Conflict is a disagreement in values, beliefs, goals, or interests between people or groups, perceived as a threat to their needs. Conflict is inevitable in health care, where people with different roles share scarce resources and high stakes.

• Functional (constructive) conflict brings problems into the open, stimulates new ideas, and improves decisions.
• Dysfunctional (destructive) conflict drains energy, damages relationships, reduces productivity, and can harm clients.

The manager's aim is not to eliminate all conflict but to keep it at a productive level and resolve it constructively. Too little conflict can mean apathy and "groupthink"; too much produces chaos.

Negotiation is a process in which parties with different interests reach an agreement through give-and-take. Collaboration is working jointly toward a shared goal, pooling knowledge and resources. Coordination is aligning the work of individuals and units so that effort is not duplicated or left undone.

Types (levels) of conflict

Common causes: scarce resources (equipment, staff, budget); interdependence of tasks; unclear roles and responsibilities (role ambiguity); differences in values, goals, or professional culture; poor communication; structural factors such as different leadership styles, competing authority, or policies; and change.

Stages of conflict (Filley's model)

1. Antecedent conditions (latent conflict) — the circumstances that make conflict possible (e.g., short staffing)
2. Perceived conflict — parties recognize the disagreement
3. Felt conflict — emotions arise (anger, anxiety, mistrust)
4. Manifest (overt) conflict — open action: arguments, complaints, withdrawal
5. Resolution or suppression
6. Aftermath — the feelings that remain and shape future conflict

Managers intervene best early, at the perceived or felt stage.

Conflict-handling modes (Thomas–Kilmann) — defined by assertiveness (concern for own goals) and cooperativeness (concern for others' goals).

Other strategies commonly named

• Smoothing: a form of accommodation — emphasizing areas of agreement and playing down differences; calms feelings but may leave the real issue unresolved.
• Confrontation: bringing the conflict into the open and dealing with it directly; the basis of collaboration.
• Superordinate goals: uniting parties around a higher shared goal (e.g., client safety).
• Formal procedures and rules (policy-based resolution): quick and consistent, but may not address underlying feelings or root causes.
• Third-party help: mediation (a neutral party helps the parties reach their own agreement) and arbitration (a neutral party decides).

Principled negotiation (Fisher and Ury)

1. Separate the people from the problem.
2. Focus on interests, not positions.
3. Generate options for mutual gain.
4. Use objective criteria (policy, evidence, staffing standards).
5. Know your BATNA (best alternative to a negotiated agreement).

Good negotiators prepare with facts, listen actively, stay calm, avoid personal attacks, and look for trade-offs that cost one side little but mean much to the other.

Steps a nurse manager uses to resolve a staff conflict

1. Meet the parties privately and in a neutral setting; stay neutral.
2. Listen to each side to understand facts and feelings — the first step.
3. Define the problem together, separating people from the issue.
4. Identify interests and generate options.
5. Agree on a solution and on who does what by when.
6. Follow up and evaluate.

Coordination tools on a unit and across departments

• Regular unit meetings and huddles to share client status, workload, and priorities
• Clear role descriptions and assignment boards
• Committees and task forces with members from all affected departments for cross-department problems (e.g., delayed specimen transport)
• Liaison persons and standard referral forms
• In the community: coordination among the rural health unit, barangay officials, BHWs, and other agencies through local health board mechanisms

Interprofessional collaboration

• Rests on mutual respect, shared goals, clear roles, and open communication.
• The nurse contributes continuous, holistic observation of the client and the client's own priorities.
• Managers promote collaboration through joint rounds, shared protocols, and team training.

• Recognize conflict early and address it directly rather than letting it grow.
• Choose the conflict mode that fits the issue, the relationship, and the time available; collaboration for important, long-term issues.
• Use assertive communication; avoid gossip, sarcasm, and public confrontation.
• As a manager, act as a neutral facilitator or mediator, ensure fair process, and keep the focus on client care.
• Coordinate staff, supplies, and equipment so that client safety and quality of care come first.
• RA 9173 Section 28 includes coordination with the health team and linkage with community resources within nursing scope.

• Client safety outranks harmony. A safety conflict is not resolved by avoiding or accommodating; the nurse escalates through the chain of command.
• Workplace harassment and bullying: the Safe Spaces Act (RA 11313) covers gender-based sexual harassment in workplaces and requires employers to prevent, deter, and act on it, including a committee on decorum and investigation and a workplace policy. The Anti-Sexual Harassment Act of 1995 (RA 7877) also still applies when a person with authority, influence, or moral ascendancy demands sexual favors. Other forms of bullying are handled through institutional policies and, for public employees, civil service rules.
• Due process: formal grievances follow the institution's written grievance procedure; parties have the right to be heard.
• Confidentiality: conflict discussions and investigations are private.
• The Code of Ethics for Registered Nurses expects nurses to maintain collegial relationships and to resolve disagreements professionally.

Case 1. Two staff nurses argue repeatedly about how patient assignments are made. What should the head nurse do first?

Answer: Meet with both, listen to each side in private, and clarify the facts. Imposing a solution first (competing) or ignoring it (avoiding) skips understanding of the real issue.

Case 2. A new electronic records system causes friction between senior nurses who prefer paper and newer nurses who want rapid change. What strategy uses the conflict productively?

Answer: Form a working group with members from both groups to plan the transition. Collaboration integrates both views and builds commitment.

Case 3. During a code, a nurse and a respiratory therapist disagree loudly on who should manage the airway. What approach is appropriate?

Answer: Competing (directive decision by the code leader). In an emergency, the team leader decides immediately; the disagreement is discussed later in a debriefing.

Case 4. Two wards both need the only available infusion pump for the night. Both head nurses agree that one ward uses it until midnight and the other afterward, and they request another pump from the supply office. What mode is shown?

Answer: Compromise for the immediate shortage, followed by a collaborative step (requesting an additional pump) to solve the underlying problem.

• Believing all conflict is harmful. Moderate, well-managed conflict improves decisions.
• Confusing compromise (both give something up) with collaboration (both fully satisfied through a new solution).
• Choosing avoiding for a client-safety issue.
• Mixing up accommodating (yielding to the other) with avoiding (withdrawing from both).
• Negotiating over positions ("I want day shifts") rather than interests ("I need to pick up my child at 5 PM").
• Thinking formal rules solve every conflict. They may end the dispute on paper but leave feelings and root causes unresolved.
• Labeling a conflict inside one person as interpersonal. It is intrapersonal.

• Conflict can be functional or dysfunctional; the manager keeps it productive.
• Types: intrapersonal, interpersonal, intragroup, intergroup, organizational.
• Causes: scarce resources, interdependence, role ambiguity, value differences, poor communication, structural factors.
• Filley's stages: antecedent → perceived → felt → manifest → resolution or suppression → aftermath.
• Collaborating = win–win, best for important issues with time available.
• Competing = win–lose, for emergencies. Avoiding = lose–lose, for trivial issues or cooling off.
• Accommodating preserves relationships; compromising gives a quick, partial solution.
• First step in managing staff conflict: listen to all sides neutrally.
• Principled negotiation: people vs problem, interests not positions, mutual-gain options, objective criteria, BATNA.
• Mediation helps parties agree; arbitration decides for them.
• Cross-department problems: a task force with all stakeholders.
• RA 11313 requires employers to act on gender-based sexual harassment at work.