abuse, nursing home conflict, organizational conflict



  1. Nelson, H. Wayne PhD, FGSA
  2. Cox, Donna M. PhD


Interpersonal conflict, often spiraling to violence and abuse, is one of the most daunting challenges facing nursing home administrators and their departmental heads. Mounting evidence documents how they spend an inordinate amount of time dealing with angry families, adversarial ombudsmen, regulators, and other hostile parties as well as handling the aftermath of the ubiquitous conflict between the residents and their direct caregivers. All this is in addition to coping with the normal interdepartmental and line staff forms of conflict that typify any organization. This paper details the special dynamics that accelerate dysfunctional conflict in nursing homes and presents strategies, tactics, and style recommendations that will help nursing home leaders build more collaborative work cultures to minimize the effects of dysfunctional conflict.


WORKPLACE CONFLICT IS pervasive. Managers spend as much as 20% of their time either trying to minimize dysfunctional conflict or spurring functional conflict to sharpen their organization's creative edge.1 Conflict is "a major responsibility of all administrators,"2(pp.13,14) and health service conflict is a growing concern, especially regarding its most extreme expression-workplace violence.3 Although emergency room violence draws the greatest public attention, mounting evidence suggests that nursing home staff face even tougher conflict challenges. Correspondingly, there is a growing concern that the training of nursing home administrators (NHAs), while adequate on the operations side, is sorely lacking in more "abstract skills such as assessment, communication, negotiation, and resolution of problems" and conflict management generally.4,5(p.72)


Achieving a collaborative work environment requires an understanding of the causes and accelerants of conflict that are unique to the nursing home. This paper focuses on 5 such accelerants: (1) goal incompatibilities that are routinely noted in nursing home environments, (2) managerial approaches that breed dysfunctional conflict, (3) organizational structure effects including extreme regulation, functional departmentation, rigid staff status distinctions, and influence of third-party advocates, (4) biomedical institutional cultural influences, and (5) emotional and psychologic factors that spur family-enacted conflict. Where applicable, we will include qualitative data derived from personal interviews with NHAs in the Baltimore metropolitan area1 that offer some insight into the unique characteristics of nursing home conflict and the way in which this conflict is perceived by administrators. Finally, recognizing that mitigating factors (ie, limited resources and regulatory constraints) will continue to influence relationships within these organizations, specific recommendations based on well-established principles of conflict control and resolution will be presented to offer practical strategies for turning conflict into a tool for building collaborative long-term care environments.