Methods: Five of the nine students enrolled in the capstone course gave consent for their journals to be used in the study following successful completion of their RN-BSN program. The participants ranged from 39-49 years of age and employed actively in a healthcare environment. The five participants were all female (four Caucasian; one African American). Two of the participants reported having previous leadership training, one in a pre-licensure nursing program, and the second as a requirement of a corporate training prior to entering nursing. RN students were required to maintain a 14-week journal that documented conflictual situations encountered in their daily practice. Using a Reflective Conflict Management Journaling tool adapted from Gibbs Reflective Cycle (1988), the students recorded one (minimum) to three (maximum) incidents of inter-personal conflict in the work setting per week.
Completion of each entry included a description of the incident, the emotional impact of the experience, a self-reported rating of their leadership performance, and identification of any positive or negatives outcomes resulting from the conflict. At prescribed intervals, after weeks 4, 9, and at the conclusion of week 14, the students responded to six additional self-reflective questions addressing their perceived growth in leadership performance and conflict management skills. These reflective questions facilitated students to engage in a deeper reflection of personal behaviors when handling conflict.
Data were obtained from students using a journaling template adapted from Gibbs’ Reflective Cycle (1998). Participants recorded 142 conflictual events, achieving saturation for this study. Recordings on the journaling template were to identify the types of conflictual incidents that occurred in the work environment. Incident types involved five types of interpersonal conflict: peer-to-peer, nurse to subordinate, nurse to supervisor, nurse to physician/other discipline, nurse to patient/patient’s family, and nurse to clerical/administrative personnel. With each event, students responded to 1) how they felt during each encounter and, 2) how they reacted to each situation. Finally, the students identified the chose the behavior used to resolve the conflict and commented on effectiveness of their conflict management style and identified any positive or negative outcomes of the incident. Recorded events over the 14-week semester then were triangulated with a set of 6 serial, self-reflection questions posed at 4, 9, and 14 weeks. The serial questions provided the student the opportunity to reflect on personal leadership strengths, personal growth in conflict in conflict management over time and to glean insights into successes or areas needing improvement in their leadership skills. Weekly data entries were categorized collaboratively by the faculty dyad. Serial questions were coded manually and compared to students’ recorded events in the journal template. By agreement of both faulty members, responses to serial questions were coded into the following themes: raised awareness of personal conflict management style, areas of needed improvement, progressive changes in leadership behaviors over time, and overall impact of the reflective practice assignment in the development of effective communication style. Analysis of the data revealed gains in students’ insights into leadership skill in the management of conflict resolution from the beginning and at the end of the course. Various degrees of change in improved leadership behavior was determined through the analysis of student responses.
Results: Participants identified a range of emotional responses as they recorded their experiences. Initial reactions included feelings of intimidation, annoyance, anger, insult, frustration and confidence. Most frequently reported gut reactions to conflictual situations were as follows: 1) avoidance of confrontation due to feelings of personal threat (4/5), non-confrontational behavior with delegation of problem resolution to supervisor (4/5), or confidence in ability to confront issues, meeting role expectations (2/5).
Students reported being “surprised, caught off guard” and, “uncertain how to handle the problem,” and “not knowing what to say.” Ways in which students perceived their leadership performance varied according to types of situation and who was involved. In conflict with peers or subordinates, behaviors of avoidance and compromise were used most often. Conflicts with supervisors and physicians resulted in silence and embarrassment. Foremost, those conflicts identified as resulting in potential or actual negative outcomes for patients were managed through accommodation or advocacy. Among the recorded cases, there was little evidence of collaboration or compromise as functional strategies for conflict resolution. At the course conclusion at 14 weeks, all students reported less use of avoidance behaviors in initial conflict management style. All students reported increased confidence in earlier confrontation of clinical issues that involved interpersonal staff dynamics and patient problems. Timely resolutions of clinical issues using improved leadership skills resulted in , increased level of confidence to handle conflict, positive feedback from peers and supervisors in leadership performance, and increased advocacy on the patients’ behalf. All participants reported favorable personal outcomes resulting from the refection assignment. Students identified leadership behaviors that either decreased potential risk to patients or improved patient outcomes during their healthcare experience.
Conclusion: This study provided insight into the phenomenon of conflict and its management experienced by practicing nurses in the healthcare work environment. Frequent conflict, such as team disharmony, poor communication, unethical behaviors, and weak managerial preparation and style were disruptive. Overt disrespect for peers, colleagues and patients led to a myriad of behaviors that contributed negatively to the business of patient care. Such behaviors were emotionally charged. Frequently experienced conflict within the work setting serves to fray the very fabric of the nursing as a profession and practice.
Journaling emphasized the benefit of reflection among practicing nurses who were transitioning to a professional, leadership role. The reflective journaling assignment for the online RN-BSN student showed effectiveness in raising awareness of personal style and professional behavior in the resolution of conflict. It also served as a way to connect theory and concepts brought forth throughout the course and in the BSN completion program. Student participants showed a positive progression in communication and in conflict management over the 14-week course. Students reported seeing improvements in ‘communication, patience and listening skills.” One student reported increased confidence in speaking up for herself. Another remarked that she felt “more empowered and able to set a good example for others.” Anecdotal comments, made at the conclusion of the assignment, such as: “it was nice to do an assignment that focused on my strengths rather than weaknesses,” and, “I don’t know what happened to me…I suffered completing this assignment….it was hard work looking at myself, but now I feel so proud of my accomplishments” supported the effectiveness of this assignment.