Conflict Management

Working in health care means conflict is a possibility on almost every shift. Even outside of healthcare, conflict is possible when engaging with others in the workplace. Nearly all employees have experienced conflict at some point. While healthcare professionals are often taught to manage conflict and stressful situations with patients and caregivers, there is also the possibility of stress, conflict, and disagreements with co-workers, including other nurses, healthcare professionals, and more (Delak & Širok, 2022). As long as human interaction occurs, differences in personality, communication style, and conduct are expected. Differences can positively influence workplace dynamics.  Sometimes, these differences can also lead to workplace conflict. Given the nature of healthcare and human interaction, conflict management in the workplace is an essential skill for healthcare professionals of all education levels and backgrounds. Healthcare, in particular, is an extremely physically and mentally stressful profession. While healthcare professions can be rewarding, stressful tasks, long hours, and proximity to others can all trigger workplace conflict. As a result, conflict management and emotional intelligence are essential skills needed for long-term work in the healthcare field (Soriano-Vázquez et al., 2023).

In particular, when time is spent on conflict that leads to unresolved situations, these negative interactions can result in staff burnout, poor employee health outcomes, and decreased productivity. On a larger scale, consistent conflict and negativity in the workplace can lead to a toxic workplace, poorer patient health outcomes, and increased staff turnover (Basoğul, 2020). That said, when handled appropriately, conflict in the workplace can be a benefit, as productive and positive conflict can lead to recognizing issues or concerns in the workplace. For instance, if there is a conflict about scheduling in the workplace, management and staff can take notice of the issue and work together regarding scheduling, such as offering more shifts, obtaining more staff for in-demand shifts, or requesting alternative shift coverage. Conflict, in general, does not have to always be a negative aspect in the workplace and can be used and seen as a source of growth and observation.

Specifically, teamwork, cooperation, respect, and effective communication are all necessary for healthcare environments to function properly. For instance, managers are estimated to spend at least a quarter of their time dealing with conflict. While managers often have more clinical experience, additional education and training in management, emotional intelligence, interpersonal skills, and conflict resolution skills are needed to effectively manage workplace conflict. As with managers, staff members should be aware of their emotional intelligence and responses to conflict within the workplace (Alan et al., 2022). Appropriate training in conflict management skills is critical to ensure prompt conflict resolution and workplace morale. A healthy work environment with good conflict resolution protocols leads to increased staff longevity, increased productivity, and better quality of care for patients, making conflict management strategies an obvious priority for healthcare facilities everywhere.

Simply put, conflict in the workplace is when there is any form of strife or discord between individuals or group members. Typically, the disagreement occurs about one coworker's beliefs, statements, or actions that are perceived to be unacceptable by the other. These opposing views result in unrest or antagonism and can lead to prolonged strain and tension in the workplace (Rahim, 2023). Conflict may arise for various reasons, such as changes in work schedules or shifts in workplace demands. However, in healthcare, many unique factors contribute to the development of friction, including emotionally and physically demanding labor, staff shortages, long hours, rapid and frequent industry changes, integration of technology, patient perception of how care should be delivered, financial strain for the institution, and hierarchies. Notably, the larger the health care institution, the more probable and frequent conflicts result from more staffing, management styles, and increased patient volume (Soriano-Vázquez et al., 2023).

In general, conflict can be divided into four main types (Matta & Fares, 2021):

• Intrapersonal conflict: This type of conflict occurs within an individual and involves an internal struggle of thoughts, emotions, or values. Intrapersonal conflict might occur when a person feels overwhelmed with patient care activities and prioritizes work tasks while finding necessary meal and bathroom breaks during a shift. This type of conflict can be difficult to identify, but if left unnoticed, it may have serious consequences, such as burnout and physical consequences for the employee.

• Interpersonal conflict: This type of conflict occurs when two individuals do not agree on how to handle a situation. Interpersonal conflict may occur if a staff member feels a coworker is not pulling their weight during a shift or a manager continually schedules them with an unfair amount of weekend shifts.

• Intragroup conflict: This type of conflict occurs amongst group or team members, such as a particular unit. Teamwork and a sense of community are necessary for a department to run smoothly. Differences or disagreements among team members can cause unrest for everyone, even if they are not directly involved in the conflict. If left unattended, the conflict can deepen and divide the group into cliques or "sides," leading to gossip, hostility, chronic complaining, competing for power, and decreased productivity. An example of intragroup conflict can be when various health care professionals, such as nurses, therapists, and doctors, are working to provide care for a patient with different views on how to proceed with patient care.

• Intergroup conflict: Intergroup conflict exists between members of different organizational groups perceived to differ in values, beliefs, or goals. Opposing groups may be clinical team members who feel unheard and undervalued by their administrators or different departments. Intergroup conflict may lead to avoidance of communication between the groups, resulting in decreased productivity and interruption of patient care goals within the organization.

Though the specific details may vary, most workplace conflict scenarios follow a predictable pattern (Lyndgaard & Kanfer, 2024). The five stages below are generally accepted to be true and are frequently used as a standard model when developing conflict management protocols. These five stages are not specific to health care workplaces and can be applied to workplaces overall (Campbell, 2021).

1. Stage 1: Potential opposition or incompatibility: These environmental factors set the stage for potential conflict and include communication (or lack thereof) within a department, role hierarchy and leadership styles within an organization or department, and personal variables of different personalities or belief systems.
2. Stage 2: Cognition and personalization: This is when people become aware of the environmental variables and view them as undesirable or incompatible. Negative emotions, such as frustration, anxiety, or anger, may develop. Employees may feel apathetic towards their jobs or confrontational towards coworkers or supervisors.
3. Stage 3: Intentions: Once one or both parties feel the conflict, decisions must be made about handling it. These decisions may be purposeful and thought out based on conflict resolution tactics. Conversely, they may be impulsive, based on learned behaviors or gut reactions. Potential intentions or styles for dealing with the conflict include competitive, collaborative, compromise, avoidance, and accommodative.
4. Stage 4: Behavior: This includes one party's behavior based on their intentions and includes the other party's reaction. This behavior is often where conflict is noticeable to observers, and management may need to mediate.
5. Stage 5: Outcomes: Depending on the behavior and any outside intervention, the outcome of conflict can be positive, with an increase in effective communication and group performance, or negative, with deepening divides and decreased teamwork and group performance.

How a person or group deals with conflict depends on many variables, including personality traits, learned behaviors and responses to conflict, presence, leadership style, and even training regarding conflict resolution (Folger et al., 2021). In general, the Thomas-Kilmann Conflict Model organizes conflict management into five categories. Though this model was developed in the 1970s, it has been updated and reimaged in recent years to include an easy-to-use online tool for individuals to learn more about their conflict management style, how they may be handling conflict, or how to improve their strategies. Healthcare organizations have also integrated conflict models into managing conflict in their workplace and for professional development and education (Ferreira et al., 2024).

The five categories of the model include (Folger et al., 2021):

• Avoidance: For some people, confrontation is very stressful. As a result, they may choose to avoid or ignore the conflict altogether. While this may temporarily avoid an undesirable or uncomfortable situation, avoiding conflict does not resolve the conflict. The feelings of unrest or dissatisfaction will only continue to grow, eventually leading to even more conflict, resentment, or a disproportionate reaction. It should be noted that, sometimes, this technique can be used positively to temporarily postpone addressing the conflict. For example, avoidance can be used either to de-escalate and allow both parties time to cool down or to complete the necessary workflow and ensure patient safety before addressing the conflict.
• Accommodative: This conflict management style involves a win-lose situation, where one party will receive the desired resolution, while the other has their opinions disregarded or dismissed. An accommodative strategy requires one's party to yield to the direction of a supervisor cooperatively or to selflessly drop their argument. Either way, resentment may result from the party losing the accommodation, and the cooperation necessary for this strategy may be difficult to maintain.
• Competitive: The opposite of the accommodative style, competitive conflict handling is considered the most confrontational and least cooperative. A power struggle occurs, and one party will win while the other loses at their expense. This strategy often involves both parties presenting their case to a manager. The manager then quickly decides which party "wins." While this approach may resolve the situation, anger, negativity, and frustration may persist between both parties.
• Compromise: In this strategy, both parties must sacrifice some of their positions to reach a mutually acceptable solution. This solution requires negotiation and cooperation from both sides. Compromise may require someone in a supervisory position to determine the solution and what the middle ground entails. While the situation may be resolved, resentment and dissatisfaction may be present among members of both parties. Neither side gets as much as they initially hoped for, but neither loses as much as they potentially could either.
• Collaborative: In this strategy, the involved parties are brought together to work through the resolution process through actively listening and planning. This collaborative aspect is the most creative and teamwork-centered solution strategy, and may uncover other issues underlying the perceived problem. This process should result in an understood and accepted solution by working together to understand each other's concerns and meet each other's needs. This process is also the most difficult process to attain since it requires a conscious effort from all parties to be empathetic and understand viewpoints different from their own. As a result, collaborative efforts are often a result of experienced managers with high-level skills in conflict management, communication skills, empathy, and emotional intelligence (Ferreira et al., 2024).

While there are different styles of conflict management, it is important to note that conflict management is not only up to the discretion of management. Senior staff members, healthcare hierarchy, and other factors can play a role in conflict management styles and conflict resolution techniques in health care settings (Ferreira et al., 2024). Particularly, the culture of an organization and the leadership styles used by those in supervisory positions will determine which conflict management strategies are used and how effective they are. Regarding patient care and health outcomes, the seriousness of the problem also plays a role in which approach is most appropriate. Truly, simple, one-time-only issues can be effectively resolved through avoidance or accommodation and do not require the time and effort spent on a collaborative solution. However, larger, more far-reaching issues should involve compromise or collaboration to address underlying issues and prevent the recurrence of the problem. Given the ever-changing nature of healthcare dynamics, patient care demands, and more, it is important to be aware of various conflict management and leadership styles in the workplace (Folger et al., 2021).

After an individual understands why conflict occurs and how personal and group differences affect managing it, this knowledge can be applied to effective conflict management. People in supervisory or managerial positions often mediate conflict and restore a peaceful work environment. Still, all healthcare professionals can learn to manage conflict and contribute to effective communication and a smoothly flowing department. There are many models for managing conflict, but at their core, they all have the same basic principles in common (Putz et al., 2022; Kızılkaya, 2024).

• Conflict is inevitable and can be a positive move towards growth if appropriately managed.
• Even if conflict is not appropriately managed, this experience can be a learning opportunity to develop conflict management skills and emotional intelligence.
• Resolution is likely easier and more satisfactory if all parties participate in conflict management rather than avoiding conflict.
• Individuals or groups must want to participate in the resolution process for it to be effective.
• Behavioral, cognitive, and communication skills require self-awareness and emotional intelligence. These skills can be learned with practice and training.
• The conflict resolution environment should be neutral, respectful, and safe for all parties.

Once a neutral environment and rules of respect have been established, all parties should be allowed to present their viewpoints without interruption or judgment. The opposing party should use this opportunity to listen closely and let go of preconceived ideas about the issue. Sometimes, it may be discovered that each party has a different idea about what is causing the conflict, making it nearly impossible to resolve without realizing it. Solutions may be proposed once the problem has been identified and agreed upon. The type of management strategy needed for the situation determines who might propose the solution, and it can consist of acquiescence, compromise, or collaboration. In the most collaborative scenario, each side could develop proposed solutions for review (Folger et al., 2021; Campbell, 2021).

A helpful acronym to use when solving conflicts is VALUED.

• V = Validate: People want to feel heard and understood. Even if a solution is not what individuals hope for, they are more likely to accept it peacefully if they feel valued and acknowledged throughout the process.
• A = Ask: Ask open-ended questions to get to the bottom of what someone is feeling. Open-ended questions also allow people to express their views on the matter at hand.
• L = Listen: Don't assume you know what someone thinks or feels. Listen and try to understand the point of view being presented.
• U = Uncover interests: What underlying factors might influence a person's viewpoint? Why do they think/feel/believe the way they do, and what experiences or perceptions of theirs may differ from yours?
• E = Explore options: Discuss ways that the problem could be solved. Try to be creative, think of multiple approaches, and consider how each approach may benefit or disadvantage each party differently.
• D = Decide: You must conclude which solution best suits your unique scenario.

Once conflict management has occurred, managers need to ensure that the issue has been resolved and not just pushed aside to resurface later. This assurance is best achieved through clear communication in four steps (Folger et al., 2021; Campbell, 2021):

• Feedback: Touch base with everyone involved individually and ensure they clearly understand the solution reached and have no lingering concerns. This understanding ensures everyone is on the same page, but conveys concern and care for employees as important team members. It is important for team members to feel heard and appreciated, even if the conflict was not resolved in a way they would have preferred.
• Informal and Formal Communication: Summarizing what was discussed and what solutions were agreed upon should be communicated verbally, in conversation, and in writing as a follow-up. For simple, easily solved conflicts, formal communication is not always necessary. Still, in most cases, this added step does ensure that everyone is on the same page and has something to refer back to if any confusion arises.
• Clear and Concise Communication: It is important to be clear and to the point. Verbose communication, being vague to avoid negative reactions from others, or talking in circles can lead to confusion, further conflict, or staff feeling unheard and unappreciated. Even if a manager's information is likely poorly received, communicating clearly and concisely is extremely important.
• Delivering Messages as Facts: What you say should be true, detailed, and supported by your actions. A manager who says one thing but does not follow up with actions that support their words will lose the trust and respect of their subordinates. Whatever solution is reached must determine how supervisors address the conflict moving forward.

Examining how the conflict was handled, considering how communication could be improved in the future, and holding regular conflict management training are ways a supervisor can maximize conflict management skills for themselves and staff and keep a department or team running smoothly. Conflict itself is inevitable, but the response to it can delineate the entire culture of a healthcare team and determine its long-term success.

Conflict management strategies in healthcare have become increasingly studied over the past decade, particularly due to the COVID-19 pandemic, the rise of artificial intelligence in healthcare, and shifts in workplace dynamics. Even healthcare educational institutions are integrating conflict management in the workplace, which was not part of the curriculum previously (Putz et al., 2022). Emotional intelligence awareness and conflict management skills are essential for healthcare professionals' well-being and long-term growth in healthcare (Kızılkaya, 2024). At the same time, conflict management might seem like a trivial human resources task for many newly hired or recent graduates, but conflict management is an essential skill. Communication skills, discussions with management, and awareness of conflict styles are all essential for long-term, successful careers. If conflict is not adequately addressed at work, this unresolved conflict can strain relationships outside of work, such as with family members, causing a strain on work-life balance (Şahin & Yozgat, 2024).

Moreover, teamwork in healthcare will always be a concern given the nature of working in healthcare. There is often a multi-disciplinary approach to patient care, with nurses, therapists, physicians, and social workers caring for the same patient. This can be compounded by the need to care for other patients and manage administrative responsibilities. Now is the time to incorporate more changes in the workplace to foster more sustainable, healthy, and long-term working environments for all healthcare professionals (Zajac et al., 2021). While many discussions pertaining to workplace conflict have focused on workplace violence nurses experience from patients, more research from organizational psychologists, nurse managers, and hospital leadership has focused on the role of burnout and well-being of health care staffing long-term (Somani et al., 2021).

While workplace dynamics cannot be changed instantly, knowing the realities many healthcare workers face at work is important. Staff changes, staff shortages, increased patient volume, updates to documentation systems, emergency codes, medical supply shortages, and more can further influence workplace conflict. Even the healthiest of workplaces will have conflict at some point. Taking time to be aware of dynamics in the workplace and having honest, transparent conversations with your manager or management team about concerns is essential (Wei et al., 2022). If management is unwilling to listen to your concerns, it is possible to consider approaching conflict resolution and management differently or speak to another manager. It is in the best interest of managers to ensure a safe, healthy, sustainable working environment for all staff and patients (González-García et al., 2025).

Whether it concerns schedule issues, supply issues, or conflict with a co-worker,  managers and non-managerial healthcare providers must work together to ensure the smooth flow of a functioning unit for all staff and patients (Nikitara et al., 2024). You can suggest regular unit meetings with leadership to discuss concerns, if possible. Healthcare staff can suggest being a part of the hiring or interviewing process for new hires to assess workplace flow and dynamics of new staff well before they are brought into the clinical environment. Clinical leadership can also be made aware of any underlying staff dynamics and workplace conflicts to better address next steps for collaboration in patient care (Stanley et al., 2022). While managing conflict can be intimidating and concerning at times, it is important to remember that all workplaces will have conflict at some point.

During your career, you will have a different opinion from your supervisor or co-workers on an administrative task, a patient care task, or even a patient health outcome. Regardless, conflict management and resolution skills are essential for healthcare professionals of all specialties, workplaces, and disciplines. Whether you just graduated from school or have been practicing for years, conflict management is a lifelong skill as essential as excellent patient care techniques (Chimonas & Korenstein, 2021).

You are the nurse manager on a pediatric unit. A senior nurse, Sam, comes to you one day and asks to have her schedule changed because she does not want to work with another nurse, Aubrey, anymore. Sam has been a nurse for 10 years and has worked on this unit for the past five years with no issues. Sam states that Aubrey is lazy, does not do her share of department responsibilities, and is not providing appropriate patient care. Sam states that she is finding it increasingly difficult to work alongside Aubrey.

Since changing the schedule for the immediate future is difficult at the last minute, and hearing that another staff member is not contributing equally is also concerning, you decide to call Aubrey in for a meeting with you and Sam. You choose your office as the meeting place and let each nurse know they will be given a chance to speak. You also explain that polite language and behavior are expected.

You allow Sam to express her concerns first. Sam states that the unit responsibilities should be performed once per shift, such as restocking supply cabinets in the patient rooms, performing a supply check on the crash cart, and wiping down surfaces at the nurse's station. Sam reports that, about halfway through her shift, if these things are not done, she will do them, but that typically the responsibilities are equally shared when she works with other nurses. Sam states that whenever she works with Aubrey, she does all these tasks by herself, making her feel frustrated or angry for the remainder of the shift. Sam states it has gotten to the point where she feels annoyed even starting a shift with Aubrey and would like to be scheduled opposite her.

Aubrey is visibly upset by the meeting and Sam's accusations. Aubrey is a new grad nurse with less than a year of experience, and this is her first full-time job out of nursing school. When Aubrey speaks, she states that she is aware of the unit responsibilities and prefers to leave them towards the end of her shift, as she feels that is when the most restocking and cleaning are needed. Aubrey states that whenever she works with Sam, she finds that they have already been completed if she completes any of the tasks later in her shift. She is aware that Sam does not seem to like her and seems to avoid her, but until this meeting, she did not know why.

Sam softens her stance as the miscommunication at the root of the conflict is revealed. Aubrey suggests more open communication regarding who will complete each task at the start of the shift, and Sam agrees. Sam states that she was upset about the pace at which Aubrey works, but she agrees that Aubrey is not lazy and that there was a misperception in the workflow. Sam was taught to complete tasks during her shift instead of waiting until the end, but she was unaware that Aubrey was already planning on completing these tasks. The nurse manager determines that each nurse will choose tasks to complete, but then be allowed to complete them in their time frame. As the manager, you incorporate this routine as part of each shift's beginning to avoid this issue in the future. About a week after the meeting, you check in with Aubrey and Sam, who report sharing the tasks equally. Aubrey and Sam state that they are communicating much more openly, which has led to a better work environment for them and other nurses on the unit.

Mike is a nurse in the emergency room and asks his coworker, Amanda, to cover a shift for him next weekend to attend a concert. Amanda agrees, but asks Mike to cover a shift for her next month in exchange, so she can be off on her son's birthday. Both Amanda and Mike submitted shift changes online through the employee portal, but the portal was glitching, and they were doing a system update for all staff. Both Amanda and Mike agree to have this shift change be verbal to avoid any issues with the nurse manager regarding scheduling conflicts.

A few weeks later, Amanda has covered Mike's shift with no issue, but Mike tells Amanda that he can no longer cover her as planned. Mike does not explain why, but states that it was a personal matter and that he cannot cover the shift as scheduled. Amanda is angry about this situation and goes to the nurse manager. While doing so, Amanda forgets to assess a patient's IV patency, leaving Mike to assess and care for her and his patients. The manager says that since the exchange of shifts was not reported in writing, Amanda must work the shift as scheduled or find another nurse to cover her shift. The nurse manager also asked why neither Mike nor Amanda had emailed the nurse manager regarding shift changes and coverage since you, as the nurse manager, can adjust shifts in the calendar, even during employee portal updates. Amanda is furious, yells at the nurse manager for taking sides, and calls in sick on her son's birthday (the next day after this shift), leaving the department short-staffed.

The next day, Amanda is scheduled to work; instead of being assigned patient care for the first hour, she is scheduled to meet with the nurse manager. The nurse manager asked Amanda about the discrepancies with shift care coverage, as the nurse manager had always had an open email policy and had changed shifts via email when there were existing portal issues. As the manager, you are also aware that Mike had to care for Amanda's patient while she was yelling at you. You ask Amanda what is going on since this is not typical behavior. Amanda is a seasoned ER nurse with good rapport among staff. Amanda apologizes for yelling earlier and states that she is in the middle of a divorce and is thinking about stepping back from working full-time, cutting back on her sick days, and leaving options. She also states that the possible divorce would also influence her finances, so she is unsure about time off options and scheduling from now on.

As the nurse manager, you thank Amanda for her candor and express your concern for her during the divorce process. You also offer Amanda institutional support services, such as those for emergency therapy and counseling services, as her outburst of yelling and changing a shift without documentation was not professional. Since this is Amanda's first time yelling at staff in front of patients, you decide not to write her up, but recommend that she seek mental health therapy and counseling services. You also ask Amanda to have any staff changes done formally in the portal or via email if the portal has technical issues. Amanda agrees and apologizes to Mike later. Mike also admits to you that he was unable to cover Amanda's shift because his dog had an emergency surgery, and that he could not cover this shift because his dog of 20 years is like family to Mike. After a few months, Mike and Amanda seem to have no more workplace conflicts.

Sunrise Rehabilitation Center is a multidisciplinary outpatient clinic that serves pediatric and adult clients. The occupational therapy (OT) department consists of a senior OT, Sarah, with over 10 years of experience, and a newly licensed OT, James, who joined the team three months ago. Both therapists share patients and contribute to collaborative treatment plans.

During team case discussions, Sarah noticed that James modified a standardized sensory integration protocol when working with children diagnosed with sensory processing disorder. Sarah, who values evidence-based practice and consistency in intervention delivery, raised her concerns in a team meeting, questioning James’s methods. James felt publicly criticized and believed Sarah was dismissing his clinical reasoning and attempts at patient-centered care.

The disagreement escalated, leading to an interpersonal conflict. Their communication became strained as time passed, creating intragroup conflict that affected the broader OT team’s morale and collaboration. Staff began feeling tense, and some avoided joint treatment planning meetings altogether.

Recognizing the impact on the team, the clinic director scheduled a mediation session using a collaborative approach. Both Sarah and James were encouraged to share their experiences without interruption. The director acknowledged their emotions and contributions to the team. Open-ended questions explored the motivations behind James’s treatment modifications and Sarah’s emphasis on standards. Each party actively listened to the other’s viewpoint, facilitated by a neutral mediator. It was discovered that James prioritized adaptability for individual clients, while Sarah focused on safety and reproducibility in care. A joint decision was made to develop flexible guidelines within evidence-based frameworks and establish a peer review process for non-standard interventions.

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