Interpersonal Conflict in the Healthcare Work Environment

In my experience, the healthcare work environment is incredibly emotionally charged. Health care providers pour out empathy yet, often, this empathy is not recharged, frequently leading to conflict. Unfortunately, I found that interpersonal conflict in the healthcare work environment is often accepted as inevitable. An imbalance of power and authority can create a culture of workplace hostility and decreased patient safety.

Health care providers are often intimidated to speak up due to repercussions on themselves, thus placing patients in risk and potential harm. Kirk (2011) defines this as moral distress stemming from factors such as perceived powerlessness and ineffective communication, which can result in frustration, self-doubt, decreased patient satisfaction, and increased organizational costs. A culture of acceptance that conflict is inevitable can lead to acceptance of poor behaviors and an imbalance of power. However, this does not have to be a foregone conclusion. Conflict can be healthy and addressed professionally.

The Department of Defense (DoD) and the Agency for Healthcare Research and Quality (AHRQ) addressed this issue through the development of the TeamSTEPPS® program. The philosophy is that teamwork and communication can transform the culture of healthcare while preventing and mitigating medical errors and patient injury. In a previous role as a staff nurse in a Pediatric Intensive Care Unit (PICU), I had the fortune of being under unit leadership who believed in the change to this culture. Each staff member, including RN’s, MD’s, APRN’s, RT’s, and Pharmacists who worked in the PICU attended the TeamSTEPPS® program. This program taught multiple disciplines to respond quickly as a team with effective and respectful communication. The group learned communication skills, such as how to address problems and quickly remedy situations professionally, including in front of family members, and that safety is everyone’s responsibility. For example, if a team member was not communicating well or performing a skill ineffectively, any other team members involved were expected to speak up and address it using probing questions, constructive criticism, and appropriately intervene. The change in culture felt awkward at first but became 'normal' over time with that team. Unfortunately, as the team falls apart, so does the gains, so we must realize that this is a continuous process. The American Nurses Association (ANA) Code of Ethics for Nurses states, “the nurse owes the same duties to self as to others” (ANA, 2015). It's the proverbial "put on your own oxygen mask first before helping others." We must continually remind ourselves and each other to fuel ourselves.

References:

Agency for Healthcare Research and Quality (2019). TeamSTEPPS® Rapid Response Systems Guide. Retrieved from https://www.ahrq.gov/teamstepps/rrs/index.html

American Nurses Association. (2015). Code of ethics with interpretative statements. Silver Spring, MD. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics-For-Nurses.html

Johansen, M. L. (2012). Keeping the peace: Conflict management strategies for nurse managers. Nursing Management, 43(2), 50–54. doi:10.1097/01.NUMA.0000410920.90831.96

Kirk, S. (2010). Moral distress: A literature review. The Arizona Bioethics Network.