Journal of Nursing Management, 2011, 19, 8091

Conflict coaching training for nurse managers: a case study of a two-hospital health system
ROSS BRINKERT
PhD

Assistant Professor of Corporate Communication, Department of Corporate Communication, The Pennsylvania State University, Abington, PA, USA

Correspondence Ross Brinkert Department of Corporate Communication The Pennsylvania State University 1600 Woodland Road Abington PA 19001 USA E-mail: rsb20@psu.edu

B R I N K E R T R . (2011) Journal of Nursing Management 19, 8091 Conflict coaching training for nurse managers: a case study of a two-hospital health system

Aim This study evaluated the application of the Comprehensive Conict Coaching model in a hospital environment. Background Conict coaching involves a coach working with a client to improve the clients conict understanding, interaction strategies and/or interaction skills. The training of nurse managers as conict coaches is an innovative continuing education programme that partially addresses conict-related concerns in nursing. Method Twenty nurse managers trained as conict coaches and each coached a supervisee. Qualitative data were gathered from nurse managers, supervisees and senior nursing leaders over an 8-month period and organized using standard programme evaluation themes. Results Benets included supervisor conict coaching competency and enhanced conict communication competency for nurse managers and supervisees facing specic conict situations. Challenges included the management of programme tensions. Additional benets and challenges are discussed, along with study limitations. Conclusion Conict coaching was a practical and effective means of developing the conict communication competencies of nurse managers and supervisees. Additional research is needed. Implications for nursing management Conict is common in nursing. Conict coaching is a new conict communication and supervision intervention that demonstrates initial promise. Conict coaching seems to work best when supported by a positive conict culture and integrated with other conict intervention processes. Keywords: coaching, communication, conict, nurse manager, training
Accepted for publication: 13 May 2010

Introduction
Conict is typically dened as involving two or more people in perceived opposition (Almost 2006). A recent extensive review of conict in nursing demonstrated
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the importance of its causes, costs and benets (Brinkert 2010). Conict is apparent across nursing relationships. Among nurses, it has been described in terms of role conict (Cooper 2003), burnout (Poncet et al. 2007), horizontal violence (Abu AlRub 2004)
DOI: 10.1111/j.1365-2834.2010.01133.x 2010 The Author. Journal compilation 2010 Blackwell Publishing Ltd

Conflict coaching training for nurse managers

and intergenerational conict (Swearingen & Liberman 2004). Among nurses and other professionals, including physicians, conict has often involved integrating different viewpoints and has been connected to vertical violence (Buback 2004). Conict has also been documented as occurring between nurses and patients, between nurses and patients families and among all three parties (Luce & White 2007). Conict has also been shown to exist in terms of the wider organization and larger socio-economic context (Haddad 2002). Nursing-related conict has many direct and indirect costs (Gerardi 2004). Persistent conict is particularly notable as it is linked to key challenges facing the eld. These include increased burnout (Espeland 2006), decreased work satisfaction and team performance (Cox 2003), increased errors and increased likelihood of turnover (Lambert et al. 2004). Good communication makes a difference. Communication is signicantly better in hospitals with good attraction and retention rates for nurses (Stordeur et al. 2006). Supportive and collaborative communication from managers is very important for nurses coping with ambiguities related to managed care (Apker 2001). The teaching of practical conict management strategies has led to signicant differences in handling stress (Haraway & Haraway 2005). While there are numerous demands for conict management interventions, there are few conict education programmes available (Vivar 2006) and more systematic efforts merit attention (Porter-OGrady 2004), including the use of conict coaching (Brinkert 2010). The remainder of this article describes conict coaching and presents a case study. Conict coaching is a way to address and manage conict in nursing. It provides a framework for nurse managers to support nurses and allied health professionals (especially those reporting to nurse managers) in working through conict.

across disciplines while emphasizing a social constructionist framework (Gergen 1999), seeing conict as predominantly communication based (Folger & Jones 1994) and employing a narrative structure (Winslade & Monk 2000, 2005, Kellett & Dalton 2001). The CCCM includes a beginning conversation, four stages and a parallel process (or continuous stage) (see Table 1). The preparatory conversation consists of four tasks: (1) clarifying the coaching process; (2) determining the client-process t; (3) determining the coach-client t; and (4) deciding whether to commit. Stage 1: Discovering the Story involves determining the clients baseline situation. The coach invites the client to share the initial story before working with the client to rene and test it. Stage 2: Exploring Three Perspectives uses three dominant concepts from research on conict communication to provide the client with expanded views on the situation for both themselves and others. Identity, emotion and power are used to make sense of the situation retrospectively and prospectively. For instance it is often the case that the onset of conict threatens our identity, is experienced in terms of an emotion and diminishes our sense of power. Stage 3: Crafting the Best Story makes use of Appreciative Inquiry (Cooperrider & Whitney 2005) in getting the client to create a vision of a best future outcome. Similar to Stage 1, the coach and client shift from inviting to rening and testing the best story.
Table 1 The comprehensive conflict coaching model The preparatory conversation The parallel process: Clarifying the process LEARNING ASSESSMENT Determining client-process fit Needs assessment Determining coach-client fit Goal setting Obtaining client consent Reflection and feedback Stage 1: DISCOVERING THE STORY Learning transfer Initial story Refining story Testing story Stage 2: EXPLORING THREE perspectives Identity Emotion Power Stage 3: CRAFTING THE BEST STORY Initial story Refining story Testing story Stage 4: ENACTING THE BEST STORY Communication skills Conflict styles Negotiation Other dispute resolution processes

Background on conflict coaching

Conict coaching is a one-on-one process to develop a clients conict understanding, interaction strategies and/or interaction skills (Brinkert 2006). Conict coaching has its earliest roots in the elds of alternative dispute resolution and executive coaching. Originally conceived as an alternative to mediation, it can be used in a number of ways to support individuals as they proactively or reactively handle conict with others. The Comprehensive Conict Coaching model (CCCM) (Brinkert 2006, Jones & Brinkert 2008) integrates conict management research and theory from

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Stage 4: Enacting the Best Story consists of the coach supporting the client in selecting and honing the communication strategies and skills to bring the best story to life in actual interaction with others. The CCCM includes four main ways that coaches can support clients in this respect: developing communication skills; effectively applying conict styles; preparing for negotiation; and integrating other dispute resolution processes. The Parallel Process Learning Assessment is intended to determine the need and effectiveness of the coaching experience for the client. This includes needs assessment, goal setting, reection and feedback and learning transfer.

20 frontline nurses and other frontline professionals were consented to participate in coaching with a nurse manager.

Design
The study involved gathering qualitative information on the application of the CCCM within a nursing management environment. This case study describes the ndings related to the training of 20 nurse managers as conict coaches using multiple sources of qualitative data (Yin 2003) and some supporting quantitative data. Different professional perspectives were combined with the inclusion of senior leaders, nurse managers and frontline nurses. Senior leaders and nurse managers were able to provide study data at different points in time and do so in both face-to-face interviews and in a condential questionnaire format. Most interviews used at least two techniques for inquiring about a key concept. For instance, nurse managers were asked an openended question about the handling of conict (a direct approach) and were also asked to share a critical incident (an indirect approach).

Methodology Ethical considerations

Institutional Review Board approval was sought and granted by both the authors university and the research site. The study at all times involved voluntary participation and protected the condentiality of participants.

Site
The CCCM was applied within a US Magnet status 500-bed two-hospital health system with a teaching college. The pre-existing conict management system incorporated the following: frontline individual-level skills; supervisor skills; escalation within the organizational hierarchy; organizational development interventions or training opportunities; human resources development interventions or training opportunities; and formal grievance procedures (for unionized employees). The conict coaching programme was appealing to the hospital given the underdevelopment of some existing elements (e.g. frontline individual-level skills), the underutilization of elements given apparent need and the recognition that employees should have access to options (Lipsky et al. 2003).

Data gathering
Pre-training interviews: senior leaders and nurse managers participated in 30-min interviews and were invited to submit additional anonymous written responses. Training: nurse managers participated in 12 hours of training spread over four separate days and completed written evaluation forms. Post-training coach-client sessions: nurse manager coaches and professional clients (most often frontline nurses) carried out conict coaching sessions and anonymous written feedback in the month after the end of coach training. Post-training interviews: senior leaders and nurse manager coaches participated in interviews and were invited to submit additional anonymous written responses 3 months and 6 months post-training (see Table 2).

Participants
Senior leaders three senior nursing leaders (including the chief nursing ofcer and two divisional directors) were consented to provide contextualizing information over the course of the project. Nurse managers 20 nurse managers (including some directors) were consented to be directly involved with the conict coaching training as well as pre and post activities. Professionals 82

Data analysis
Data gathering took place from November 2007 through to July 2008. All interviews were audio recorded and professionally transcribed. In accordance with the data analysis and interpretation process proposed by Cresswell (2003), coarse coding evolved into the development of themes based on narrative passages. Themes were arranged within the ve adapted

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Table 2 Data gathering Study interval Pre-training (-2 months) Participants Senior leaders Data Semi-structured interviews Questionnaires Question examples What role, if any, do managers play in assisting professionals in managing work-related conflict as part of the supervision process? In terms of managers and professionals working one-on-one to develop the professionals abilities to manage conflict effectively, what approach do managers and professionals follow? What are your organizations goals for the conflict coaching training programme? What kinds of conflicts do you face at work? What kinds of conflict do those you manage face at work? What are the most important work-related conflict issues that you feel need to be addressed? What ideas, exercises, and/or activities were most and least valuable to you? What are your ideas for adapting specific parts of this training for use in your work? What are your recommendations for future training sessions? Please comment on how the client seemed to benefit or not benefit from the coaching session. Please explain how the conflict coaching training prepared and/or did not prepare you to effectively carryout the coaching session. Are you likely to use the conflict coaching model with others (or with this client-professional regarding another issue) within the next six months? Please explain. What was most and least beneficial about your conversation with your manager/coach today? Please comment on how your manager/coach could be even more helpful in terms of the kind of conversation you had today. Please comment on whether or not it would be beneficial to have a follow-up conversation with the manager/coach and/or have a similarly structured conversation on a different issue. Are you aware of managers informally using elements of the conflict coaching training in their work with professionals? If so, please describe. Are you aware of managers closely applying the five step conflict coaching model in their work with professionals? If so, please describe. Please feel free to share any additional thoughts or feelings related to this interview/ questionnaire or the larger study. To what extent are you informally using elements of the conflict coaching training in your work with professionals? If you are using elements informally, please describe. To what extent are you closely applying the five step conflict coaching model in your work with professionals? If you are using the model, please describe. Please feel free to share any additional thoughts or feelings related to this interview/ questionnaire or the larger study. See above: Post-training (+3 months)

Managers

Semi-structured interviews Questionnaires Questionnaires

Training

Managers

Post-training coaching (+1 month)

Managercoaches

Questionnaires

Professionalclients

Questionnaires

Post-training (+3 months)

Senior leaders

Semi-structured interviews Questionnaires

Managers

Semi-structured interviews Questionnaires

Post-training (+6 months)

Senior leaders Managers

Semi-structured interviews Questionnaires Semi-structured interviews Questionnaires

See above: Post-training (+3 months)

programme evaluation domains of social intervention programmes (Rossi et al. 2004): (1) programme demand; (2) programme composition; (3) programme implementation; (4) programme outcomes; and (5) programme efciency. Each of these results categories is described below (see Table 3).

Results Programme demand

Evaluating programme demand is important for establishing that there is indeed a pressing issue to be

addressed (Rossi et al. 2004). While the existing literature attests to the frequency and importance of conict in nursing, the determination of local need was sought to conrm the relevancy of conict within this particular setting and improve the delivery of the training programme. Four themes relating to programme demand emerged from the pre-interviews with nurse managers and senior nursing leaders. Ubiquity of conict Nurses and senior nurse managers readily acknowledged that nurse managers deal with conict. It is 83

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Table 3 Results [based on adapted programme evaluation structure of Rossi et al. (2004)] Category Programme demand Theme or sub-theme Ubiquity of conflict Related research participant quote I think they struggle with two things. One, with their own, with managing the nursing piece, because theyre dealing with different cohorts of nurses that have different needs And I think the second thing that their conflict is continually with the rest of the health provider team, simply because everybody is fighting for the same limited resources [T]heres a tremendous amount of communication that has to be done in a very short period of time [E]verybody that I have [is] capable of identifying issues that need to be addressed. And some are better at acting on those and feeling confident. And others just need, they need more support, or, quite frankly, have no idea how to move forward. And you could move him thorough the disciplinary process and eventually let him go. Butyou could use that other avenuedo an action plan on how he could improve. People dont like to, I guess, confront is the word, when theyre feeling somethings bothering them. And that just drives me nuts. Because conflict is very detrimental in a clinical area. Theres a lot of studies that show that conflict causes increase in mortality and morbidity. And thats what I want them to know, that when theres conflict, its really the patient that, they take it personally, but from my standpoint, I worry how the patient falls out in that conflict. And I want them to understand that their actions create this dynamism on the unit, which really affects patient care. Conflict is a barrier to communication and when health care people cant communicate, the patient really becomes endangered. I think it is very useful for somebody that is new in management to have those kind of tools and that type of set up, to learn that when theyre starting their job. I would have loved to have something like that when I was a new manager. I loved being out there. It was nice to communicate with other people and to work with people that we dont normally work with on a normal basis. I mean, we see these managers, or we see these other directors but we dont work side by side with them to really listen to what they say. Not applicable The classes were, I felt were excellent, but actually having to do it was good, especially because it was real. It wasnt something that you made up. You know what I mean? It was actually real, something that was happening. [M]y new director was using this role, this model, in dealing with some conflicts with the staff before I got there. She told me she had that one page cheat sheet with her when she was dealing with some of the staff about some interpersonal behaviours. I see a big change as far as the way my assistant nurse manager interacts with not only the service aide but also with physicians and with visitors. So her whole way of communicating and how she portrays herself has changed. So that was a good thing because that was a big problem. I would probably say [I apply the training content] a couple times a week because every day theres something going on. This one gets pissed. This one gets that. This one took lunch long. This one does Even though theyre not significant conflicts they mean a lot to these people. [I]t was really useful because it makes things easier for yourself. You dont have to problem solve everything I used to go home drained... but now they come to me and they manage it themselves or, if they cant, then I know how I can help them manage it. [Y]oure in such a rushed environment here, you think to yourself, oh my God, Ive got 20 minutes to get this over with. Whereas, if you nip it in the bud in the beginning and take the time in the beginning to really go through the techniques, I think its beneficial in the long run. And thats one thing I have done, I have taken the time... Coach (referring to how client seemed to benefit from coaching): Did not grasp that her actions for calling [the patient] a [derogatory name] were unprofessional. Client (referring to benefit from coaching and available options): That she reinforced that I should have apologized I wanted to do this, however, a co-worker told me not to talk with [the person] because she was too upset.

Conflict competencies

Intervention pathways

Programme composition

Preferred uses of conflict coaching Theory and research foundation

Develop nurse managers as coaches Group-based training

Programme implementation

Programme outcomes

No ill consequences Client post-coaching feedback challenging but useful process Training design successes and future modifications

Beneficial aspects of the training and model

Varied application of the training and model

Model-related tensions Expertise-facilitation

Time investment

Assessments of benefit

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Table 3 (Continued) Category Theme or sub-theme Simplicity-complexity Related research participant quote So once I got the structure down as you had given it to us and I paid attention to it and started to see the value in each of the steps and some of the examples that we had done in class and that you, the information you shared with us, it was a useful tool. Now I got a better way of shortening some of the processes in those steps to make it come out to the same thing in the end... I think the fact that the coach and I are friendly and work very well together may have swayed her to take my side, could have hampered her objectivity. [F]or time effectiveness, maybe having it in two [full-day] sessions, versus four [half-day sessions]. I think it should be offered to other levels of supervisory people within the institution. We all have different titles but similar roles. We all have the same day-to-day issues of employee interactions or team efforts and work. And I think it would only make it better if we all had similar education and we could see how well it works for the whole of the institution, being on the same page... [Y]ou made the cheat sheet for us, but even smaller than that, just some little, just a card for me to refer to, on my desk. Some kind of reminder to be more structured with [the model] would be really good [I]t doesnt take a lot to get you back, it just takes a moment of focusing on [the model] and I think [the card] would really help me.

Role management issues Programme efficiency Preference for full training days Pre and post-training support advisable

Additional written prompts advisable

common for conicts to arise with patients and their families, frontline nurses, other professionals and staff who report directly to the nurse manager, other departments (including other nurse managers), physicians, senior leaders and insurance companies. Common conict topics included scheduling, carrying out daily work assignments, discipline, handling difcult behaviours and interdepartmental conict. Additional conict-related topics included preparing for and executing accreditation visits, carrying out new policies and procedures, juggling numerous work demands and generally promoting team accountability at all levels of the organization to ensure the best patient care possible. Some nurse managers noted their lack of involvement in direct conict but spoke at length about involvement in others conicts. Conict competencies Nurse managers of varying experience levels attributed increased conict competency to those nurse managers with more managerial experience. Most nurse managers described themselves as fairly good to very good at handling conict issues. Many attributed their success to the use of one or more effective strategies and skills such as demonstrating respect, listening effectively and knowing when to engage. It was not uncommon for nurse managers to express reasonable comfort and success in dealing with conict but to also note that there were certainly aspects of conict that were outside of their control. The conict competencies of frontline nurses and other supervisees were consistently characterized as varied and often described in polarities. In

terms of those with decits, some were described as lashing out inappropriately while many others were described as being unwilling to directly engage others on important issues. Intervention pathways Nurse managers worked through conict communication issues with their supervisees in two basic pathways. There was often but not always a clear distinction between the two. The rst pathway concerned matters of formal discipline. Here the supervisee might be given clear instructions about necessary behaviour change or the nurse manager and supervisee might work together to come up with a formal plan. The second pathway concerned non-disciplinary interventions. This encompassed a wide range of situations in which a supervisee faces circumstances that do not pose an immediate threat to employment. There was a remarkably strong culture in the organization of nurse managers approaching supervisees in these situations and attempting to support them in acting directly to ameliorate the situation. Preferred uses of conict coaching In these early interviews, three primary likely uses of conict coaching by nurse managers became clear: (1) integrating a new organizational member (e.g. proactively supporting individual adaptation to sensitive work topics and patterns); (2) assisting an individual chronically stuck in conict and/or stuck in a particularly problematic current situation (may or may not be a formal disciplinary matter); and (3) developing an 85

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individual with the potential for a formal leadership position. Nurse managers were most committed to starting conict coaching training in order to develop a greater sense of accountability in frontline professionals, develop frontline professionals confrontation skills and simply improve their own abilities to effectively intervene with others.

Programme composition
Evaluating programme composition involves considering the appropriateness, practicality and likely effectiveness of programme theory, especially at the point of conceptualization (Rossi et al. 2004). The conict coaching training content was designed in recognition of the impact of conict in nursing and with a foundation of conict communication theory and research as noted above. The training process was shaped by the general learning principles of providing a comfortable and rewarding learning environment, offering many practice opportunities and relating material to the workplace (Beebe et al. 2004). It was also guided by andragogical principles, including acknowledgement of adult learners prior experience and accommodation of their self-determined learning needs (Knowles et al. 2005). The training programme emphasized developing nurse manager training participants as conict coaches to supervisees. Training participants received a training workbook as well as a theory and research-based book and corresponding CD-ROM with coach and client resources. The training sessions included teaching segments supported by Power Point, individual written activities, pair and small group activities (including coaching role plays and case analyses) and large group dialogue and discussion. The training needed to be scheduled so that a maximum number of nurse managers could attend and that the functioning of the hospital would not be affected. The training was carried out for 3 hours on each of 4 days over 1 month.

completed a reading assignment and written work to demonstrate understanding and application of the session material. One nurse manager and three professionals did not submit their anonymous post-coaching feedback forms even although it seemed that these individuals participated in coaching sessions. One senior leader did not take part in the 3-month follow-up interview because of scheduling difculties. A different senior leader and one nurse manager did not take part in the 6-month follow-up interview because of scheduling difculties. Also, another nurse manager did not take part in the 6-month follow-up interview because she had voluntarily left to work at another organization. It is also noteworthy that the post-training coaching and related coach and client questionnaire process was somewhat challenging to coordinate because of the research consent process but represented a valuable training exercise. While it was not done in the case reported here, a process of anonymously aggregating post-coaching client feedback and sharing it with nurse manager coaches could provide useful insight to coaches. An active training environment with actual coaching and ongoing training support was clearly important.

Programme outcomes
Evaluating programme outcomes is done to determine the impact of the intervention (Rossi et al. 2004). Programme outcome data came from training evaluations and post-training interviews with nurse managers as well as coach and client post-coaching questionnaires. Programme outcomes are organized around four themes. Training design successes and future modications Quantitative data gathered with a ve-point scale in a questionnaire format at the end of the conict coaching training indicated a predominance of high and moderately high ratings. The highest overall rating was for item no. 2, the applicability of the training to the nurse managers work, with 68.42% of respondents selecting high and 31.58% of respondents selecting moderately high. The lowest overall rating was for item no. 8, the level of perceived effectiveness in assisting professionals regarding conict communication, with 31.58% of respondents selecting high, 63.16% of respondents selecting moderately high and 5.26% of respondents selecting neither high nor low (see Table 4). Qualitative responses gathered in questionnaire format at the end of the conict coaching training and in follow-up interviews in the 6 months post-training

Programme implementation
Evaluating programme implementation is valuable for ensuring that the intervention is proceeding as expected (Rossi et al. 2004). Participant involvement throughout the research process seemed reasonable given the requests made of participants and the dynamic nature of work in a hospital environment. Exceptions to full participant involvement were as follows. There were six instances of nurse managers missing one of the four training sessions. In each case, the nurse manager 86

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Table 4 Nurse manager training evaluation findings (n = 19) High 1. 2. 3. 4. 5. 6. 7. Your level of satisfaction with the overall training The applicability of the training to your work The quality of the training content The quality of the materials The quality of the training activities The quality of the trainers presentation and facilitation What is your level of effectiveness in understanding the conflicts that professionals face? 8. What is your level of effectiveness in assisting professionals regarding conflict communication? 9. To what degree will this training be generally useful to you in carrying out your work? 10. To what degree will the conflict coaching model be useful to you in carrying out your work? 47.37% 68.42% 57.89% 57.89% 47.37% 63.16% 36.84% (9) (13) (11) (11) (9) (12) (7) Moderately high 52.63% 31.58% 42.11% 36.84% 52.63% 36.84% 57.89% (10) (6) (8) (7) (10) (7) (11) Neither high nor low 5.26% (1) 5.26% (1) 5.26% (1) Moderately low Low

31.58% (6) 57.89% (11) 63.16% (12)

63.16% (12) 42.11% (8) 36.84% (7)

period indicated that nurse managers appreciated the blend of training methods, including self-reective written activities, dyadic conversational activities, small group conversational activities, large group dialogue and discussion, and lecture segments with Power Point. Some wanted more of a self-awareness emphasis in the training. Nurse managers appreciated the inclusion of concrete examples and cases for discussion as well as the provision of role play scenarios. It was very important to have these tailored to the nurse managers work setting. Additional specic examples, cases and scenarios would be an improvement for nurse managers. They would have helped to make the conceptual material even more comprehensible and applicable. Tight integration of the Power Point and workbook are important. Providing nurse managers with a one-page model overview sheet was widely appreciated as a way to make the training content easier for the nurse managers to understand (and later apply). Some nurse managers recommended enhancing the overall training and coaching experience by assigning the conict coaching book in advance of the training. Unfortunately, it was not yet available. Convening the training at a comfortable off-site location was widely appreciated. It made it easier for nurse managers to step outside the hectic day-to-day routine and reect. Many commented that it was valuable to take part in training that was more dialogic (as opposed to one-way) and concentrate on other nursing manager colleagues (and not include frontline nurses and other professionals). It would have been helpful for the nurse managers to compress the schedule using whole training days but maintain an interval between days. One nurse manager commented that it was uncomfortable participating in the training with

different levels of formal nursing leaders (from nurse managers through to divisional directors). Benecial workplace applications of the training and model From the point of view of workplace application, nurse managers generally characterized the main benets of the training as providing a good conict coaching structure and knowledge base. They valued the training in part because their work involved conict on a daily basis. Particularly after the coaching session, nurse managers emphasized the benets of client perspective taking and generation of a best story. At this point in time, many nurse managers also commented on new found awareness and tools for addressing supervisees conicts. This was reected in the realization that the nurse manager could assist the supervisee without needing to take direct control in these situations. All parts of the model were used in the aggregate actual conict coaching sessions that were carried out. This seemed to indicate the applicability of all of the major content areas covered in the model and coach training. The predominant benets identied by coaching clients were coming to understand different perspectives on the situation and generating one or more workable solutions. Clients also appreciated feeling that the coach/manager understood the clients point of view. Quantitative data gathered anonymously from coaches at the end of an actual conict coaching session indicated a predominance of moderately high and high ratings. The highest overall rating was for item no. 1, the level of perceived effectiveness in understanding the conicts that professionals face, with 47.37% of respondents selecting high, 47.37% of 87

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respondents selecting moderately high and 5.26% of respondents selecting neither high nor low. The lowest overall rating was for item no. 4, the degree to which nurse manager coaches thought the professional client benetted from the coaching session, with 10.53% of respondents selecting high, 78.95% of respondents selecting moderately high, 5.26% of respondents selecting neither high nor low and 5.26% of respondents selecting moderately low (see Table 5). Quantitative data gathered anonymously from clients at the end of an actual conict coaching session indicated a predominance of high and moderately high ratings. The highest overall rating was for item no. 1, the coachs level of effectiveness in understanding the conict that the client faced, with 88.24% of respondents selecting high and 11.76% of respondents selecting moderately high. The lowest

overall rating was for item no. 3, the degree to which clients benetted from the coaching session, with 41.18% of respondents selecting high, 52.94% of respondents selecting moderately high and 5.88% of respondents selecting neither high nor low (see Table 6). Nurse manager follow-up interviews 3 and 6 months post-training included scaled items that could be compared. The highest overall rating was at 6 months posttraining for item no. 2, the degree to which the conict coaching model was useful for nurse managers in carrying out their work, with 66.11% of respondents selecting high and 38.89% of respondents selecting moderately high. The lowest overall rating was at 3 months post-training for item no. 2 with 30% of respondents selecting high, 60% of respondents selecting moderately high and 10% of respondents selecting neither high nor low (see Table 7).

Table 5 Conflict coaching evaluation findings coach/nurse manager version (n = 19) High 1. What was your level of effectiveness in understanding the conflicts that the professional faced? 2. What was your level of effectiveness in assisting the professional regarding conflict communication? 3. To what degree did the conflict coaching training prepare you to carry out this actual coaching session? 4. To what degree do you think the client benefitted from the coaching session? 47.37% (9) 21.05% (4) 21.05% (4) 10.53% (2) Moderately high 47.37% (9) 78.95% (15) 68.42% (13) 78.95% (15) Neither high nor low 5.26% (1) 10.53% (2) 5.26% (1) Moderately low 5.26% (1) Low

Table 6 Conflict coaching evaluation findings client/professional version (n = 17) High 1. What was the manager/coachs level of effectiveness in understanding the conflict that you face? 2. What was the manager/coachs level of effectiveness in assisting you regarding conflict communication? 3. To what degree did you benefit from the coaching session? 88.24% (15) 64.71% (11) 41.18% (7) Moderately high 11.76% (2) 29.41% (5) 52.94% (9) Neither high nor low 5.88% (1) 5.88% (1) Moderately low Low

Table 7 Nurse manager training follow-up findings [+3 months n = 20 (1st entry below); +6 months n = 18 (2nd entry below)] High 1. To what degree was this training generally useful for you in carrying out your work? 2. To what degree was the conflict coaching model useful for you in carrying out your work? 3. To what degree have your goals for the conflict coaching training programme been met? 40% 50% 30% 61.11% 30% 50% (8) (9) (6) (11) (6) (9) Moderately high 55% 44.44% 60% 38.89% 65% 44.44% (11) (8) (12) (7) (13) (8) Neither high nor low 5% (1) 5.56% (1) 10% (2) 5% (1) 5.56% (1) Moderately low Low

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Varied application of the training and model While the collected data did not capture the number of conict coaching meetings that were carried out (beyond the round of post-training coaching sessions), the qualitative breadth of applications was obtained. At the 6-month mark, all respondents except one reacted to the inquiry into the informal use of the conict coaching training by sharing one or more examples of how it had positively impacted their work. The nurse manager with the outlier response went on respond to the inquiry into closely applying the model by sharing how she had repeatedly used it with a technician in order to keep him accountable on key issues. Informal uses of the training included addressing issues early, applying techniques to more effectively address issues in teams, effectively adopting and promoting perspective-taking and routinely using one, two or three stages of the model. More closely applying the model was variously interpreted as applying one stage in detail, using the larger model to address a serious issue, or simply noting that the application of the model was situational. In general, closely following the model was connected to dealing with major issues such as handling a staff member who was verbally inappropriate in a patient care area or grooming an individual for a new professional role. Five nurses reported not using the model recently, with four indicating they will likely use it in the future and one noting that she would need more supports to put it in place. Model-related tensions Expertise-facilitation. Some nurse managers expressed appreciation for learning the model because it provided them with a method for supporting supervisees without having to take personal responsibility for developing and implementing the solution. The model seemed to allow coaches to not have to x all problems that arose. They saw themselves as becoming more facilitative. Coaches appreciated the model for emphasizing the perspective of the client/supervisee and for placing best story conception and implementation with the client. While the facilitative aspect of the model was positive for nurse managers, nurse managers were aware of drawing on their expertise when working through conict. Also, supervisees plainly valued the managers expertise within the conict coaching conversation. The coaching conversation is consonant with the existing supervisorsupervisee relationship but is experienced as positively different by some clients. Time investment. Early on in the process, some nurse managers expressed fears that the model would take too

long to implement. After the training process and actual coaching experience, there was some acknowledgment that the application of the model does not take as long as expected. Also, there was some acknowledgment that certain conicts are worth the conict coaching investment. Most coaching sessions lasted 3060 minutes. The overall range extended from 15 to 90 minutes. Another related time tension concerned the apparent time required for learning the model. Coaches and clients expressed that coach effectiveness and efciency comes with time. Assessments of benet. While coaches and clients both, on average, gave high ratings to the coachs level of conict understanding, coach conict-related assistance and client benet, clients scored each of these items more favourably than coaches (see Tables 5 and 6). This may be a simple difference of opinion. It also may demonstrate a lack of appreciation by the coach for what the client is achieving in the coaching session. For example, in one instance, the coach assumed that the client had not learned a certain point and yet the client clearly indicated learning the precise point that was of concern to the coach. (See quotes related to Assessments of benet entry in Table 3.) Also, while many coaches and clients were in agreement that a follow-up session was or was not seen as a probable benet, clients more often than coaches indicated the probable benet of a follow-up session on the same or different topic. Simplicity-complexity. The conicts that nurse managers and nurses face are complex and yet many nurses insist that the model needs to be easy to apply. In terms of the hardcopy presentation, the model was given to nurse managers in both a simple one-page format and in a book-length version. This simplicitycomplexity issue seems to be a balancing act both at the training and coaching levels. The depth of the content and skill areas makes the model powerful but it is clearly more attractive as its presentation can also be simplied. Coaches and clients noted that it takes time to learn. One nurse manager found the model too complex for her to adopt as a coach, although discrete content topics were valuable for this individual. Role management issues. The role of a conict coach can enhance the work of nurse managers. It can also generate role tensions. One nurse manager coached a client and then ended up mediating that same client and another party. In a separate instance, one client mentioned that the coach possibly lacked objectivity, favouring the clients perspective within the session. 89

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R. Brinkert

Programme efciency
Evaluating programme efciency is worthwhile for determining whether outcomes were achieved with the best use of resources (Rossi et al. 2004). Nurse managers would have preferred to have full training days. This probably would not affect core training outcomes and would certainly decrease travel time. Given that the pre- and post-training research contact seemed to reinforce the training, some kind of pre- and post-training support is probably advisable. The inclusion of coaching seemed particularly important as coaches applied their skills and gained condence in their abilities and the value of the process and as clients were supported. Other points of contact, even of short duration, may be important to reinforce the core training. One nurse manager found it very helpful to use the follow-up interviews with the researcher-trainer as a coach-thecoach process, even although the researcher-trainer did not originally conceive of this possibility. Coach training could also be made more efcient with the use of easily accessible written prompts that coaches can keep in their work spaces and by having conict coaching be integrated with the organizational dispute system, including have it offered to managers throughout the organization.

nurse managers and frontline nurses and to extend organizational dispute resolution processes to the individual level. The initial application of the CCCM demonstrates one way to address these challenges. In the case reported above, conict coaching was an attractive, useful and effective means of developing nurse managers conict competencies and supporting nurse managers conict interventions with supervisees. In this particular health system, more can be done to advance the conict coaching abilities of those who have already been trained as coaches, develop a positive conict culture throughout the nursing arena and integrate various conict intervention processes. While conict coaching represents a new nursing conict communication and supervision intervention, its value needs to be determined with greater empirical evidence, including statistically sound research ndings.

Acknowledgement
The author did not receive payment for the intervention described above; however, he has since been paid for conict coaching work with other health care professionals.

References
Abu AlRub R. (2004) Job stress, job performance and social support among hospital nurses. Journal of Nursing Scholarship 36 (1), 7378. Almost J. (2006) Conflict within nursing work environments: concept analysis. Journal of Advanced Nursing 53 (4), 444453. Apker J. (2001) Role development in the managed care era: a case of hospital-based nursing. Journal of Applied Communication Research 29 (2), 117136. Beebe S.A., Mottet T.P. & Roach K.D. (2004) Training and Development: Enhancing Communication and Leadership Skills. Allyn & Bacon, Boston, MA. Brinkert R. (2006) Conflict coaching: advancing the conflict resolution field by developing an individual disputant process. Conict Resolution Quarterly 23, 517528. Brinkert R. (2010) A literature review of conflict communication causes, costs, benefits and interventions in nursing. Journal of Nursing Management 18, 145156. Buback D. (2004) Home study program: assertiveness training to prevent verbal abuse in the OR. Association of Operating Room Nurses Journal 79 (1), 148164. Cooper S.J. (2003) An evaluation of the Leading an Empowered Organisation Programme. Nursing Standard 17 (24), 3339. Cooperrider D.L. & Whitney D. (2005) Appreciative Inquiry: A Positive Revolution in Change. Berrett-Koehler, San Francisco, CA. Cox K.B. (2003) The effects of intrapersonal, intragroup, and intergroup conflict on team performance effectiveness and work satisfaction. Nursing Administration Quarterly 27 (2), 153163.

Limitations
The current study involved the researcher as trainer. Also, project implementation was both complicated and informed by the fact that the training and research aspects of the conict coaching programme sometimes intertwined. The intensive pre- and post interviews probably would not have been part of a typical training intervention yet some type of pre-training input process may be desirable in future non-research conict coaching situations, as it may enhance the group training experience and lead to customization of the training design. The fact that nurse manager self-reported ratings dropped from the end of training to the 3-month follow-up point and then rebounded at the 6month follow-up point is difcult to interpret given the small number of participants and the limitations of data design and collection (see Tables 47).

Conclusion
The present study responds to and reinforces the call to address the topic of conict communication in nursing. Existing literature demonstrates the need to develop the conict communication competencies of 90

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Cresswell J.W. (2003) Research Design: Qualitative, Quantitative, and Mixed Methods Approaches, 2nd edn. Sage, Thousand Oaks, CA. Espeland K.E. (2006) Overcoming burnout: how to revitalize your career. The Journal of Continuing Education in Nursing 37 (4), 178184. Folger J.P. & Jones T.S. (eds) (1994) New Directions in Mediation: Communication Research and Perspectives. Sage, Thousand Oaks, CA. Gerardi D. (2004) Using mediation techniques to manage conflict and create healthy work environments. AACN Clinical Issues 15 (2), 182195. Gergen K.J. (1999) An Invitation to Social Construction. Sage, London. Haddad A. (2002) Ethics in action: fairness, respect, and foreign nurses. RN 65 (7), 2528. Haraway D.L. & Haraway W.M. III (2005) Analysis of the effect of conflict- management and resolution training on employee stress at a healthcare organization. Hospital Topics 83 (4), 1117. Jones T.S. & Brinkert R. (2008) Conict Coaching: Conict Management Strategies and Skills for the Individual. Sage, Los Angeles, CA. Kellett P.M. & Dalton D.G. (2001) Managing Conict in a Negotiated World: A Narrative Approach to Achieving Dialogue and Change. Sage, Thousand Oaks, CA. Knowles M.S., Holton E.F. III & Swanson R.A. (2005) The Adult Learner, 6th edn. Elsevier, Oxford. Lambert V.A., Lambert C.E. & Ito M. (2004) Workplace stressors, ways of coping and demographic characteristics as predictors of physical and mental health of Japanese hospital nurses. International Journal of Nursing Studies 41, 8597. Lipsky D.B., Seeber R.L. & Fincher R.D. (2003) Emerging Systems for Managing Workplace Conict: Lessons from Ameri-

can Corporations for Managers and Dispute Resolution Professionals. Jossey-Bass, San Francisco, CA. Luce J.M. & White D.B. (2007) The pressure to withhold or withdraw life-sustaining therapy from critically ill patients in the United States. American Journal of Respiratory & Critical Care Medicine 175 (11), 11041108. Poncet M.C., Toullic P., Papazian L. et al. (2007) Burnout syndrome in critical care nursing staff. American Journal of Respiratory and Critical Care Medicine 175 (7), 698 704. Porter-OGrady T. (2004) Constructing a conflict resolution program for health care. Health Care Management Review 29 (4), 278283. Rossi P.H., Lipsey M.W. & Freeman H.E. (2004) Evaluation: A Systematic Approach, 7th edn. Sage, Thousand Oaks, CA. Stordeur S., DHoore W. & the NEXT-Study Group (2006) Organizational configuration of hospitals succeeding in attracting and retaining nurses. Journal of Advanced Nursing 57 (1), 4558. Swearingen S. & Liberman A. (2004) Nursing generations: an expanded look at the emergence of conflict and its resolution. The Health Care Manager 23, 5464. Vivar C.G. (2006) Putting conflict management into practice: a nursing case study. Journal of Nursing Management 14, 201 206. Winslade J. & Monk G. (2000) Narrative Mediation: A New Approach to Conict Resolution. Jossey-Bass, San Francisco, CA. Winslade J. & Monk G. (2005) Does the model overarch the narrative stream? In Blackwell Handbook of Mediation: Theory and Practice (M. Herrman ed.), pp. 217228, Blackwell, New York. Yin R.K. (2003) Case Study Research: Design and Methods, 3rd edn. Sage, Thousand Oaks, CA.

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