A survey of conflicts at work and their impact on nurses

JOURNAL OF MILITARY PHARMACO MEDICINE N03 2022 184 A SURVEY OF CONFLICTS AT WORK AND THEIR IMPACT ON NURSES Nguyen Hoang Long1, Pham Tien Dung2 Summary Objectives To describe the conflicts between nur[.]

A SURVEY OF CONFLICTS AT WORK AND

THEIR IMPACT ON NURSES

Summary

Objectives: To describe the conflicts between nurses and other hospital

personnel, and examine nurses’ perceived impacts of those conflicts on their

work performance and health Subjects and methods: In this cross-sectional

survey, a convenience sample of 202 nurses (of the 288 invited individuals)

provided consent to participate in the study Data were collected from March to

June 2021 using self-administered questionnaires Participants were asked to rate

the frequency and impact of conflicts with other nurses, direct supervisors,

physicians, other healthcare staff (e.g., dieticians, physical therapists,

pharmacists), and non-healthcare staff Results: Nurses reported a high

prevalence of conflicts with other nurses (89.6%), direct supervisors (65.9%),

physicians (77.7%), other healthcare staff (63.4%), and non-healthcare staff

(61.4%) The impact of nurses’ conflicts with direct supervisors was rated the

highest (1.46 ± 1.09), followed by conflicts with physicians (1.37 ± 1.08),

non-healthcare staff (1.35 ± 1.00), other nurses (1.34 ± 1.21), and other healthcare

staff (1.22 ± 1.03) Conclusion: Both intra- and inter-professional conflicts of

nurses should be addressed properly Special attention should be paid to

nurse-nurse manager, nurse-nurse-physician, and nurse-nurse-nurse-nurse conflicts

* Keywords: Conflict management; Healthcare personnel; Inter-professional

conflicts; Workplace conflict; Nurses’ conflicts

1 College of Health Sciences, VinUniversity

2 Department of Nursing, National Hospital of Dermatology and Venereology, Dong Da District

Corresponding author: Nguyen Hoang Long (long.51@hotmail.com)

Date received: 23/3/2022

Date accepted: 21/4/2022

INTRODUCTION

In hospitals, healthcare professionals

with different backgrounds, schools of

thought, and fields of specialty work

together for the common goal of ensuring

safe and quality services Work is

often demanding and stressful, with

overlapping roles and responsibilities [1]

It has been reported that most

healthcare professionals observe or

experience conflicts on a weekly basis

[2] Various negative outcomes of

conflicts in the healthcare sector have

been discussed, such as decreased team

performance, reduced trust, poor

mental health, and drained personal

resources [3] A recent study found

that four in every ten conflicts that

occur in hospitals might have potential

adverse outcomes for patient care [2]

Nurses’ functions require a wide range

of interactions among themselves, as

well as with other healthcare

personnel This makes workplace

conflicts a significant issue among

nurses [4] Dewetty and Osborne [5]

indicated that over 53% of nurses who

participated in their survey reported

frequent workplace conflicts

Researchers have examined both

quantitatively and qualitatively the

types of conflicts, conflict management styles, and consequences of conflicts among staff nurses, nurse managers, and nursing students The findings suggest that nurses face various types

of intra- and inter-professional, and tend to use less preferred management styles (e.g., avoiding or forcing) to solve these conflicts [4] Inter-professional conflicts are believed to hinder nursing quality, and timely and patient-centered care [2] Nurses, like other healthcare professionals, also suffer from stress, fear, irritability, low self-esteem and confidence, stomachache, headache, withdrawal, and isolation as a result of workplace conflicts [3] Therefore, finding ways to improve conflict management is important to promote the quality of patient care, a healthy work environment, and nurses’ health [3, 4, 6]

However, to date, the association between the occurrence of conflicts and their impact on nurses remains unclear Obviously, the trouble caused

by different types of conflicts is not the same, and conflicts with more impact should be managed properly This

study aimed: To describe the conflicts

between nurses and other hospital

personnel, and examine the relationship

between these conflicts and nurses’

work performance and personal health

The findings are expected to help

identify conflicts that may require

more attention than others

SUBJECTS AND METHODS

1 Subjects

Participants were nurses attending

professional development programs at

the Faculty of Nursing, Thai Nguyen

University of Medicine and Pharmacy

Data were collected between March

and June 2021

The participants were recruited using

a convenient sampling method

All students who took courses in the

second semester of the academic year

2020 - 2021 were invited Among the

288 students, 202 students (70%) gave

consent and completed the survey

2 Methods

This was a cross-sectional study

Self-administered questionnaires

were used to collect data The

demographic questionnaire obtained

participants’ basic information, such

as age, gender, work experience, and

work position Participants were asked to rate the frequency of conflicts

with other nurses (1 item), direct supervisors (1 item), physicians (1 item), other healthcare staff (e.g., dieticians, physical therapists,

pharmacists) (1 item), and non-healthcare staff of the hospital (1 item)

The frequency ranged from never (0), sometimes (1) to frequently (2), and very frequently (3) Once the participant declared conflicts with others, he/she was asked to evaluate the impact of such conflicts on his/her work performance (1 item) and personal health (1 item) The rating scale consisted of four levels: no (0), a little (1), much (2), and very much (3)

The total impact-of-conflict score with each type of personnel is a sum of its relevant impact-on-work performance and impact-on-personal health scores

The sample characteristics of participants and occurrences of conflicts are depicted using descriptive statistics The study was approved by the ethical review committee of Thai Nguyen National Hospital (decision number 234/HDDD-BVTWTN, dated

on March 25th, 2021)

RESULTS

Table 1: Characteristics of participants (n = 202)

The mean age of the participants was 34.6 ± 4.8 years, and their work experience ranged from 1 to 32 years Most of the participants were women (82.7%) Nurses with administrative positions accounted for 9.4% of the participants Remarkably, nearly seven out of ten participants (68.8%) were working in inpatient wards

Characteristics Frequency Percentage

(%) (min - max) ± SD

(23 - 53)

(1 - 32) Gender

Professional Education

3-year college degree and higher 156 77.2

Work position

Department

Non- or para-clinical department 34 16.8

Table 2: Nurses’ conflict with colleagues at work (n = 202)

Most of the nurses reported frequent conflicts with others, for example, with nurses (89.6%), direct supervisors (65.9%), and non-healthcare staff (61.4%)

Frequency of conflict Frequency Percentage (%) ± SD

The mean score for conflict with other nurses was the highest (0.92 ± 0.37), followed by conflict with physicians (0.82 ± 0.49)

Table 3: Impact of conflicts on nurses

Types and impact of conflict ± SD Min - max

With other nurses (n = 181) 1.34 ± 1.21 0 - 6

With direct supervisors (n = 133) 1.46 ± 1.09 0 - 4

With other healthcare staff (n = 128) 1.22 ± 1.03 0 - 4

With non-healthcare staff (n = 124) 1.35 ± 1.00 0 - 4

The impact score for each category of personnel was calculated from the responses of participants who reported having conflicts with that group For

example, 21 nurses reported no conflict with other nurses (Table 2) The impact

score of conflicts with other nurses was then calculated from the information obtained from the remaining 181 respondents (1.34 ± 1.21)

The impact score of conflict with direct supervisors ranked the highest (1.46 ± 1.09) The lowest impact score was reported for conflicts with other healthcare staff (1.22 ± 1.03) In general, the scores on the impact of conflict on work performance were higher than those for personal health in all groups

DISCUSSION

The current study found that nearly

nine out of every ten nurses (89.6%)

reported conflicts with other nurses

Conflicts with nurse supervisors were

also highly prevalent (65.9%) Nurses’

conflicts can occur among peers or

across generations [6] Interestingly,

although toxic behavior, such as

bullying, verbal violence, and aggression,

is common in conflict situations, it

tends to occur in private [6], and less

experienced nurses are at a higher risk

of being victims of such manners [7]

This reality contradicts the fact that a

supportive and friendly environment,

which helps to resolve conflicts

effectively, is an essential factor in

retaining nurses [8] In other words,

nurses and nurse managers should pay

special attention to the effective

management of intra-professional

conflicts Conflicts at workplace occur

because of several reasons, which

range from nurses’ personal attributes

(e.g., age, background, values, stress

levels, communication styles) to group

or organizational characteristics (e.g.,

culture, staffing model, workload,

conflict management system) [2, 3, 5,

7, 8] Therefore, the approach should

be comprehensive but tailored to

specific institutions

Nurse-physician conflicts were ranked

as the second most common type of conflict in this study (77.7%) Nurses and physicians work closely under the interplay of various independent and interdependent roles and responsibilities, which tends to give rise to conflicts

Conflicts between nurses and physicians emerge from differences in professional judgments, goals, experience, and positions in the work hierarchy [6];

poor communication is believed to be a major cause behind such conflicts [3, 9] A review by Tan, Zhou [10]

revealed that nurses and physicians had different communication styles, and they both had suboptimal communication skills To enhance communication

improvements in mutual understanding, trust, respect, and collaborative attitudes were recommended [10]

More importantly, early interventions enhancing nurse-physician communication should be implemented not only at healthcare institutions but also at medical and nursing schools [9]

Studies have reported an increase in nurses’ motivations when they are able

to work collaboratively with physicians,

on recognition of their autonomy, and when conflicts are managed

constructively [6]