Authors

  1. Angelo, Elizabeth MSN, RN-BC, CPHQ, NEA-BC

Article Content

The highs and lows of leadership have one thing in common-people. Working with people is the most meaningful aspect of our jobs and, often, the toughest and most draining. Dealing with difficult personalities is a part of every nurse leader's career. Like many aspects of leadership, having a thoughtful and consistent approach can make all the difference. This article shares tips for effectively navigating interpersonal conflict.

  
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Impact of interpersonal conflict

Incivility in healthcare is well documented and may present in both overt and subtle ways.1-4 Unprofessional and disruptive actions can compromise patient safety, increase turnover and absenteeism, and reduce joy in work.2,4 Common sources of conflict include passive-aggressive communication, clique behaviors, lateral or vertical aggression, and other types of incivility.5,6

 

Consider the following negative behaviors:

 

* defensiveness. It's human nature to deflect when we hear something negative about ourselves. Often, employees will try to steer critical conversations to focus on someone else's shortcomings instead. Be prepared with specifics that are difficult to refute and calmly redirect by stating that this conversation is focused on the employee and how you can help him or her improve. Remind employees that you're invested in their success and you owe it to them to share this information for the good of the team.

 

* victim mentality. A team member may feel that he or she is being unfairly singled out or held to a higher standard. You may hear comments such as, "You never told me I needed to do that" or "How come other people aren't getting in trouble for this?" Remind employees that personnel conversations are confidential and you can't comment on other interactions, but you're holding them to the same standard as everyone else and the expectation was clear.

 

* passive aggressiveness. Confront passive-aggressive communication as directly as possible such as, "I was disappointed to hear from your peers that you're upset about (policy, schedule, behavior standard, and so on). You didn't express those concerns to me. My expectation is that you communicate with me directly if you have a concern to bring forward."

 

* vertical aggression. Sometimes strong or experienced staff members will bully new leaders. Address this head on and state your expectations such as, "I'm sensing that you don't support some of the changes we need to make. Your peers look up to you and value your expertise. I'm counting on your support as I learn about this department. I'll be looking to you to set the example for the behaviors and culture we want to have here and to follow policy so that others know it's the expectation."

 

* bullying. If you have clear evidence that someone is being bullied, it needs to be addressed right away. Be prepared with clear examples of actions either taken or left undone, as well as the impact these actions had, how you expect things to change, and when you'll follow up.

 

* the informer. Often, performance information is relayed by an employee's peer. This can put leaders in a difficult spot, especially if it's about an issue that lacks objective evidence. Unless it's an urgent patient safety matter, ask the team member to hold his or her peer accountable and help with the scripting to do so. If you hear the same information from more than one peer, it's probably time to talk to the employee yourself such as, "I'm concerned about what I've heard from several team members..."

 

 

These behaviors pose a challenge for even the most experienced nurse leader and can spread if not addressed effectively.7 Interpersonal conflict can critically hamper communication, leading to errors and patient harm.3,4 Despite the prevalence of incivility and interpersonal conflict, nurse leaders are challenged to recognize and address negative behaviors in a timely manner.8 In addition, nurse leaders may unwittingly contribute to patterns of poor performance by not holding employees to a consistent standard, making excuses for difficult employees and situations, and hoping that the problem will resolve itself.7

 

Dealing with conflict

Every nurse leader should develop a toolkit of consistent practices to approach difficult situations with clarity and confidence. Consider the following tools for success.

 

First, be consistent. Are you confident that your team knows your expectations? Are your expectations unspoken and implied, or have you clarified them in team meetings, protocols, and published department norms? And can you honestly say you apply these expectations consistently and fairly across your team? You can potentially save yourself many uncomfortable conversations throughout the year by reviewing department norms at least annually during a team meeting. Include well-known, but often problematic, standards, such as dress code, attendance, paid leave, behavior, and other norms. Spelling out what's expected also gives you a clear frame of reference if you do need to address an issue because you know when the employee was last reminded of the policy. Don't apologize for what's expected, and don't assume that it's already well understood. Convey to your team that you feel they deserve to know exactly what's expected of them and have the chance to review the standards at least once each year to ensure everyone is on the same page.

 

Beyond consistently setting expectations and following through, it's important that your team has an idea of what they can expect from your interactions with them. Have you ever worked for an unpredictable leader who was sometimes friendly and at other times angry? I've known nurses who were physically ill before a shift because they dreaded the interactions they might have with a leader who behaved erratically. Nothing discourages a team more than a leader who's inconsistent in his or her behaviors and expectations. Before we can challenge others to improve, we may need to do some self-reflection.

 

Keep the team in mind. Negative behaviors aren't just a drain on you as a leader, they also significantly impact your team. Engaged and high-performing employees find it discouraging to witness a coworker's poor performance go unchecked. If you want to continue to build your team with people who care about their work and are genuinely invested in improving their workplace, it's essential to address poor performance and negative attitudes.

 

Do you remember the feeling of anticipation before the department schedule comes out? Schedule publication is often a highly anticipated event. Beyond seeing when they're scheduled, employees want to know with whom they'll be working. We all know the feeling of relief when we see a trusted coworker coming to help, or disappointment when it's someone who doesn't pull his or her weight. Team dynamics makes all the difference during a tough shift. Are there employees on your team with whom no one wants to work? Are there sighs or eye rolling when you state who's coming in to help? If so, you owe it to the team to figure out what's going on and address it. Teamwork and team dynamics have a very real impact on employee retention and patient safety. High-performing teams are more likely to deliver solid clinical outcomes, have fewer sentinel events, and lower turnover rates-all good reasons not to turn a blind eye to the employee with whom no one wants to work.1,2,4

 

Get your mind (and heart) right. The best time to deal with a personnel situation is the soonest you can do so both calmly and kindly. Before you address a challenging employee, it's vital to take the time to ensure that you're in the right frame of mind. Refocus yourself on your purpose: You're here to serve patients and staff. You're here to nurture individual employees and grow their talents. And you're here to build a team that's connected to their mission and the people they serve. With your employee's best interest in mind, every difficult conversation should begin from this perspective.

 

If you're angry, distracted, or rushed, the conversation won't be as powerful or meaningful as it can be, and you risk having an uncomfortable encounter that does more harm than good. It's key to approach the interaction with a genuine desire to provide feedback that will enable the employee to improve. Hold important conversations at a time and place that demonstrates respect for the employee's privacy and allows you to minimize distractions and interruptions.

 

Convey worth and dignity. The employee in front of you is a professional with life experiences, training, talents, and skills. He or she wants to be respected as a valuable member of the team and wants you to remember that life outside of work isn't always smooth sailing. The employee may be balancing multiple demands, and there's more than one side to every story you've heard. Just think, some employees have never had the benefit of working with a consistent and caring leader. And some employees have never worked with a leader courageous enough to call out negative behaviors and poor performance and expect more from them.

 

When your words and demeanor convey to employees their worth and dignity in every interaction, you begin to build trust. And trust is the foundation for growth. None of us likes to be talked down to or treated indifferently. Each of us wants to feel seen, heard, and known as an individual. Receiving feedback from someone who we know is invested in our success is different than being corrected by someone we don't respect. You can find positive and proactive ways to reinforce what's going well and correct what isn't.

 

It's essential that your employees don't only hear from you when something is wrong. Recognition is a powerful (and often underutilized) tool to build trust and convey what types of actions are valued on your team. Call out positives in an email, a note to the employee's home, or a staff meeting-and be specific. Let them know what you saw or heard and how it positively impacted the team or their patients. Recognize them for additional steps to build professionalism, such as participating in a professional governance group or work team, releveling, or going back to school. Remembering birthdays and service anniversaries is another way to let employees know that you see them as individuals and value the relationship you have with them.

 

Observe healthy boundaries. Another way we convey worth and dignity to our employees is by observing healthy boundaries. We do this by respecting their choices as professionals and expecting that they'll participate in the needed positive change. In doing so, we acknowledge that we can't solely own their success. Remember that there's no amount of effort or angst on your part that will compensate for someone's unwillingness to change. This was a hard lesson for me to learn as a leader. I saw the potential in people and felt so disappointed when they were unwilling to change. When an employee entered the discipline process or left the organization, I often wondered what I could've done better and blamed myself when it didn't work out. As much as we care, we can't make people change and allowing them to avoid the consequences of their behaviors is a form of enabling that doesn't serve anyone well.

 

Nurses are notoriously caring and many of us have helper personalities that make healthy boundaries more challenging to decipher. In addition, many of us entered nursing leadership with a promotion that made us leaders of the same group of people who were our peers. This is a difficult transition and one that requires us to undertake extra reflection about professionalism and boundaries. It's hard to go from being a friend and peer to being accountable for the performance of the department and the people working in it. Seek out a mentor who can help you navigate the transition and offer support.

 

Lead with your truth. If you need to have a difficult conversation, lead with the tough message and be clear. Why? Because even in challenging encounters you have the opportunity to build trust. If you lead with small talk and gradually work up to your real message, the employee may worry that bad news is just around the corner during future conversations. Don't equivocate and don't use the "compliment sandwich" method of giving feedback (sandwiching criticism between praise). Try saying, "We need to have a hard conversation" or "There's something difficult I need to talk with you about. I'm concerned about the feedback I've been receiving from patients." Even in conveying a tough message, you can build trust by showing the employee that you'll be honest with him or her and share feedback openly.

 

Don't leave your employee guessing about the problem or what he or she needs to do to improve. Clearly state the performance gap; your expectations; why it matters; and the timeline for improvement, including when you'll round back to ascertain improvement and give a progress update. When employees don't hear from us about an issue, they may assume it's entirely resolved or no longer a problem, or they may worry needlessly. Check back after a tough conversation to update the employee on the progress you're seeing. Also provide support and available resources to help him or her make the needed change. A developmental action plan or other feedback tool is helpful to ensure clear communication.

 

Keep in mind that if you can't state the problem in a few key phrases, you're probably not ready for a difficult conversation. Take the time you need to refine your message so the employee knows exactly what the concern is.

 

Anticipate the reaction. One of the toughest things about managing difficult conversations is feeling unprepared and apprehensive about how the employee will respond when you address problematic behaviors. I've found the most common negative reactions to be defensiveness, deflection, and denial. Defensive comments may include, "No one's ever brought this to me before." You can reply, "I'm invested in you and want to see you succeed. I owe it to you and our department to be transparent with you and share these concerns." Deflection can take the form of an employee asking you why his or her coworker didn't directly bring up the concern. Often, it's because others are too intimidated by the situation to be able to speak up. Your reply can be, "Accountability between colleagues is always encouraged but as your leader, I owe it to you to share this feedback. Do you feel your colleagues perceive you as approachable and open to feedback?" Denial may include the employee refuting that the incident of concern ever happened. You can calmly remind the employee that we own others' perceptions of our behaviors and you want to help him or her understand where some actions may be giving people the wrong impression.

 

Of course, the employee's reaction may be acceptance and even appreciation that you're willing to discuss the issue. No matter what the response, if you've taken the time to prepare thoughtfully for a conversation, you can feel more confident that you'll be prepared to manage the reaction.

 

Expect the best of people. In general, I've found that people know when you're sincerely in their corner. Having someone who believes the best about you and knows you can be even better is an incredible motivator to change. Communicate confidence in your employee's desire to be successful and reiterate your commitment to his or her growth. Expect the best and communicate that-you'll be surprised how often people will rise to the occasion. Meaningful support and high expectations can be an inspiring combination. And when you see success, call it out, praise it, and provide positive reinforcement to help your employees continue making needed changes.

 

Use your resources. Nursing has always been a teaching profession. We take pride in sharing what we know with others. Chances are, if you're struggling with a difficult employee situation, you have a peer who's dealt with a similar situation. Build your network of trusted advisers and be intentional about seeking and sharing knowledge. Is there someone you particularly respect for his or her ability to lead a variety of employees? Ask him or her to mentor you. Ask other leaders to help you see blind spots or develop talking points. Practice having difficult conversations with a willing peer and return the favor.

 

Don't forget about human resources and your organization's employee assistance program. These departments have extensive expertise navigating difficult situations and can help leaders who proactively seek assistance, especially when the intent is to help a struggling employee. Through the years, I've found my partnerships with both of these teams to be invaluable.

 

Ask for feedback and listen. The leaders who I respect the most are constantly learning. They aren't afraid to ask for feedback and they listen, not for what they expect to hear, but what's being said. Do you want to grow in your ability to coach employees with difficult personalities? Ask hard questions and listen openly and intently. If we approach these situations with humility, then we have nothing to lose when we receive feedback on ways we can improve. Consider asking a trusted mentor or peer the following questions: Can you help me think differently about this situation? Would you help me practice this conversation? Would you be willing to give me feedback about how I approached this tough situation? Can you help me see some blind spots I might have right now? How do you think my efforts are being perceived?

 

Nursing leadership requires wholeheartedness. We need to invest in ourselves and our own growth to serve others well. It's time well spent to learn new skills, add to communication tools, and process difficult conversations.

 

Be clear about your mission and courageous enough to acknowledge when someone doesn't align with it. What if you've poured all you have into a difficult employee but aren't seeing the needed changes? You've given clear feedback, invested in his or her growth, offered support, and demonstrated consistency. You've sought wisdom from your resources and accepted feedback about your approach. Despite these efforts, it's evident that your employee isn't interested in improving.

 

It's never pleasant to make a tough decision to place someone in the discipline process, terminate employment, or replace a position. But, ultimately, you may find that these actions are the appropriate next steps given the coaching and accountability you've already implemented. If it's necessary to take these actions, you can do so with the assurance that you've given the employee every opportunity to succeed.

 

Don't give up. Not every employee will appreciate your investment in them, but many will. Perhaps you've been shaken by bad experiences in the past and grown doubtful about your ability to coach employees successfully. This is a great time to recommit yourself to the practices outlined in this article.

 

New tools for success

Set aside the time you need to thoughtfully prepare for difficult conversations. Be proactive by communicating clear expectations and recognizing good work. Remind yourself of the "why" and the importance for your team and your patients that these negative behaviors don't go unaddressed. And don't get discouraged! Remember, we're in this together.

 

INSTRUCTIONS Managing interpersonal conflict: Steps for success

TEST INSTRUCTIONS

 

* Read the article. The test for this CE activity is to be taken online at http://nursing.ceconnection.com.

 

* You'll need to create (it's free!) and login to your personal CE Planner account before taking online tests. Your planner will keep track of all your Lippincott Professional Development online CE activities for you.

 

* There's only one correct answer for each question. A passing score for this test is 13 correct answers. If you pass, you can print your certificate of earned contact hours and access the answer key. If you fail, you have the option of taking the test again at no additional cost.

 

* For questions, contact Lippincott Professional Development: 1-800-787-8985.

 

* Registration deadline is June 4, 2021.

 

PROVIDER ACCREDITATION

Lippincott Professional Development will award 1.0 contact hour for this continuing nursing education activity.

 

Lippincott Professional Development is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

 

This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 1.0 contact hour, and the District of Columbia, Georgia, and Florida CE Broker #50-1223.

 

Payment: The registration fee for this test is $12.95.

 

REFERENCES

 

1. American Nurses Association. Incivility, bullying, and workplace violence. 2015. http://www.nursingworld.org/practice-policy/nursing-excellence/official-position. [Context Link]

 

2. Brooks AMT, Polis N, Phillips E. The new healthcare landscape: disruptive behaviors influence work environment, safety, and clinical outcomes. Nurse Leader. 2014;12(1):39-44. [Context Link]

 

3. Castronovo MA, Pullizzi A, Evans S. Nurse bullying: a review and a proposed solution. Nurs Outlook. 2016;64(3):208-214. [Context Link]

 

4. The Joint Commission. Sentinel event alert, issue 40: behaviors that undermine a culture of safety. 2008. http://www.jointcommission.org/sentinel_event_alert_issue_40_behaviors_that_unde. [Context Link]

 

5. Layne DM, Nemeth LS, Mueller M, et al Negative behaviours in health care: prevalence and strategies. J Nurs Manag. 2018;27(1):154-160. [Context Link]

 

6. Powers C, Normand L, Whitcomb K. Is clique behavior sabotaging your nursing team. Nurs Manage. 2014;45(11):38-43. [Context Link]

 

7. Middaugh D. Just say yes...no! Medsurg Nurs. 2018;27(4):264-265. [Context Link]

 

8. Zadeh SE, Haussmann R, Barton CD. Healthcare risk managers' consensus on the management of inappropriate behaviors among hospital staff. J Healthc Risk Manag. 2018;38(4):32-42. [Context Link]