Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

ORGANIZATION RECOMMENDATIONS

1.1 Organizations identify and take action to prevent/mitigate factors contributing to conflict, for example:
• effects of shift work;
• team composition and size;
• workload and staffing;
• manager span of control;
• level of staff involvement in decision-making and provision of care;
• resource allocation;
• diversity in the workplace; and
• physical space.

1.2 Organizations support the systems and processes that minimize conflict, promote team functioning, value diversity and enact a culture of inclusiveness. Common attributes that exist between and among Health-care professionals include:
• educational background;
• work values;
• ethnicity and culture;
• age;
• roles and responsibilities;
• power;
• scope of practice; and
• gender.

1.3 Organizations implement a regular assessment, which may include quality indicators, to identify the types and outcomes (short-term and long-term) of conflict among nurses, physicians and other Health-care professionals. Assessment data is used to develop and implement both action and communication plans for the organization.

1.4 Organizations implement and sustain evidence-based strategies that support/enable leaders to foster self-awareness, possess emotional intelligence, competencies and utilize conflict management principles.

1.5 Organizations ensure all employees, physicians, and volunteers have the knowledge and competencies related to conflict management by:
• Providing ongoing mandatory skills-based education regarding cooperative or active style of managing and mitigating conflict, clear communication, effective team building through transformational leadership practices, and the promotion of mastery of emotional intelligence skills;
• Ensuring education is accessible to shift workers;
• Supporting changes in staff behaviour by using a comprehensive educational approach for different levels (e.g., individuals, teams, organization) tailored to specific settings and target groups. This includes implementing mechanism for refresher courses and/or regular updates; and
• Being congruent with the competencies frameworks for leaders (e.g. LEADS in Caring Environment Framework) and interprofessional practice (e.g. Canadian Interprofessional Health Collaborative, A National Interprofessional Competency Framework).

1.6 Organizations provide internal and/or external third party assistance (e.g. spiritual care, ethicists, safe workplace advocate, and professional practice specialists/consultants) to offer productive support, shared decision-making, and/or manage/mitigate conflict.

1.7 Organizations commit to the sustained use of cooperative or active conflict management styles (e.g., integrating and compromising), clear communication (e.g., crucial/learning conversations) and transformational leadership practices to create healthy work environments by:
• Ensuring all leaders, future and present, acquire leadership competencies in the management of conflict;
• Adopting recruitment processes that assess conflict management capabilities;
• Recognizing individuals, leaders and managers who demonstrate active management styles;
• Implementing a formal mentorship program for managers and point-of-care leaders;
• Meeting the College of Nurses of Ontario Nursing Practice Standards (2009) for nurses in an administrator role; and
• Requiring managers to demonstrate accountability for effective conflict management styles, clear communication and transformational leadership.

 1.8 Organizations evaluate the feasibility and effectiveness of the strategies, standards and policies of conflict management.

1.9 Organizations ensure multi-faceted and comprehensive structures, processes, and supportive policies (e.g. Universal Code of Conduct and Respect in the Workplace) are in place. Organizations should support those in leadership roles to apply organizational policies and processes that exist to recognize, assess, monitor, manage and mitigate conflict.

1.10 Organizations value, promote, enable and role model a culture that recognizes, prevents, mitigates and manages conflict, while enhancing the positive outcomes by:
• Developing structures and processes to foster effective intra- and interprofessional collaborative relationships;
• Utilizing a professional practice model that supports practice accountability, autonomy, reflection, self-awareness and decision-authority related to the work environment and patient/client care;
• Promoting professional autonomy and decision-making;
• Implementing and sustaining effective staffing and workload practices;
• Ensuring a climate of appreciation, trust and respect;
• Including resources in orientation sessions; and
• Utilizing a variety of tools such as education, media campaigns and performance review processes.

1.11 For interprofessional collaborative practice, organizational supports are provided to address conflict in a constructive manner by:
• Valuing the potential positive outcomes of conflict;
• Identifying common situations that are likely to lead to disagreements or conflicts, including role ambiguity, power gradients and differences in approaches to patient/client care goals;
• Establishing a safe environment in which to express diverse opinions and viewpoints regardless of outcome; and
• Establishing consistency and clarity about role expectations among Health-care professionals.