Who Let the Dogs Out? managing Conflict With Courage and Skill Pettrcy, /f;V, MS „ he ability to communicate effectively is an essen- tial skill for every job setting. Many nurses enter the joh market because they are unhappy or frustrated in their current work environment, often because of unresolved conflict. In healthcare, people work closely together and rely on their colleagues imd other team members when caring for patients and their families. These team mem- bers come from vaiying backgrounds and cultures, and hold diverse values. This diversity, in addition to the innate stress and urgency in most acute care hospital settings, makes conflict a common occurrence. If a group does not resolve conflict effectively over time, a toxic and negative work environment is created. Effective communication skills will greatly enhance nurses' ability to influence their environment. The American Association of Critical-Care Nurses (AACN) li'adership Development Workgroup identified conflict management as 1 of 4 key leadership or "influencing skills."' Conflict management is a process of working through opposing views to reach a common goal. Key Components and Sti-ategies Controlling ILmotional Responses Controlling emotional responses is the first com- ponent of conflict resolution. Recognizing your per- sonal bias is essential in being ahle to hear other perspectives on an issue. In conflict situations, we may react almost immediately with anger or hurt, and not be clear regarding the underlying reason behind this reaction. Our instinctive response is either "fight." which may be exhibited as sarcasm or anger, or "flighl," exliibited as avoidance or silent treatment. [hese options can be expressed as "silence or vio- lence." It is important to reflect on your emotions and to identify the "story" that is behind them. Lisa Pettrey is the director of Heart, Vascular and Critical Care Services in Columbus, Ohio. Increased self-awareness is key to identifying the story that is creating your emotional response. Although it is difficult (or seemingly impossible) to take time to reflect on these issues during a busy day on a nursing unit, the more awareness you haye of your values, preferences, and "hot buttons," the easier this is to accomplish. Several resources such as person- ality inventories (DiSC tool, Myers-Briggs personality type indicators) are listed in the "Tor More Infor- mation" box on page 24. These tools can provide greater insight into your personal style and preferences. With greater self-awareness, your abilit\' to regulate or control your emotions improves because you know more about what underlies your emotional response. Self-regulation is 1 of the 5 components of emotional intelligence; it is defined as the ability lo control or redi- rect disniptive impulses and moods, and the propensity to suspend judgment, to think before acting.' Even a few moments of restraint before reacting in haste can greatly improve your ability' to.

1. Who Let the Dogs Out?
managing Conflict With Courage and Skill
Pettrcy, /f;V, MS
„ he ability to communicate effectively is an essen-
tial skill for every job setting. Many nurses enter the joh
market because they are unhappy or frustrated in their
current work environment, often because of unresolved
conflict. In healthcare, people work closely together and
rely on their colleagues imd other team members when
caring for patients and their families. These team mem-
bers come from vaiying backgrounds and cultures, and
hold diverse values. This diversity, in addition to the
innate stress and urgency in most acute care hospital
settings, makes conflict a common occurrence. If a
group does not resolve conflict effectively over time, a
toxic and negative work environment is created.
Effective communication skills will greatly enhance
nurses' ability to influence their environment. The
American Association of Critical-Care Nurses (AACN)
li'adership Development Workgroup identified conflict
management as 1 of 4 key leadership or "influencing
skills."' Conflict management is a process of working
through opposing views to reach a common goal.
Key Components and Sti-ategies
Controlling ILmotional Responses
Controlling emotional responses is the first com-
ponent of conflict resolution. Recognizing your per-

2. sonal bias is essential in being ahle to hear other
perspectives on an issue. In conflict situations, we
may react almost immediately with anger or hurt, and
not be clear regarding the underlying reason behind
this reaction. Our instinctive response is either
"fight." which may be exhibited as sarcasm or anger,
or "flighl," exliibited as avoidance or silent treatment.
[hese options can be expressed as "silence or vio-
lence." It is important to reflect on your emotions
and to identify the "story" that is behind them.
Lisa Pettrey is the director of Heart, Vascular and
Critical Care Services in Columbus, Ohio.
Increased self-awareness is key to identifying the
story that is creating your emotional response.
Although it is difficult (or seemingly impossible) to
take time to reflect on these issues during a busy day
on a nursing unit, the more awareness you haye of
your values, preferences, and "hot buttons," the easier
this is to accomplish. Several resources such as person-
ality inventories (DiSC tool, Myers-Briggs personality
type indicators) are listed in the "Tor More Infor-
mation" box on page 24. These tools can provide
greater insight into your personal style and preferences.
With greater self-awareness, your abilit' to regulate
or control your emotions improves because you know
more about what underlies your emotional response.
Self-regulation is 1 of the 5 components of emotional
intelligence; it is defined as the ability lo control or redi-
rect disniptive impulses and moods, and the propensity
to suspend judgment, to think before acting.' Even a
few moments of restraint before reacting in haste can
greatly improve your ability' to handle a situation effec-
tively. Feelings are normal and natural, but when not

3. handled appropriately, they can get us into trouble.
Seeking understanding involves exploring issues
from diverse points of view and obtaining understand-
ing of other perspectives. Steven Covey' lists "Seek flrst
to understand, then to be understood" as one of his
"Seven Habits of Highly Effective People" in his land-
mark book. Our normal instinct is to be understood, to
make our case. We listen with the intent to reply, not to
understand. Ifyou are on the "edge of your seat" wait-
ing for a break in the conversation so that you can jump
in, you cannot be truly listening. Most of us are forming
our reply while the other person is talking. The skill of
active listening is even more difficult if stakes or emo-
tions are high, but when an effort is made to deeply lis-
ten to what another person is saying, defenses go down
and effective communication begins to take place.
Identifying Common Needs and interests
Identifying common needs and interests refers to
cleariy stating what you need and clearly hearing
Critical Care Careers 2 0 0 3 CRITICAL CARE NURSE /
SUPPLEMENT, FEBRUARY 2003 21
what others need, then listing everyone's concerns.
Many times when emotions are controlled and dialogue
has hegun, it becomes clear that there is a common
goal, interest, or purpose thai can be identified. Look for
the "tliird story," or the one tbat a keen observer who
had no stake in the issue wotild tell/
Seeking Mutual Benefit

4. Seeking mutual henefit involves building on mutual
needs or goals and seeking a win-win solution. Generate
and invent multiple options. Weigh ibe options, select-
ing the best. If practical or possible, trial the solution.
Courage and Commitment
Tbese skills require commitment and practice.
Many of us are afraid to address issues in ibe work-
place. We are fearful of retribution, burting other peo-
ple's feelings, or making Ibe situation or relationship
worse. Ibc strategies of "silence or violence" are not
effective ways of coping. Oftentimes, we do not dis-
cuss our frustrations and grievances witb coworkers,
but they know there are concerns because we avoid
tbem, drop sarcastic barbs, or tell otber coworkers. Tbey
know there is a problem, but may not understand what
happened. Tbis frequent scenario leads to greater hurt
and ultimately toxic work environments. If our intent is
to strengthen a relationship, improve our ahility to
work with others, or advocate for a patient, effective
conflict resolution is always tbe best cboice.
Practical Strategies and Support
Seif-awareness is the core of all leadersbip and
influencing skills, and conflict resolution is no excep-
tion. Utilize some of tbe strategies listed in Table 1 to
provide you with information about your preferences
and ways of interacting. Understanding your person-
ality type and preferences are essential in beginning to
effectively interact witb otbers. Identifying your "pet
peeves" and knowing wbat pushes your buttons can
make a tremendous difference in your ability to man-
age confiict. These personalit)' inventories can also be

5. applied as a group and can provide inslgbt into tbe
specific Strengtbs and cballenges tbat will result from
tbe mix of types witbin tbat group.
For nursing units or other workgroups, there are
many strategies tbat can be employed as a group. The
creation of "group norms" for the team can clarify
expectations regarding key work issues and communi-
cation. These differ from clinical standards, ihey are
nonns that reflect the culture of a unit and address team
Table I Conflict Resolution'
Baseline assessment
Establish a baseline for how you deal with conflict in
general. For this exercise to be elTective, you must be
honest. Identify which of the following statements
reflects your usual approach:
a. 1 dy to pursue my own goals and sUuitl rny groiuid.
b. I try to cooperate by giviîig in on some points in
exchange ibr others.
c. I try to point out factors everyone agrees on and not
dwell on points of disagreement.
d. I try to get eveiyone involved in working out a
solution and deal with all concerns.
e. I try to ease tension and let others take responsibility
for solving problems.
KEY: a = compelilive, b = compromising, c = accommo-
dating, d = collaborating, c ~ avoidance

6. This baseline reflects how you deal witli conflict in general.
Clear-cut, riglit and wrong ways to deal with conflict are
not always apparent. Certain sitviations call for certain
responses. Recognizing the dilVerent approaches to deal
wiLh conflict can help you to see different ways to
resolve it. Knowing your baseline can help you sec aî eas
in wtiich you need to strengthen or modify your appn)adi.
Sharing exercises
Discuss how a conflict situation was handled hy using
the 4 skills.
Role-playing
Identify a situation that has meaning and assign roles to
menihers to act out the conflict. Choose a situation that
is mcaningftil to the group members.
Variations on role-playing
Make role assignments that ai-e similar to current roles
or assign opposing roles.
Assumptions on conflict
• You have 50% responsibility for causing and resolving
the conflict.
• Most conllicts can be resolved and many prevented
using the light a]>proach.
• You can't change people. You can change your own
behavior.
• Most people aren't evil. They behave the way they do

7. because they don't know how tlieir behavioi" affects
oLhei-s or becatise they have a sti'ong need to do
what they do.
Five things to do when faced with conflict
1. Remember that any conflict represents only a small pait
of your life.
2. Take action to resolve the conllict. Doing something
constructive is a great way to spend your energy
rathei- Uian beating your head against a wall.
3. Remember that conflict Is not pei-sonal.
4. Give it space. Put conflict in its place emotionally or
even physically to allow a cooling oiî period.
5. Review the situation for future i-eierence. Dealing with
conflict can be a terrific learning tool.
22 CRITICAL CARE NURSE / SUPPLEMENT, FEBRUARY
2003 Critical Care Careers 2 0 0 3
issues that often cause conflict. They can also set expec-
tations regarding how staff members communicate with
each other. Tor example, 1 group norm may state that if
a staff member has an issue with a peer, she can go to 1
other person for advice and coaching, btil that she can-
not talk to anyone else about the issue unless she has
addressed it with the peer. Another norm might slate
that staff members must offer assistance to their peers if
their own work is complete before sitting down. Staff

8. must hold each other accountable for the norms.
Safe practice and role-playing can often be helpful.
Practicing the skill of providing feedback to others by
using situations that are meaningful to the group can
greatly Increase skill. When role-playing a situation, it
may be helpful to have team members play roles
opposite to their normal roles. For example, a patient
care technician and a nurse may role-play a situation,
each playing the other's role.
Application of conflict situations to the 4 key com-
ponents can be helpful. An application example is
provided in Table 2. The same process can be used in a
staff meeting or team meeting using a situation that is
creating conflict on a unit, or the model can be
applied to personal conflict situations.
Summary
Although nurses often think in terms of clinical
ability when discussing competence, strong interper-
sonal communication skills are also essential for effec-
tive practitioners. Conflict management skills are key to
creating work environments with good retention, work
satisfaction, and high-quality measures. Nurses desir-
Tlable 2 How does this apply to mc.with patients and families?'
Setting: It was a very busy evening on the unit, and Sarah hadn't
even had time to get to dinner. Slie was caring lor one newly
admitted patient whose hlood pressm-e was fluctuating
eiralically. and slie was aiso assigned Mr Archnian. ¡s she was
leaving
Mr Archman's room, she saw his wife appi'oaching. Mrs

9. Arcliman iisked Sarah when Dr Gutzman had last heen to see
her
husband. Sarali wasn't sure bul Üiought he liad been in earlier.
Mi-s Ai-chman hecame verĵ upset, "I demand that the doc-
tor talk to me immediately. I haven't seen him for two days."
Sarali knew she didn't have time to dea! with these complaints.
Sarah feels angry aiid fi-ustraled that she has to deal with a
problem that she did not
cause. Sarali recognizes that Mrs Arcliman is upset tor many
reasons besides the
lack of communication bul that is no reason to take it out on the
nurse. Sarah knows
from t:alking witli other staff that Mrs Archman is a demanding
family member, and
some staff members have heen trying to avoid her.
Control emotions and bias
Seek understanding
Identify needs and
common interests
Seek mutual benefits
Outcome
As Sarali is faced with Mrs Arcbman, she takes a dee|i hreatb
and says. "I would like to
talli with you about your concerns. Right now. 1 have to check
on another patient.
Would you like to sit dowii? I will be with you in a few
minutes." Mi-s Archman
takes a seat in hei- husband's room. This allows Sai-ah to gather
her thoughts and

10. make sure her other patient is cared for.
Once Sarah completes her work on her other patient, she returns
to Mrs Archman and
says, "You seem to be very upset about your husband's cai-e.
What can I do to help
you?" Mis Archman gives Sai-ah a list of concerns ahout her
husband's caj-e and says
that tile 2 higgest concerns are that no one seems to talk to her
about his condition
and tbat she hasn't been able to rest since he was admitted.
Sarah encouraged Mrs
Archman to express her fears ahout her husband's status and
explained some of the
treatments and procedni'es tbat had occun-ed in the last 24 houi-
s.
Sarah went on to explain that the staff and the doctors are all
working together to give
the highest quality of care to Mr .Archman. She noted that staff
is busy but there may
be a way to provide the communication Mrs Archman wants,
thus heipijig her to be
more relaxed so she could rest. Mi's Archman agi'eed that what
she wants is the best
for her husband. Sarah identified ways the stall' could help to
keep Mi-s Archman
informed by calling lier at home each moniing and meeting with
her when sbe comes
into the unit. Sarah also helped Mrs Archman I'ÜCILS on
specific questions to ask her
husband's physician and write them down so she would get the
infonnation she
wants. Sai-ah shared hei- plan with the other stall", and they
agreed it might he helpful.

11. Later in the shift, Sarah saw Mrs Archman as she left the unit to
go home. Mre
Archman said, "You have been veiy helpful and seem to really
care. Thank
you." The staff noted tliat Mrs Archman was much more relaxed
when she came to
the unit. Mr Archman's condition improved, and a basket of
cookies arrived on the
unit from the couple when he was discharged from the hospital.
Critical Care Careers 2 0 0 3 CRITICAL CARE NURSE /
SUPPLEMENT, FEBRUARY 2003 23
For More Information
DiSC: Dimensions of Behavior Personal Profile. Syslam 2800
Series. Chicago. 11: Carlson Learning Company, Center for
Internal (^ange; 1994.
Effective Communication. Feedback, and Listening. Available
at:http://web.c.b8.neu.c;du/-(:wertheiin/interper/
feedbark.htm. liLt[)://wwvv.di.scoveryoiirpersonality.rom/
MBTl.hüiii? source=looksniai't
Stirijrc PM. Kleint:i- A, eds. Vie Fifih Discipline Fieläbook:
Strategies
und Tools for Building a Learning Organization. New Yock,
NY:
Bantam Doublcday; 1994.
Bvans S. Cohen SS, Hot Buitims: ¡low io Hesolve Conflict and
Cool
Even/one Down. New York. NY: Haiper Cotliiis; ^ÜOL

12. innian-Ebel B, 1999. Taik Is Not Cheap! Saving tke High Cost
of
Misunderstanding at Work and Home. Marietta, Ga: Bard
Press.
Gilbert ifA, Haw to Win an Argiimenl: Surefire Strategies for
Getting Your Point Acnm, 2jid ed. .New York, N>': MJF Books;
2001.
Tssaiis W, SL'iige P. Dialofíiie and the Art of Thinking
Together: A
IHoncering Approach ta Communicating in Business and in
Life.
New York, NY; Doublcday Putîlications; 1999.
ing to learn to communicate with courage and direct-
ness can master these skills, contributing to environ-
tiienis where caregivers can collaborate in providing the
highesl quality care.
. A C K N O W L E D G M K M
The ;iulhin' acknowit'ilgcs ilic tW)-il)()2 l,i:adfi-slil|)
Itodopaiem Work Oroup for
liii'ir ilulicUfd work ami amtrilnilidiis Üial Mi)cd créale It's Afí
About You: A
tihiepn'ntjbr Injhiencing ¡'riictia'. referenciid in Ihis article.
1. .American Assodalion of Crilical-Care NursfS. / / Alt About
You: A
Bluiipriitt for Influencing Practice. Aliso Viqo. CíiÜl": AACN:
200i¿,
2. PatUTson K, Greiiny J, McMillan R, Switzler A. Crucial
Conversation:
Tnob for i'atking Wien Stakes Are. High. f!w Vbr-li. NY:
McGraw-Hill:

13. 2üO2;31.
3 Goliíüían D. Wiirking With Emotional Intelligence. New
York, XY: Baiitüiii
Uooks: 1998.
4. Covey S. Seven Habits of Highli/ Effective Pmpk. N'ev Yni-
k, NY: Simon &
Srhiister: 1989:235-240.
5. Slorif D, Patton B. Hepii S. Di/fkiilt Conversations: How to
DÜCIÍÜÍÍ lV¡i(ii
kitte>y MosI New York, N>': IVnjriiifi Piil.iiam; 2000:149,
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