentine, 1995).
Conflict Management Styles in Nurses
Studies of conflict management styles in health care
spanning the latter part of the 20th century primarily
used nurses as participants. Staff nurses were found to
use avoidance as their predominant conflict management
159
style (Baker, 1995; Cavanagh, 1991; Eason & Brown,
1999; Hightower, 1985; Marriner, 1982). In contrast,
nurses in supervisory positions were more likely to use
compromise as the most frequently used conflict man-
agement style (Woodtli, 1987). However, Eason and
Brown (1999) found that both managers and staff nurses
used avoidance as their primary style, followed by
accommodation. Because more than 90% of the nurses
in the United States are women, it is unclear whether
gender, professional socialization, or both influenced
their choice of styles in these studies.
Lavin (1990) studied the relationships between
assertiveness, self-esteem, conflict management style,
and a variety of demographic variables in nurses. The
study found that assertiveness was positively related to
collaboration and competition as well as to positive self-
esteem. A significant negative relationship was found
between assertiveness and an accommodating conflict
resolution style.
Although the findings of studies from 1980 to 2000
were relatively consistent, there has been limited
research on conflict management styles in health care
since that time. Given the major changes in the health
care environment in the last 6 years, a reexamination of
the styles used by nurses and other health care providers
is important.
Conflict and Education in Nursing
There has been limited study of conflict management
skills in nursing students. Saulo (1987) investigated the
self-reported conflict management styles of associate
degree nursing students in the Greater San Francisco
Bay area and the relationships between their styles and
their reaction to videotaped simulated situations. There
were significant differences between the styles respond-
ents reported using generally and those they indicated
they would use in simulated conflict management styles.
In addition, the subjects’ responses differed according to
the initiator of the conflict. There was a significant
difference in the styles they reported if the conflict was
with a patient or a peer, or if the conflict was with a
male or female authority figure. This reinforces the
notion that conflict management style may be contex-
tual—much like bstate,Q not btrait.Q
There is some evidence to suggest that educational
interventions may influence individuals to increase the
number of conflict management styles they use. Spicker-
man and Brown (1991) found that senior nursing
students used avoidance and compromise as their
predominant conflict management style. However,
following implementation of a variety of teaching–
learning strategies on conflict, the students’ predomi-
nant styles changed to compromise and collaboration.
Conflict Management Style in
Allied Health Professions
There is little research regarding conflict management
styles in health care professions other than nursing. A
literature search in the MEDLINE, CINAHL, Ovid Full
160
Table 2. Examples of Statement Pairs
# 6. A. I try to avoid creating unpleasantness for myself.
B. I try to win my position.
# 7. A. I am usually firm in pursuing my goals.
B. I try to convince the other person of the
merits of my position.
Note: Data from Thomas and Kilmann, 1974.
Text, and PsycINFO databases over the last 25 years
found few studies that described conflict management
styles in health care providers except in their interac-
tion with nursing or with medicine. For example,
Nilsson (1989) explored the conflict management style
nurses used in their interaction with physicians.
Analysis of the data from 415 questionnaires found a
striking pattern of conflict management styles used by
nurses, which included low use of competition and
collaboration and high use of avoidance and accom-
modation in those interactions.
Lachter and Mosek (1995) compared three aspects of
the professional/client relationship, including strategies
for conflict resolution among students in social work
(n = 62) and medical students (n = 55) at the beginning
and end of their professional education. Social work
students were significantly more cooperative and less
competitive than medical students. Social work students
adjusted their modes of conflict resolution during the
socialization process, whereas medical students retained
their original tendencies.
Since 2000, there have been only a limited number of
reported studies involving conflict in health care, and
these studies focused on the implications of implemen-
tation of various conflict management styles rather than
the styles themselves. For example, Thomas, Sexton, and
Helmreich (2003) found that in nonsurgical intensive
care units in two teaching and four nonteaching
hospitals, 90 physicians and 230 nurses perceived their
teamwork climate differently. Because the nurses felt the
climate of teamwork was less positive than the physicians
did, they were more likely to use suboptimal conflict
resolution and interpersonal communication skills.
Jordan and Troth (2002) investigated the utility of
using emotional intelligence in predicting the preferred
style of conflict resolution of nurses in Australia and
New Zealand. Emotional intelligence involves the
ability to (a) recognize, understand, and express
emotions and feelings; (b) understand how others feel
and relate with them; (c) manage and control emotions;
(d) manage, change, adapt, and solve problems of a
personal and interpersonal nature; and (e) generate
positive affect and be self-motivated. Preliminary find-
ings indicated that nurses in Australia and New Zealand
with high emotional intelligence preferred to seek
collaborative solutions when confronted with conflict
(Jordan & Troth, 2002). Given the cultural differences
between Australia and New Zealand and the United
States, it is unclear whether this finding would be
pertinent in the United States.
SPORTSMAN AND HAMILTON
One study in 2000 supported the findings of studies
from the 1980 and 1990s, which indicated that the use
of avoidance and accommodation is still frequently used
in health care, despite the emphasis on collaboration as
an effective strategy for conflict management. Friedman
et al. (2000) studied the relationship of conflict
management styles and stress in a university clinical
medical department composed of 82 physicians, nurses,
clinical staff, researchers, and support staff. The study
found that the use of collaboration reduced the
experience of task and relationship conflict, thereby
reducing stress. On the other hand, when avoiding or
competition is used, task conflict was increased. This, in
turn, increased the likelihood of relationship conflict
and stress. Using accommodation helped to decrease the
experience of relationship conflict, reducing stress in
the short term, but it also ultimately increased stress,
because accommodation did not support the individual
meeting his or her own needs.
The way in which conflict management styles are
used in the health care work place seems to have
changed little in the last 20 years. Additional studies are
necessary to validate the predominant conflict manage-
ment styles of nurses and allied health professionals.
The findings of this study may provide information
needed to foster an environment of constructive conflict
management in health care organizations.
Setting
The research was conducted in the College of Health
Sciences and Human Services of a comprehensive
university in north central Texas. The college is
composed of nine separate professional programs
including nursing, radiologic science, and respiratory
care. The school of nursing offers a Bachelor of Science
in Nursing (BSN) and a Master of Science in Nursing
(MSN). The radiologic science department includes an
associate degree program, which is the entry level to
licensure for this discipline, and a distance-education
degree program leading to a Bachelor of Science in
Radiologic Science (BSRS). A Master of Science in
Radiologic Science (MSRS) is also offered. The respira-
tory care department includes a generic Bachelor of
Science in Respiratory Care (BSRC) program and an
online Registered Respiratory Therapist (RRT) to BSRC
completion program. Both the BSRS and BSRC programs
are analogous to the RN to BSN programs found in
many schools of nursing. Radiologic technologists and
registered respiratory therapists who received their
entry-level education in an associate degree program
take upper-division professional and academic courses
in order to earn a bachelor’s degree.
Sample
A convenience sample of nursing, radiologic science,
and respiratory care students in undergraduate and
graduate programs were given an opportunity to
participate in this study. The study was explained to
320 students; 126 chose to participate for a 39%
CONFLICT MANAGEMENT STYLES IN THE HEALTH PROFESSIONS
Table 3. Alpha reliability for TKI subscales as defined by Walker
(2005)
Alpha Correlation with
Scale Reliability original version
Collaborative .84 .63
Compromise .76 .22
Competition .87 .61
Accommodate .73 .63
Avoidance .69 .62
response rate. This sample included 65 nursing stu-
dents, 52 radiologic science students, and 9 respiratory
care students. Although all of the participants in the
study were students, 45 were already licensed in a
health care discipline and pursuing either a bachelor’s
or of science degree.
Instruments
Two instruments were used in this study: a researcher-
developed demographic data instrument and the TKI.
The demographic data sheet included questions regard-
ing participants’ sex, level of education program
(associate degree, baccalaureate, or master’s), and
health care discipline. The TKI is a forced-choice
instrument composed of 30 statement pairs, which
reflect each of the five conflict management styles
identified by Thomas (1976). Respondents must choose
the statement from each pair that is most characteristic
of what they believe to be their behavior during
conflicts. A review of literature of the last 25 years
found that the TKI had been used in the majority of
studies on conflict management in health care. This
finding influenced its selection as the instrument for this
study. Table 2 provides examples of the statement pairs
found in the TKI.
The TKI was normed using managers in various
business and governmental organizations. The test–retest
reliability ranged from .61 to .68. The coefficient alphas
reported for the subscales, included Competition at .71;
Accommodation at .43, Avoidance at .62; Collaboration
at .65, and Compromise at .58 (Kilmann & Thomas,
1977). A multitrait–multimethod approach was used to
determine validity of the instrument. Convergent validity
was determined by correlating the TKI with the
corresponding scores on another conflict measuring
instrument. Effects of social desirability were corrected
for by pairing items with scores on the Edward’s Personal
Preference Schedule (Kilmann & Thomas, 1977).
The TKI is composed of 30 pairs of responses with
each response illustrating one of the five conflict
management styles. Take, for example, paired responses
illustrating bcompetitionQ and bcollaboration.Q Respond-
ents would pick their preferred style between items
illustrating bcompetitionQ and bcollaboration.Q The same
pair of styles appears 2–3 times across the TKI, but each
time competition and collaboration appear with differ-
ent illustrations for that style. Each style is paired with
each of the other four styles and appears 12 times across
161
the 30 TKI items. A score for each style is simply the
sum of the times that style was preferred over another
style in a pair of styles. Thus, the maximum score of 12
is reached by consistently preferring a style over all of
its alternatives.
The score is then compared to the score for that style
among the original TKI norm group (composed of
managers at middle and upper levels of business and
governmental organizations). If a respondent has a style
score that equals or exceeds the 75th percentile for that
style among the norm group, we conclude that the style is
a primary conflict management style for that individual.
The TKI instrument produces ipsative data, which
occur as a result of a forced choice. In this approach, the
task of the respondent is to choose between two or more
objects. In the case of the TKI, this choice is positive; in
that the preferred object is chosen from a group of
options presented. The results of an ipsative test are
scores indicating the subject’s relative position among
the dimensions.
Making direct comparison between two persons on
the basis of ipsative tests apparently is meaningless. As a
result, the majority of psychometricians have argued
that ispative questionnaires cannot be used for interin-
dividual comparison. In spite of this psychometric
criticism, ipsative tests such as the TKI are widely used
for occupational assessment (Karpatschof & Elkjaer,
2000). Karpatschof and Elkjaer, (2000) suggest that
despite the criticism, experience has shown that
carefully designed ipsative tests are useful and valid
after all.
Because the data obtained in this research were
ipsative, traditional alpha reliability was not obtainable.
Walker (2005) created a Likert-style version of the TKI
and calculated the alpha reliability for each subscale, as
well as its correlation with the original version of the
scale. Table 3 outlines the alpha reliability and the
correlation with the original scale for each of the five
styles. The alpha reliability of scales ranged from .69
(Avoidance) to .84 (Collaboration). The correlations for
four of the scales range from .61 (Avoidance) to .6
(Collaboration). However, the correlation for Compro-
mise was only .22.
Walker (2005) found that only 65%of the responses
in her study matched the higher preference between
versions and 55% matched the lowest preference. In
addition, frequently a clear preference was not indicat-
ed on either version. Therefore, despite the fact that
many believe the TKI provides useful clinical data, the
lack of reliability estimates raises concerns regarding its
use in research.
Data Collection
Following approval of the study by the university’s
Human Subjects Review Committee, the study was
explained to students during a face-to-face class period
in the fall of 2004. Packets with the consent form,
demographic data sheet, and the TKI instrument was
distributed to all members of the classes selected.
162 SPORTSMAN AND HAMILTON

Table 4. Number of Participants by Discipline and Gender

Discipline Female Male Total
Nursing 60 5 65
Radiologic science 41 11 52
Respiratory care 6 3 9
Total 107 19 126

Participants were asked to return completed instru-

ments within 2 weeks to a designation conveniently
located on campus. Students in the RRT to BSRC
program (n = 15) have online classes exclusively; they
do not come to campus for class. As a result, packets
were mailed to these students. A self-addressed,
stamped envelope was included in the packet, along
with written instructions for completing the instrument
and returning the materials.
Data Analysis
The means and standard deviations of the subscales
representing the five conflict management styles were
determined for nursing, radiologic science, and respi-
ratory care participants at various educational levels and
for men and women. Frequency distributions and bar
charts were created for all variables. Prevalent conflict
management styles of the three disciplines and men and
women were compared, using an independent samples
test. The differences in styles as a result of education
were tested using an analysis of variance. Statistical
significance was set a priori at the .05 level.
Findings
Demographic Data
Tables 4 and 5 demonstrate the demographic character-
istics of the study participants. The sample was
primarily women. The baccalaureate programs had the
highest number of student enrollments; the master’s
programs had the second highest enrollment.
Preferred Conflict Management Styles
Figure 1 illustrates the mean score for all participants on
each of the conflict management styles. It is important to
remember in analyzing these data that the maximum
score on any style on the TKI is 12. Compromise was the
conflict management style most often chosen by the total
sample, closely followed by avoidance. Competition was
the style least likely to be used by the participants.
Figure 1. Mean scores on each conflict management style for
all participants.
Preferred Conflict Management Style by Discipline
Figure 2 illustrates the mean score of the conflict
management styles by disciplines. Due to the small
sample size for the radiologic science and respiratory
care groups relative to nurses, these two groups were
combined into an allied health group.
Compromise was most often chosen as the preferred
style by the nursing students, whereas avoidance was
most often chosen by the allied health group. The nursing
group chose competition as the preferred conflict
management style less often than the other group. There
was no significant difference at the P b .05 level in the
preferred conflict management styles between nursing
and allied health students. However, compromise dif-
fered with a P value of .06 with nursing and allied health.
Preferred Conflict Management Style by Education
Figure 3 illustrates the mean scores of the styles chosen
by participants enrolled in various levels of education.
Compromise was the prevalent style chosen most often
by students enrolled in associate and baccalaureate
programs, although avoidance was more prevalent in
graduate students. The choice of collaboration seems to
increase as education increases. However, there was no
significant difference at the P b .05 level in the choice of
conflict management styles according to educational

Table 5. Number of Participants by Discipline and Education

Level
Discipline Associate Degree BS MS Total
Nursing 0 54 11 65
Radiologic science 18 2 32 52
Respiratory care 0 9 0 9
Total 18 65 43 126 Figure 2. Conflict management style by discipline.
CONFLICT MANAGEMENT STYLES IN THE HEALTH PROFESSIONS
Figure 3. Styles of all participants according to educational
preparation.
preparation. Compromise differed with a P value of .06
among the three educational (associate degree, bacca-
laureate, and graduate) levels.
Conflict Management Style and Gender
Figure 4 illustrates the frequency with which men and
women chose the five styles. Women were most likely to
choose compromise as a conflict management style,
followed by avoidance. In contrast, men were more
likely to choose avoidance, followed by compromise.
Women were slightly more likely than men to choose
accommodation and both groups chose competition
least frequently, although men chose it more often than
women. No statistical tests of difference were conducted
due to the disparity in number of women (n = 107) and
men (n = 19).
Choice of Styles
Effective conflict management requires the use of a
variety of styles depending upon the circumstances of
the conflict. Therefore, participants who scored at or
above the 75th percentile in more than one conflict style
Figure 4. Conflict management style by gender.
163
Table 6. Total Number of Styles Above the 75% Percentile
No. of Styles
Greater Frequency of Percent of Cumulative
Than 75% Participants Participants Percent
Valid .00 15 9.8 9.8
1.00 53 34.6 44.4
2.00 82 53.6 98.0
3.00 3 2.0 100.0
Total 153 100.0
may demonstrate effective conflict management. To
capture this information, identifying of the number of
participants that scored at that level was important.
Table 6 provides the frequency with which the
participants scored at or above the 75th percentile on
more than one style. More than half (55.6%) of the pre-
and postlicensure nursing and allied health students
chose two or more styles more often than the majority
of the normed group.
The percentage of participants who chose each
conflict management style at or above the 75th
percentile was also examined. Table 7 illustrates the
frequency with which a conflict management style was
chosen at the 75th percentile or above. Slightly more
than half of the participants chose avoidance and
accommodation more than 75% of the original normed
group. In contrast, less than 12% of the participants
chose collaboration, competition, and compromise
more often than 75% of the original normed group.
Conclusions
The primary result of this study was that there was no
significant difference between the prevalent conflict
management styles chosen by nursing, radiologic
science, and respiratory care undergraduate or graduate
students. The health care discipline did not explain style
preference. In addition, their educational status did not
make a significant difference in the participants’ choice
of conflict management styles.
Despite the lack of significant difference between the
conflict management styles chosen by nursing and allied
health students, this study found that compromise was
the prevalent conflict management style for undergrad-
uate and graduate nursing students, followed by
avoidance This finding contrasts with some previous
research that found that the prevalent style chosen by
staff nurses was avoidance, followed by accommodation,
and the prevalent style for nurse managers was
compromise. Avoidance, followed by compromise and
accommodation, was the conflict management style
most often chosen by radiologic science and respiratory
care students. Competition was the style least often used
by this group.
In this study, participants chose compromise more
frequently than in studies done in the 1980s and 1990s.
However, they did not choose collaboration as a
frequently used conflict management style. In evaluat-
ing this result it is important to distinguish between
164
Table 7. The Percentage of Participants at the 75th Percentile or Above
Competition Collaboration
Percent z75% percentile 8.5 9.8
compromise that involves finding an expedient, mutu-
ally acceptable solution that bpartiallyQ satisfies both
parties and collaboration, which involves working with
the other party to find a solution that bfullyQ satisfies the
concerns of both (Thomas, 1976). Compromise is an
approach that meets some needs on both sides of a
conflict. Collaboration, although resource-intensive,
offers the hope of developing a new approach to settling
the conflict that will satisfy both. Friedman et al. (2000)
found that the use of collaboration reduced the
experience of task and relationship conflict, thereby
reducing the stress. Therefore, important work-related
conflicts, if the timing warrants, are best resolved
through a process of collaboration.
Slightly more than one half of the nursing and allied
health participants chose two or more styles more often
than 75% of the original normed group. The styles
chosen most frequently were avoidance and accommo-
dation. More than one half of the participants were in
the 75th percentile only when they chose avoidance and
accommodation. If this, in fact, demonstrates a reluc-
tance to choose collaboration, the benefits of collabo-
ration in health care written about by Patterson, Greeny,
McMillan, and Switzer (2005) may be lost.
Limitations
There are significant limitations to this study that must
be considered in evaluating the strength of the results.
First, the TKI measures how subjects indicated they
would respond in a conflictual situation. Because these
are ipsative data, some would argue that they cannot be
used for interindividual comparisons (Karpatschof &
Elkjaer, 2000). In addition, the TKI does not measure
how subjects would actually respond, which, as noted
by Saulo (1987), may be quite different from what they
say they will do. In addition, despite the fact that the
TKI has been the instrument used to measure conflict
management styles in health care in a large number of
studies, its test–retest reliability on all scales ranged
from .61 to .68, which indicates that either the scale is
unreliable or the trait is unstable. The original normed
group was composed of managers at middle and upper
levels of business and government organizations, most
of whom were men. The extent to which this group is
similar to nursing and allied health undergraduate and
graduate students is unknown.
This study does not explore preferred management
styles in actual conflict situations, nor does it evaluate
which styles are actually used in conflicts within the
health care environment. It also does not consider
the effects of the use of various conflict management
styles on the outcome of the conflict or on the larger
issues of patient outcomes in a conflictual health
care environment.
SPORTSMAN AND HAMILTON
Compromise Avoidance Accommodation
11.1 51 51
The research design of the study resulted in other
limitations. The small sample size, the disparity in
the size of the nursing, radiologic science, and
respiratory care groups, and the small number of
men in the study also limits the applicability of the
study to a broader context.
Implications
To validate the findings, the study should be replicated,
increasing the number of participants and expanding
the sample group to undergraduate and graduate
nursing and allied health students in more than one
university. The instrumentation used to determine the
choice of conflict management style should also be
evaluated to determine if another instrument might be
more reliable than the TKI.
Because this study was based only on what partic-
ipants reported as their preferred choice of a conflict
management style in an imagined conflict situation,
further research is needed to explore preferred man-
agement styles in actual conflict situations and to
identify which styles are used in the health care
environment. The impact of conflict on patient out-
comes should also be more fully explored.
Because there are no significant differences in the
prevalent conflict management styles of undergraduate
and graduate nursing, radiologic science, and respira-
tory care students, one can assume that these disciplines
are more alike than they are different regarding conflict
management style. As a result, the same educational
interventions designed to broaden the use of conflict
management styles may be offered to at least these three
health care disciplines. Combining these groups, par-
ticularly if the intervention is in the work environment,
is less expensive than an intervention designed specif-
ically for each group. In addition, combining the groups
in an educational program has the advantage of
fostering interdisciplinary collaboration.
This study found that, counter to what educators
might suspect, the level of education of the participant
made no difference in their choice of a preferred conflict
management style. Is this because conflict management
concepts are not differentiated in the curricula in
undergraduate and graduate nursing and allied health
professions? Is it because students have little opportu-
nity to practice constructive management of conflict in a
clinical environment? Exploration of the extent to
which content about conflict management is embedded
in nursing and allied health curricula, along with
opportunities to apply the concepts in clinical situa-
tions, may help to answer these questions.
The responses to the TKI in this study suggest that
undergraduate and graduate nursing, radiologic science,
and respiratory care students chose more than one
CONFLICT MANAGEMENT STYLES IN THE HEALTH PROFESSIONS
conflict management style frequently. Because construc-
tive conflict management involves selecting the appro-
priate style based upon factors in the conflict, being
comfortable choosing more than one style is an
important skill. However, less than 10% of participants
chose collaboration frequently enough to be in the 75th
percentile when compared to the original normed
group. Given the emphasis upon collaboration in
resolving conflict in health care, this finding should be
explored more fully.
Conflict management literature defines collaboration
as the attempt to work with the other party to find a
solution that fully satisfies the concerns of all stake-
holders. Today’s health care leaders advocate for the use
of collaboration. For example, Standard 2 of the Stand-
ards for Establishing and Sustaining Healthy Work
Environments proposed by the American Critical Care
Nurses in 2005 states, bNurses must be relentless in
pursuing and fostering true collaborationQ (AACN,
2005). Does collaboration used in this context actually
have the same meaning as the collaboration inherent in
conflict management? Or is it a conceptual term that
infers a range of behaviors from compromise to
collaboration? Clarity in the meaning of this term is
critical to developing strategies to implement collabo-
ration in health care, but it is outside the scope of this
article to explore this issue fully.
Collaboration, in the context of conflict management,
requires a commitment of time and interpersonal energy
to be effective. In what situations is it practical to strive
for collaboration and when is it more effective to use
other conflict management styles? Is collaboration more
likely to occur if teamwork is an integral part of the care
delivery model? Is an individual, personal interaction
between collaborators necessary? If so, how can the
night nurse that rarely sees the attending physician be
able to collaborate to ensure high-quality care? As the
tension between efficiency and effectiveness in health
care continues, these questions must be answered.
Health care delivery and the conflicts that are part of
that environment are complex and interrelated. Con-
structive conflict management involves more than
simply unconsciously responding to the identified
conflict. Consciously selecting an appropriate conflict
management style for the situation at hand and
understanding typical patterns of behavior of those
who are likely to be involved in the conflict is the first
step in constructive conflict management.
Acknowledgments
This study was funded by a Midwestern State
University Internal Grant.
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