Conflict resolution in nursing is a skill that is underappreciated, underdeveloped, yet completely necessary each day. Once treated as assistants rather than peers to physicians, nurses have fought against that stigma for years and have proven to be a vital part of the healthcare system. Let’s not forget, the nursing field holds its weight, too, with interdisciplinary collaboration, scopes of practice, and career development as a health-oriented profession.
Despite statistics that prove nurses are an essential part of the healthcare team, there are still perceptions among healthcare professionals that nurses are “assistants” to physicians and the nurse-physician relationship is often strained. As a result, workplace conflict can arise. This guide will explore that relationship and leave nurses with practical advice on effective conflict resolution in nursing and dealing with difficult doctors.
COVID-19 and the tension between nurses and doctors
With the increased stress from COVID-19, many feel the tension between nurses and doctors has increased. In a private Facebook group for nurses, one nurse asked members if they’ve noticed doctors have become ruder since COVID-19 started. The post received hundreds of comments with nurses venting about their concerns with doctors since the pandemic.
With hospital policies, CDC, and department of health guidelines constantly changing, mistrust and aggravation among healthcare professionals continue to rise. Physicians feel they have to justify their medical decisions, while nurses aren’t getting the support they need and feel they must defend their ability to care for their patients. These situations, paired with short-staffing and some facilities not having the support and supplies they need to care for patients, are a recipe for stressful environments, tension-filled workplaces, and interpersonal conflict.
Conflict resolution for nursing: How to deal with difficult doctors
We learned in nursing school that excellent communication between a nurse and patients’ interdisciplinary team, including the physician, improves patient outcome and creates a professional and healthy work environment among disciplines. But it can be difficult and overwhelming when interacting with a doctor who is perceived to be rude, disrespectful, or demeaning.
These types of conflict or tension can start from anywhere: A nurse corrects a doctor related to a medication. Or a doctor makes a nurse feel incompetent in front of their peers or a patient. A nurse calls the doctor in the middle of the night. Maybe a physician yells at a nurse and speaks in a condescending tone.
Conflict resolution for nursing is really no different than resolving conflict in other relationships. But, how do you handle these situations and actually resolve conflict? Here are seven ways to improve communication skills and your workplace experience, demand respect, address bullying or harassment, and avoid confrontation with a doctor.
1. Communicate clearly and assertively to resolve conflict
Conflict resolution in nursing requires a lot of communication. Use communication tools like the Situation-Background-Assessment-Recommendation (SBAR) to relay all pertinent patient information. Doctors are busy and see a lot of patients, so their time is valuable. It’s your responsibility, to yourself and to patient safety, to ensure that you communicate all information that the provider should know and that they have a clear picture of any concerns you have regarding your patient.
Remind the doctor that you are a part of the patient’s healthcare team and your assessments, findings, and concerns are valid. Also, remember to be assertive. You are as equally important as any other member of your patient’s healthcare team. You are not the doctor’s assistant and, depending on the environment, they’re not your boss. As a nurse, you have a license to protect—just as doctors do—and the right to demand your respect.
2. Be direct
Sometimes, the physician is not aware their interactions with others are considered difficult or demeaning. Address the issue head-on by letting the physician know you feel disrespected and give clear examples:
- “The tone in which you spoke to me was demeaning or rude.”
- “The way you spoke to me, in front of the patient, was unprofessional and rude.”
- “The comment you said Tuesday during your rounds was inappropriate, and I’d appreciate it if you didn’t speak to me like that again.”
Much of conflict resolution for nursing is being aware of when to resolve. It may be best to handle the matter privately, if possible, to avoid further confrontation.
3. Remember, doctors are human too and are just as busy as nurses
An important element for conflict resolution in nursing is maintaining awareness of the responsibilities of your coworkers. Before you page or call a physician, be sure to have everything you need to present. When the physician is rounding, try to have all of your questions and concerns ready so that you don’t have to interrupt them when they are with other patients, on another unit, or at home. Remember, they also have lives in their hands and deal with large amounts of stress and pressure. You can quickly acknowledge their busy workload when speaking to a physician. For example, “I understand you’re really busy right now, so I’ll try to make this quick.” Or, “I’m sorry to call you so late. I’ll try not to hold you for long.”
4. Ask yourself, am I just annoyed with this person?
Sometimes personalities don’t mesh, and some people just don’t get along. Think about your interactions with the doctor and determine if the tension is there because they created it or if you genuinely just do not like or care for one another. We are all human, and that is okay. Ask yourself: “Is the doctor really creating tension, or am I just annoyed with them?” If it’s the latter, brush it off and find ways to make the most comfortable work environment for all parties involved. For example, you can ask another staff nurse to round with, call, or give reports to the doctor. Be proactive when resolving conflict as a nurse.
5. Report behaviors of abuse and harassment
Nurse bullying is a prevalent issue in the healthcare industry. But if you feel a physician is bullying or has attacked you, you should report it immediately. It is important to try to resolve conflicts at the most appropriate time, which is often right after the incident. Too many times, nurses sweep things under the rug. If you do not report these incidences, then they can not be addressed. Remember, you do NOT have to tolerate abuse, harassment, or bullying. You should always report:
- Sexual harassment or assault
- Threats of physical harm
- Physical assault
- Any derogatory epithets or slurs (race, color, religion, gender, national origin, age, or disability)
You can learn more about workplace violence and nurse bullying from the American Nurses Association.
If you or someone you know is a victim of sexual harassment or assault, to speak with someone trained to help, call the National Sexual Assault Hotline at 800-656-HOPE (4673).
6. Know your chain of command for reporting incidents
Most organizations have a chain of command, so it’s important to know yours for reporting incidents. The first person in your chain of command is usually your charge nurse, followed by your unit manager or director of nursing. However, if they fail to address the issue, most healthcare organizations have a safety or compliance officer you can reach out to. But if your facility does not have an officer, then the human resource director may be whom you should see.
7. Learn your facility’s policies and procedures
These safety or compliance officers oversee, develop, and revise the facility’s quality assurance and risk management plans, including employee-to-employee abuse reports. It’s their job to find ways to address these incidents and create policies and procedures to prevent them in the future. If you’re interested in learning about the policies and procedures, find out who your facility’s compliance officer is and then ask them about the process for reporting workplace bullying or harassment. And if you are reporting an incident, always follow up with them until the issue is resolved.
Bottom line, there are practical ways to implement effective conflict resolution in nursing and improve communication with doctors. But remember, you have the right to demand respect. Nurse bullying or harassment of any kind in the healthcare setting shouldn’t be tolerated and should always be reported.
Causes of conflict in nursing:
Despite establishing a professional code of conduct in the workplace, conflicts among nurses and other healthcare professionals arise more often than they should. To resolve conflict (and prevent it), it is important to understand how it arises. Conflict can bear its head in many ways. From a nurse’s perspective, some triggers can include:
- Unreasonable expectations
- Unfair criticism
- Lack of communication
- Preferential treatment
- Sexism or racism or discrimination
- Being insulted,
- Arbitrary rules
- Coworkers who do not fulfill their part.
Remaining aware of these triggers can allow for preventative action to be taken in order to avoid any behavior that would elicit a negative response.
Types of conflict nurses encounter:
– Task-based: This conflict occurs when two nurses (or any other healthcare professionals) disagree on a procedure or technique. For example, if a nurse uses a bandaging technique that differs from that of another nurse. There may be multiple ways to bandage a patient’s injury, but there may be a certain way to do it that is better than another way. Collaborate with your managers and coworkers to discuss the varying outcomes of the different techniques.
– Value-based conflict: When two nurses have different personal values and beliefs. This happens often, and it can create tension. It is important to navigate these conflicts with empathy and an open mind.
– Interpersonal-based conflict: When nurses or nurses and their patients disagree, that can be an interpersonal conflict. For example, if a patient disagrees with a nurse’s assessment or recommendation.
– Intrapersonal conflict: Another form of internal conflict. Intrapersonal conflict can be a nurse who feels the pressure to balance their job duties, personal life, and beliefs. Ethical dilemmas are often a source of this type of conflict. A nurse at work may feel conflicted if their child is home sick.
– Intersender conflict: This conflict arises when a nurse receives different messages from different sources.
Examples of conflict resolution for nurses:
Example 1:
The department has been busy all day. Your nursing team is experiencing a consistently moderate to high workload. To make matters worse, you’re down a coworker to the stomach flu. When lunchtime approaches, your manager pulls you aside and asks if you can take a working-lunch, instead of your usual 60 minutes away. What do you do?
- Tell your manager you agree to have a working-lunch for 30 minutes, and the other 30 minutes you’ll take as you usually do, away from your desk.
- Ignore your manager, no one is the boss of you!
- Agree to your manager’s request and have a working lunch.
- Politely decline your manager’s request and take your 60-minute lunch break how you see fit.
The correct answer here is any of them except B! The main takeaway here is to communicate your needs clearly to your manager. This may include setting boundaries or volunteering. For example, you could say: “Mrs. Ratchett, I understand your request for me to take a working lunch today to help with the volume of patients, and today I volunteer to help with your request, however, I would like you to know that next time I will be taking my full lunch as I usually do. My lunch break is a valuable time for me and when I give that time up, it can really negatively impact the rest of my day and my mood. Thank you for understanding”
This response is understandable, honest, mature, and direct. You are not killing your manager’s request, instead, you’re volunteering to help with her request, but you’re also setting clear boundaries for yourself. A+
Example 2:
You’re in an examination room with a Dr. and a patient who is in for a follow-up. When reading over the previous visit’s notes, the doctor finds a mistake and chastises you in front of the patient for messing up again. What do you do?
- Remain silent and keep the interaction to yourself, maybe tell your shrink.
- Immediately tell the doctor you do not appreciate their comment, in front of the patient.
- Tell the doctor you did not appreciate their comment once the patient has left, and then inform your manager.
- Find an appropriate time and place to confront the doctor about their comment and maturely explain how it made you feel.
First, let me remind you: confronting the doctor (or any other healthcare professional) in front of the patient is never a good look for either party involved, including the company itself. As long as you didn’t pick A or B, then you’ve selected the right answer. As in many scenarios in nursing, “it depends”. The main idea here is that you need to find the right time and place to address the doctor or whoever offended you. This can be tricky, as one needs the emotional intelligence to remain composed, despite the insult, and the maturity to articulate their feelings in an effective manner (aka communication skills) when the time is appropriate. For instance, you could say,
“Excuse me Doc, may I have a moment of your time, I know you’re very busy today– as am I. I feel it is necessary to bring to your attention that I was offended by your comment earlier. It was insulting and embarrassing and I need you to stop all comments like that. Instead, if you have a problem with my performance or see anyways in which I can improve, please bring that to my attention in a responsible way. Thank you for understanding.”
This response is mature, direct, and forward-thinking. It provides a solution and it confronts the problem directly. A+
Why conflict resolution in nursing matters:
Conflict resolution in nursing helps keep productivity levels optimal as well as the environment safe and inclusive. Make no mistake, a strong healthcare team will have the ability to resolve conflict well, and in doing so, they will:
- Increase efficiency
- Increase patient and employee safety
- Reduce patient errors
- Bolster communication among staff
- Collaborate more frequently
- Boost morale
Quick hit conflict resolution tips:
- Assess the situation
- Understand the conflict – clarify the source, investigate the situation
- Find a safe and private place to talk and address the conflict promptly.
- State your concerns clearly and calmly
- Focus on the issue rather than the person involved
- Listen with an open mind and let everyone have their say
- Collaborate through dialogue, and determine ways to meet the common goal, agree on the best solution, and determine the responsibilities each party has in the resolution
- Follow up with others if needed
- Evaluate how things are going and decide preventative strategies for the future
Aspen University offers online RN to BSN, MSN, and DNP programs to help you advance your nursing career. For aspiring registered nurses, consider Aspen’s BSN Pre-Licensure program.
Portia Wofford is an award-winning nurse, writer, and digital marketer. After dedicating her nursing career to creating content and solutions for employers that affected patient outcomes, these days, Portia empowers health practices to increase growth opportunities and become the number one providers in their communities through engaging content that connects and converts. Follow her on Instagram and Twitter for her latest.