Running head: NURSING ASSIGNMENT CONFLICT 1

Nursing Assignment Conflict

Emily Borges, Andrew Cox, Lauren Kalanta, Alex Santella, and Jay Sparks

California State University, Stanislaus

January 6th, 2016

Nursing Assignment Conflict

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Nursing assignments are time-consuming, complex, and often lead to conflict amongst

staff (van Oostveen, Braaksma, & Vermeulen, 2014). They can directly influence nurses,

patients, and environmental outcomes (Allen, 2015). Creating well-balanced assignments is

crucial for ensuring the safety and quality of patient care and job satisfaction for nurses. There

are many strategies for managing conflict (Johansen, 2012). This paper looks at the different

types of conflict and then analyzes a conflict resolution website to determine its quality and

credibility. A specific example of a nursing assignment is discussed and resolution for this

conflict is explored. It also discusses the possibility of introducing computerized decision

support system to improve nursing assignment outcomes. These factors will aid in nursing

assignment conflict.

Background

How is it determined which nurses are assigned to take care of patients while in the

hospital? Typically it has been the responsibility of the charge nurse to create the nursing

assignments. Assigning the responsibility of care for several people is no easy task. How many

patients is too many? Certainly some patients may require more care than others, while other

patients may have a greater health risk requiring further attention. Assignments that are decided

by the charge nurse can create conflicts within the nursing staff.

Conflict is defined as a disagreement in values or beliefs within oneself or between

people that either causes harm or may cause harm (Yoder-Wise, 2015). There are several types of

conflict as well as different modes of conflict resolution that will be discussed. Types of conflict

include intrapersonal conflict, interpersonal conflict, and organizational conflict (Yoder-Wise,

2015). Intrapersonal conflict involves a confrontation within a person in which the way they

think or act differs from ones sense of self (Yoder-Wise, 2015). Interpersonal conflict involves a
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difference of opinion, priority, or approach between two separate individuals or more (Yoder-

Wise, 2015). Organizational conflict occurs when there is a disagreement about policies and

procedures, personnel conduct of code, or accepted norms of behavior (Yoder-Wise, 2015).

When discussing how conflict is dealt with in their personal lives, the group consensus

centers around a collaborative approach. The group members agree that when dealing with

conflict, they try to incorporate the viewpoints from all parties to maximize benefits for all,

resulting in a win-win situation. On the other hand, the group members agree that when in the

position of student nurse, they tend to use the conflict style of avoidance. The group collectively

feels that they are taken advantage of as a student nurse. Rather than helping the student nurse

practice important skills like dressing changes and medication administrations, staff nurses often

delegate simple tasks such as checking vital signs and glucose. When the conflict of being given

only simple tasks arises, the group members feel that they are less experienced and they do not

want to overstep their boundaries by declining. Instead, they avoid the conflict and become

frustrated.

In order to improve the groups conflict resolution style, the members need to learn how

to face conflict with confidence rather than avoiding it. The group members should evaluate why

nursing assignments will increase safety and quality of care as well as improve job satisfaction

(van Oostveen et al., 2014).

There is a difference between the conflict resolution styles in their personal lives and in

their roles as student nurses. Vocalizing the difference can help the group members express their

concerns when taking on the student nurse role. This process of self-reflection in a group setting

helps build confidence for when a conflict arises next. When facing a future conflict with a staff

nurse, the group members will be assertive and respectful. They will lay out clear expectations
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from the beginning of the shift by stating, I am a student nurse and I can perform almost all

nursing skills with the supervision of a registered nurse, except hanging blood products. I would

like to practice as many skills as possible today with your patience, supervision, and guidance.

Website for Resolving Conflicts in Health Care

Strict criteria was used to evaluate the website prior to incorporating it into this paper.

University of Marylands online article Evaluating Web Sites: A Checklist served as a tool for

evaluating its credibility (University of Maryland Libraris, 2014). The website nursingworld.org

was selected to explore different types of conflict resolution in healthcare. Its credibility was

analyzed using a checklist from University of Maryland Libraries (2014). This website is run by

the American Nurses Association (ANA) (American Nurses Association, n.d.). The American

Nursing Association is a non-profit organization that provides valuable information to nurses as

well as advances the nursing profession by fostering high standards of nursing practice,

promoting a safe and ethical work environment, bolstering the health and wellness of nurses, and

advocating on health care issues that affect nurses and the public (American Nurses

Association, n.d.). Nursingworld.org was chosen for this project because of the massive amount

of valuable information available on this website. This information includes conflict resolution

strategies, interviews with working nurses, and conflict management modules for nurses and

nurse managers to engage in. The information is structured as a comprehensive program that

nurses can participate in (American Nurses Association, n.d.). This provides the authors with a

deeper understanding of conflict resolution and the available resources for resolving conflicts in

the nursing profession. By investigating conflict and evidence-based resolution for nursing

assignments, it is envisioned that balanced aryland Libraries, 2014). This tool provides a

comprehensive checklist for assessing websites. Using this tool led the authors of this paper to
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determine that nursingworld.org is a valid and credible website. It has a clear author, the ANA,

which is a non-profit organization with the goal of advancing the nursing field (American Nurses

Association, n.d.). Additionally, the information is clear, up to date, and all of the information

appears to be factual and well-researched.

Example of Nursing Assignment Conflict

During clinical, student nurses experience and observe an array of conflicts with nursing

staff. One conflict that is commonly witnessed is when patients are being assigned to nurses at

the beginning of shift. Patient assignments determine the course of the day depending on the

type of patient the nurse is taking care of. Oftentimes nurses complain, request a different

assignment, or even deny taking on an assignment.

This was the case for a nurse who was assigned to the psychiatric patients within the

Emergency Department for several consecutive shifts in a row. The nurse complained after the

assignment had been made, stating aloud, This isnt fair. I have had this assignment the last

three shifts. It is as if they do not value my critical thinking or skills in different areas by always

assigning me with the psychiatric patients. The assumption being made is that the charge nurse

has been conducting patient assignments unfairly. This not only creates interpersonal conflict

between the charge nurse assigning the patients and the nurse assigned to them, but to the other

nurses who may be perceived as having an easier or more sought after assignment. In this

scenario, it wasnt until later in the nurses shift during a demanding period that they then vented

their displeasure of their assignment to the charge nurse. Unfortunately, this avoidance towards

an issue resulted in assumptions being made. The charge nurse was then placed in a position of

managing the situation appropriately to resolve the conflict at hand.

Resolution of Nursing Assignment Conflict

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In order to successfully resolve conflict, those involved must first be able to understand

and process the stages of conflict (Yoder-Wise, 2015). This process involves navigating through

the phases of frustration, conceptualization, action, and outcomes (Yoder-Wise, 2015). During

the stage of conceptualization, conflict may be interpreted differently with each nurse focusing

on different results (Yoder-Wise, 2015). It may also be interpreted as a battle for control, which

can lead to frustration and feeling a loss of control (Yoder-Wise, 2015). Nurses, as like any other

human being, are prone to differences of perspective. Conceptualization based on ones own

beliefs and feeling serves as the basis for future frustration (Yoder-Wise, 2015). Conflict derived

frustration tends to be prominent when nurses feel that their goals are being blocked or that their

input is not acknowledged (Yoder-Wise, 2015). This emotional and initial response to conflict

can create a negative impact on the work environment.

A nursing leader should be able to uphold the hospitals values and goals by

understanding the culture of the work environment (Siebert & Chiusano, 2015). This can be done

by analyzing the environment and taking action in order to resolve or avoid conflict. Use of

assertive communication that does not give way to emotions or place blame is an appropriate

method when taking action towards conflict resolution (Yoder-Wise, 2015). Using first person

perspective when speaking places the focus on the intended statement rather than the opposing

person (Yoder-Wise, 2015). Taking action by way of clear communication leads to the final

phase of outcome (Yoder-Wise, 2015).

After understanding the process of conflict, strategies must be implemented in order to

reach a desired outcome. Conflict resolution strategies include avoiding, competing,

accommodating, collaborating, and compromising (Yoder-Wise, 2015). Avoiding, refusing to

acknowledge the conflict, typically involves a lose-lose situation for both parties and is not an
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effective method (Yoder-Wise, 2015). Competing, compromising, and accommodating can be

effective strategies to achieving resolution but at the sacrifice of one party leading to a win-lose

situation (Yoder-Wise, 2015).

Collaborating and effectively communicating is vital when resolving conflict and may

prevent conflict from occurring at all (Siebert & Chiusano, 2015). For example, an in depth look

into staff disatisfaction at Childrens Hospital Boston revealed that acknowledging staff concerns

created a positive change in the attitudes of the nurses and the overall work environment

(Marine, Meehan, Lyons, & Curley, 2013). Taking into consideration the input of all staff

members and collaborating to reach a resolution can help charge nurses when assigning patients.

An innovative approach to solving this particular conflict is the establishment of

computer-generated nursing assignments (Sir, Dundar, Steege, & Pasupathy, 2015; van Oostveen

et al., 2014). These computerized systems assess how many nursing care hours each patient will

need and assigns them an acuity score (Sir et al., 2015). It then generates an assignment

recommendation based on patient census, survey-based perceived workload, and patient acuity

scores. In their study, van Oostveen et al., found that a 30% time reduction was achieved when

patients were assigned using a computerized decision support system (2014). They provide a

balanced assignment and decrease the perceived workload (Sir et al., 2015; van Oostveen et al.,

2014). This will lead to increased job satisfaction as well as improved quality and safety of care

(van Oostveen et al., 2014).

In the previous personal example, the nurse initially used avoidance as his

communication style. Clear communication should have been used for a better outcome (Yoder-

Wise, 2015). Going through the stages of conflict, it would be natural for the nurse to feel an

initial frustration. He should have then conceptualized why he was assigned this patient again
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and the best course of action for resolving his frustration. During the action phase, the nurse

should have approached the charge nurse and used respectful and assertive communication to

talk about the assignment. The nurse and the charge nurse could have then collaborated to come

up with a solution for a better outcome (Yoder-Wise, 2015).

Additionally, the use of computer-generated nursing assignments could have helped to

avoid this conflict altogether (van Oostveen et al., 2015). Since these systems take perceived

workload from nursing surveys into account, it is likely that consecutive assignments to the

psychiatric patients would be tagged as being high acuity. If it was not already tagged, it could be

added to the system. The nurse would not have received this assignment again and the conflict

would not have taken place. His frustration would have been avoided, leading to increased job

satisfaction and higher quality patient care (van Oostveen et al., 2014).

Conflict resolution is a valuable tool in nursing leadership and management, especially

when creating nursing assignments that may not seem fair. The website, nursingworld.org, has

been found to be reliable and consistent towards promoting professional conflict resolution

strategies in the nursing profession. Communication and collaboration are crucial towards

resolving conflicts in the nursing profession (Siebert & Chiusano, 2015). In personal experience,

both communication and collaboration were utilized to resolve the conflict.

Computerized-generated nursing assignments are an additional alternative that may help

reduce the conflicts that result from the charge nurse creating nursing assignments (Sir et al.,

2015; van Oostveen et al., 2014). This will decrease conflict, resulting in greater job satisfaction,

improved quality of care, and improved nursing staff retention (van Oostveen et al., 2014). When

conflict does occur, it is crucial that resolution is conducted professionally by utilizing

communication, compromise, and collaboration.

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References

Allen, S. B. (2015). The Nurse-Patient Assignment: Purposes and Decision Factors. Journal of

Nursing Administration, 45(12), 628-635.

American Nurses Association. (n.d.). Conflict Engagement. Retrieved from

http://www.nursingworld.org/MainMenuCategories/CertificationandAccreditation/Continui

ng-Professional-Development/Conflict-Engagement

Johansen, M, L. (2012) Keeping the peace: Conflict management strategies for nurse managers.

Nursing Management, 43(2), 50-54.

Marine, K., Meehan, P., Lyons, A., & Curley, M. (2013). Inequity of patient assignments: Fact or
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fiction?. Critical Care Nurse, 33(2), 74-77.

Siebert, S. & Chiusano, J. (2015). Understanding the charge nurse's role in staffing. American

Nurse Today, 10(9), 9-10.

Sir, M. Y., Dundar, B., Steege, L. M. B., & Pasupathy, K. S. (2015). Nursepatient assignment

models considering patient acuity metrics and nurses perceived workload. Journal of

biomedical informatics, 55, 237-248.

University of Maryland Libraries. (2014). Evaluating web sites: A checklist. Retrieved from

http://www.lib.umd.edu/binaries/content/assets/public/usereducation/evaluating-web-sites-

checklist-form.pdf

van Oostveen, C. J., Braaksma, A., & Vermeulen, H. (2014). Developing and testing a

computerized decision support system for nurse-to-patient assignment: a multimethod

study. Computers Informatics Nursing, 32(6), 276-285.

Yoder-Wise, P. S. (2015). Leading and managing in nursing. St. Louis, MO: Elsevier Mosby.