Nurses Conflict Management in Regional Public Hospital of Southeast Aceh District, Indonesia

Nurses Conflict Management in Regional Public Hospital of Southeast Aceh District, Indonesia

Rahmah Adilah¹, Hajjul Kamil²*, Ardia Putra2, Yuswardi², Putri Mayasari²

¹Graduate of the Bachelor of Nursing Study Program, Faculty of Nursing, Universitas Syiah Kuala Banda Aceh, Indonesia

²Department of Fundamental Nursing and Nursing Management, Faculty of Nursing, Universitas Syiah Kuala Banda Aceh, Indonesia

*Corresponding Author

DOI: https://doi.org/10.51584/IJRIAS.2024.912054

Received: 18 December 2024; Accepted: 26 December 2024; Published: 22 January 2025

ABSTRACT

Conflict is a significant problem in the nursing work environment, especially with the increasing demands on health services that can trigger potential conflicts. This study aimed to identify the dominant conflict management strategies nurses use at the Regional Public Hospital of Southeast Aceh District. This study type was quantitative research with a cross-sectional study design. The Slovin formula (e = 5%, N = 193) determined the sample size, totaling 131 implementing nurses with criteria, sampling using simple random sampling techniques. Data was collected using a questionnaire to measure conflict management strategies, including compromise, competition, accommodation, softening, avoiding, and collaboration. As data analysis, descriptive statistical tests were implemented. The study results showed that most nurses, 57.3%, used conflict management and compromise strategies, 68.7%; competition, 51.1%; accommodation, 59.5%; softening, 50.4%; and collaboration, 61.1%, while the avoidance strategy, 70.5%, was the least utilized. These findings indicated that nurses at the Regional Public Hospital of Southeast Aceh District actively used conflict management and compromise strategies, which were the most widely used to achieve mutually acceptable solutions. Although avoidance is underused, it can prevent escalation of conflict. Hospitals should strengthen communication skills training and conflict management strategies for nurses, particularly collaboration strategies and nursing education. It is suggested that a comprehensive conflict management curriculum be integrated.

Keywords— conflict management, strategy, nurses, hospital.

INTRODUCTION

The use of health services increases along with the community’s growing need for access to quality services. Nurses play an essential role in the health care system, filling more than half of the total health workers in hospitals (WHO, 2023). In Indonesia, of the 1,272,802 registered health workers, nurses comprise 649,452 individuals, the largest profession in the health sector (Ministry of Health 2023 in Central Statistics Agency 2024). Their contribution is not only in providing health care but also in improving the operational efficiency of hospitals, demonstrating the strategic role of nurses in achieving the goals of health organizations (Suganda et al., 2022). However, this critical role ultimately occurs in the challenge of conflict in the workplace. Conflict can arise from interdependent relationships between individuals or teams working to achieve common goals and incompatibilities or differences of opinion in tasks (Pangetuti et al., 2020). Previous research has shown that conflict in healthcare organizations is a global issue. For example, 38% of nurses in Australia, 32% in the United States, and 23% in Korea reported experiencing conflict in the workplace (Özkan Tuncay et al., 2020). Around 15% of nurses in Indonesia report experiencing conflict yearly (Marlina et al., 2020).

Ineffective conflict management can negatively impact the quality of care, health team relationships, and patient satisfaction (Suganda et al. 2022). Therefore, mastering conflict management strategies is an essential skill for nurses. Marquis and Huston (2017) identified six main conflict management strategies: compromise, competition, accommodation, collaboration, avoidance, and prolonged approach. These strategies are essential to minimize the negative impact of conflict and create synergy within the health team.

Conflict between nurses is also relevant in Aceh, especially at the Regional Public Hospital of Southeast Aceh District. Although initial research shows that communication and conflict management in this hospital are relatively good, they have not yet described each conflict management strategy. Conflicts still often occur due to limited resources, differences of opinion, and competition between groups (Daniyanti & Kamil, 2018). Initial data shows that implementing conflict management strategies has not been fully optimal in supporting the quality of service and work teams (Rohani, 2018). This study aims to analyze the description of conflict management in nurses at the Regional Public Hospital of Southeast Aceh District by describing nurses’ conflict management strategy.

METHOD

This quantitative research was designed as a cross-sectional study with a population of 193 nurses at the Regional Public Hospital of Southeast Aceh District. The sample size of 131 people was calculated using the Slovin formula (Sihotang, 2023) with an e-value of 5%. Afterward, proportional sampling was used to determine the number of samples representing 18 units of working. The sampling used a simple random sampling technique according to the criteria with a lottery to select samples randomly, and sample replacement was carried out by re-drawing if the respondent did not meet the requirements.

Data collection was conducted from 2nd to 16th May 2024. A questionnaire with two parts adopted from Daniyanti and Kamil (2016) was utilized as a data collection tool. Part A identified the characteristics of respondents, while Part B evaluated conflict management strategies, including compromise, competition, cooperation, softening, avoiding, and collaboration. The validity and reliability of the questionnaire were tested in prior studies, yielding a validity score of 0.632 (indicating an acceptable correlation with the constructs measured) and a reliability coefficient of 0.750 (indicating a good level of internal consistency). The validity test involved analyzing item-total correlations to ensure that each question accurately reflected the intended dimension of conflict management. In contrast, the reliability test used Cronbach’s alpha to measure consistency.

Data collection was carried out by filling out a questionnaire by respondents after obtaining permission from the hospital and receiving an explanation before the study from the researchers. Respondents were given the right to agree or disagree to participate in the study by ensuring the confidentiality of respondents. Data analysis was done using descriptive statistical tests, and the results were presented as frequency distributions and percentages. This study passed the ethical feasibility test from the Research Ethics Committee of the Faculty of Nursing, Universitas Syiah Kuala, with document code 111060100324, dated April 2nd, 2024.

Challenges in data collection included limited availability of respondents due to shift work, which may have influenced the representativeness of the data. These factors could affect the generalizability of findings and should be considered when interpreting the results. Future studies could address these limitations using longitudinal designs and incorporating observational methods to validate self-reported data.

RESULTS

The following table presents the research findings sequentially:

Demographic Data

Table 1. Frequency Distribution of Demographic Data (n=131)

Table 1 shows that most respondents are between 31 and 40 years old, as many as 71 (54.2%) respondents. The respondents are dominated by women, with as many as 96 (73.3%) respondents. Most of them have a Diploma III in Nursing education, as many as 115 (87.6%) respondents. In addition, most nurses work in inpatient wards, with as many as 53 (40.5%) respondents. As many as 47 (35.9%) respondents have 0–5 years of work experience.

Conflict Management

Table 2. Frequency Distribution of Used and Utilization of Conflict Management (n=131)

Table 2 shows that 75 (57.3%) respondents frequently use conflict management strategies in their work environment. In contrast, 42.7% of respondents, or 56 nurses, used less utilized strategies.

Conflict Management Strategy

Table 3. Frequency Distribution of Conflict Management Strategies (n=131)

Table 3 shows that the compromise strategy is the most widely used, with 90 (68.7%) respondents. It is followed by collaboration, with 80 (61.1%) respondents; accommodation, with 78 (59.5%) respondents; competition, with 67 (51.1%) respondents; and softening, with 66 (50.4%) respondents. On the other hand, the avoidance strategy is the least utilized, with 92 (70.2%) respondents.

DISCUSSION

The study’s findings indicated that 75 respondents (57.3%) most frequently employed conflict management. This demonstrated that, despite 56 respondents (42.7%) having minimal use of conflict management in this institution, effective conflict management was a component of everyday work practices. Maintaining work harmony and providing high-quality healthcare in a hospital setting requires effective conflict management (Mardiyanti et al., 2019). Research by Sitanggang (2023) emphasized that the ability of nurses to overcome and resolve conflicts between each other contributes significantly to improving the quality of nursing services. Effective conflict management by nurses can lower work-related stress and enhance emotional health, promoting job satisfaction and performance. Research by Michinov et al. (2024) revealed that good conflict management was closely related to increased self-efficacy and emotional intelligence, two essential factors that protect against stress among nurses. Conflict management is a conflict resolution approach founded on an awareness of the interdependence of human resources within the organization to achieve mutual triumph for the benefit of the organization (Pakpahan, 2022).

Conflict Management; Compromise Strategy

The study revealed that the compromise strategy was the most frequently used conflict resolution approach by 90 (68.7%) respondents. This finding aligns with previous studies highlighting compromise as an effective win-win solution, allowing both parties to reach an acceptable outcome through mutual concessions (Marquis & Huston, 2017). Saputra and Alkhusari (2021) emphasized its practicality in resolving conflicts efficiently without jeopardizing long-term relationships among healthcare staff, which is invaluable in a dynamic hospital environment where collaboration is essential. Furthermore, the findings align with research by Gulo and Silitonga (2024), which showed that implementing a compromise strategy significantly reduced nurses’ work-related stress. This suggests compromise facilitates rapid conflict resolution, supports nurses’ mental well-being, and fosters positive interpersonal relationships in stressful situations. Overreliance on a compromise strategy may limit opportunities to explore other conflict resolution methods despite its advantages.

Research by Fernando et al. (2018) suggests that strategies such as collaboration or accommodation may outperform compromise in certain situations. For example, in dealing with complex conflicts that require innovative and integrative solutions, accommodation may be more appropriate in hierarchical relationships where maintaining harmony is paramount. Therefore, managers and nurses need flexibility in choosing the conflict management strategy that best suits the situation to achieve optimal results and maintain harmony within the team.

Conflict Management; Competitive Strategy

The study revealed that the competition strategy was employed by 67 staff nurses (51.1%). This strategy was primarily chosen in situations requiring quick decision-making, such as medical emergencies. The findings are supported by Setianingrum et al., (2021), who explained that challenging and high-pressure work conditions, such as those experienced during the COVID-19 pandemic, could affect job satisfaction. In such situations, the competition strategy effectively resolves conflicts promptly and ensures smooth task execution in the field. Sitanggang (2023) described the competition strategy as an approach that focuses on fulfilling individual interests, often at the expense of others. Nurses commonly utilize this strategy in urgent situations requiring firm and decisive actions, such as conflicts related to work responsibilities. However, Ibrahim et al., (2018) found that when head nurses excessively apply the competition strategy, it can affect the quality of vertical relationships between the head nurse and team members. Overusing this approach may create tension within work relationships and disrupt team harmony.

Furthermore, research by Kristian et al., (2020) emphasized that although the competition strategy plays a critical role in urgent situations, it must be applied cautiously. They recommended adopting a multifaceted conflict management approach, including collaboration and accommodation strategies, to create a more harmonious and productive work environment.

Thus, while the competition strategy can serve as a solution in certain situations, flexibility in selecting the most appropriate conflict management strategy based on the context is essential. Balancing various strategies ensures optimal conflict resolution outcomes, fosters positive working relationships, and contributes to better team dynamics and overall productivity.

Conflict Management; Accommodation Strategy

The results of the study showed that accommodation strategies were used by 78 staff nurses (59.5%). Research conducted by Suganda et al., (2022) supports this finding, which shows that nurses who frequently use accommodation strategies tend to have more harmonious working relationships and lower stress levels. Nurses often use this strategy to maintain team balance and ensure that patient interests remain the top priority. However, this study also warns against overusing accommodation strategies, as this can lead to an imbalance in workplace relationships where individual needs are often ignored for the sake of the group. This imbalance can decrease nurses’ service quality and emotional exhaustion (Kesworowati et al. 2023).

In addition, research by Saharani and Hidayat (2023) highlights that accommodation strategies do not always produce positive results. Sometimes, it can create new challenges, such as decreased motivation and productivity, if not complemented by other methods. These findings underscore the importance of balance in applying accommodation strategies, where nurses must assess when and how to use this approach to avoid potential negative impacts. In other words, although accommodation can help maintain harmonious relationships and prevent conflict escalation, it is essential for nurses not to neglect their interests overly and to ensure continued well-being and work effectiveness.

Conflict Management; Softening Strategy

The results showed that 66 staff nurses (50.4%) used softening strategies. Daniyanti and Kamil (2016) found that communication and collaboration between parties can be difficult during escalating conflict. A softening strategy can help relieve tension, generate sympathy, and reduce the emotional intensity of the conflicting parties. As a result, this approach allows for smoother cooperation in solving problems and finding more effective solutions. In this strategy, individuals involved in the conflict seek mutual understanding and togetherness through self-reflection and awareness. Further research shows that softening strategies reduce tension, maintain harmonious relationships, create a more conducive work environment, minimize conflict, and support team performance (Bordean et al., 2020). According to Marquis and Huston (2017), softening strategies effectively resolve minor disputes. Still, they are less appropriate for dealing with significant conflicts, such as competition in service delivery or production results. Therefore, it is essential to choose the right conflict management strategy based on the type and intensity of the conflict. While softening strategies are helpful for minor conflicts and maintaining good relationships, adapting strategies to the specific context is essential to achieve optimal conflict resolution outcomes and maintain positive working relationships.

Conflict Management; Avoidance Strategy

This study found that avoidance was the least frequently used This study found that avoidance was the least frequently used strategy among 92 nurses (70.2%). This is consistent with the general preference for a more active and direct approach to conflict resolution in nursing practice. This preference is consistent with previous research emphasizing the importance of timely and effective conflict management in an environment where patient care is paramount (Staryo et al., 2024). Avoidance is often associated with temporarily reducing conflict but does not address the underlying problem. As Dontigney (2016 in Marquis and Huston, 2017), avoidance can occur when the conflict is perceived as trivial or when the costs of addressing the problem outweigh its benefits. While this approach may offer short-term relief, it often results in unresolved conflict that resurfaces with greater intensity. The current study’s findings support this by indicating that nurses are reluctant to use avoidance, as it is not practical in the long term for maintaining harmonious relationships or ensuring optimal care delivery. Nurses with higher emotional intelligence, as demonstrated by Soriano-Vázquez et al., (2023), are better equipped to manage conflict proactively and adaptively, thereby avoiding the need to use conflict avoidance as a strategy.

This study also highlights the importance of emotional intelligence in managing conflict. Nurses with high emotional intelligence are more likely to engage in conflict resolution strategies that promote understanding and cooperation, such as collaboration or compromise, rather than avoiding the issue altogether. Emotional intelligence plays a vital role in helping nurses cope with stressful situations, maintain composure, and resolve conflicts effectively without letting them escalate (Soriano-Vázquez et al., 2023). The findings of this study are broadly consistent with previous research on conflict management in nursing. Studies by Marquis and Huston (2017) and Staryo et al., (2024) suggest that avoidance, while applicable in specific contexts, is less effective in nursing environments requiring quick and efficient action. Instead, collaboration and compromise are seen as more effective strategies for encouraging long-term cooperation and improving the work environment.

Conflict Management; Collaboration Strategy

The results showed that 80 respondents (61.1%)of nurses used a collaborative strategy. This approach emphasizes the importance of open communication and mutually beneficial conflict resolution (Marquis & Huston, 2017). Another study involving 147 nurses showed similar results, with most respondents choosing a collaborative strategy. Meanwhile, nurse managers tended to select a combination of collaboration and avoidance strategies (Kristian et al., 2020). Wijayanti’s (2019) study showed that nurses at Hospital Ahmad Dahlan used a collaborative style more often, which has been proven to improve the quality of nursing services. A similar study at the Syiah Kuala University Teaching Hospital showed that 97.2% of nurses used a collaborative strategy, supporting the effectiveness of this approach in creating integrative solutions and positive working relationships (Afifah et al., 2023).

During the COVID-19 pandemic, nurse managers effectively collaborated to resolve team conflicts amid high pressure. Research by Suganda et al. (2022) emphasized that collaboration enables mutually beneficial agreements through cooperative discussions and the participation of all parties. Collaborative strategies are more dominant because they provide positive long-term results, including improved working relationships and quality of service. Collaboration also requires high communication skills, which are more honed in nurses with interpersonal experience (Marquis & Huston, 2017).

CONCLUSION

Research conducted at the Regional Public Hospital of Southeast Aceh District indicates that most nurses predominantly use compromise strategies to manage conflicts. This approach reflects their ability to find a middle ground acceptable to all parties, enabling conflict resolution without favoring one side. Additionally, collaboration strategies are frequently employed to create mutually beneficial solutions through open and cooperative communication. Other strategies, such as accommodation, competition, and softening, are also applied depending on the situation. The competition strategy is often utilized in urgent situations, although it risks damaging teamwork. Conversely, the accommodation strategy prioritizes the interests of others to maintain harmonious relationships.

In contrast, the softening strategy is typically employed to ease tension but proves less effective in addressing root causes. The avoidance strategy is the least utilized, highlighting nurses’ preference for confronting conflicts directly rather than evading them. The findings emphasize the importance of reinforcing compromise and collaboration strategies, which 68.7% and 61.1% of respondents. Strengthening these strategies can enhance team dynamics and improve the quality of patient care. Training programs tailored to real-world nursing conflicts should be prioritized to improve hospital conflict management. Such training could include simulations of common workplace conflicts, such as role disputes or workload distribution, to prepare nurses for effective resolution.

Additionally, nursing education institutions should integrate specialized modules on conflict management into their curricula, incorporating case studies and role-playing exercises to equip students with practical skills before entering the workforce. Future research could expand the scope by involving more hospitals to provide a comprehensive understanding of conflict management practices in nursing. Further studies could also explore the effectiveness of specific conflict management training programs and their impact on nurse performance, team cohesion, and patient care outcomes. Comparative studies between healthcare settings, such as public and private hospitals, could provide insights into how organizational culture influences conflict resolution approaches.

ACKNOWLEDGEMENT

The Southeast Aceh District Public Hospital’s management, who granted permission and assistance during data collection activities, and all nurses who volunteered to participate in this study are among the people the researcher would like to thank for their support and contributions.

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