Conflicts with Colleagues in Oncology Care

May 2021 Vol 12, No 5

Improving communication skills in the workplace is vital to avoiding conflicts with coworkers, and to ultimately avoiding burnout, according to Helen Meldrum, MEd, EdD, associate professor of psychology at Bentley University in Waltham, MA.

“If we don’t improve our communication skills, we’ll just be taking the bait all day long,” she said at the AONN+ 11th Annual Navigation & Survivorship Conference. “And if we take the bait all day long, we’re going to end up feeling really burned out about our profession.”

Dealing with Conflict in the Internet Era

News travels fast, particularly when it’s bad news. Even before the Internet, dozens of people could hear about an encounter in the workplace in which 1 person feels they were mistreated by a coworker; that person tells an average of 12 people, and each of those people tell an average of 5 people.

“Bad public relations within an organization travel at lightning speed. Depending on the size of the organization you work in, up to 70 people could hear that you were a jerk from one of those types of encounters,” she added. “But then, of course, the Internet came into our lives.”

According to Dr Meldrum, we are in “a new world.” This is a world in which healthcare professionals cannot afford to make missteps with coworkers or patients, because when people feel mistreated in the Internet age, retribution can be swift.

She warned of avoiding reactive communication habits (ie, “he made me so mad that I couldn’t stop swearing at him,” or “it’s all your fault that this has turned out like this”). Language like this is basically “admitting to feeling incapable of making a creative first move to stop the vicious cycle that one has been drawn into in the workplace,” she said.

Why Do People Become Emotionally Charged?

Every person has his or her own emotional baggage. Whether that baggage is light or heavy, it has a tendency to rear its ugly head during workplace dilemmas. But in the healthcare setting in particular, Dr Meldrum says that people tend to get very worked up about waiting times and delays. “Suffice it to say that these conflicts and irritations really add up,” she said.

Some research that included oncology nurses in workplace settings found that 64% of respondents experience a toxic personality in their current work environment, and 94% had worked with someone like that at some point during their career. Additionally, 91% of nurses reported experiencing verbal abuse, and negative interactions affected mood 5 times more strongly than positive encounters. “They don’t really have to tell us that in a study,” she said. “I think we’ve all felt the effect of backstabbing, not feeling psychologically safe, and feeling like we can’t speak up.”

To avoid making these emotionally charged situations worse, avoid hedging words like “hope” and “maybe” (ie, “I hope this will solve your problem”). Instead, opt for language that shows you’re taking action (ie, “I will call that doctor for you”).

“Hedging words make people crazy,” she said.

Adding to these healthcare system dynamics is the nature of working in an oncology setting. “In oncology we’re dealing with such potently important issues that we often feel uncomfortable, edgy, and embarrassed,” she said. “And so we come across as cold, insensitive, and brutal.”

What an emotionally charged coworker wants most, besides not feeling invisible, is to be recognized and to feel like the situation that led to their being upset is not going to happen repeatedly. “People are inherently worried that they’re going to get sucked into a repetitive situation where they will be on the losing end over and over again,” she said.

Learning to Deal Effectively with Workplace Conflict

According to Dr Meldrum, conflict is natural and inevitable, and it can be constructive. “We learn patterns,” she said. “And one of the biggest patterns we learn is what I call the 2 R’s of conflict: roles and resources.”

From a very young age, we learn to fight about roles (“You’re not the boss of me”) and resources (“You gave my brother a bigger piece of cake than me”), and these same arguments carry over into the workplace when we are adults: “You’re not my supervisor, so don’t tell me how to do my job,” and “She always gets a better vacation schedule than me.”

“So, what has changed with how we fight as little kids and how we fight as adults?” she asked. “It’s not just our height, it’s the presence of the word policy. People will start yelling at each other, ‘you’d know if you’d read the employee policy manual.’ So this is why we escalate so quickly when we have fights.”

After both parties get upset during a dispute, the disagreement is internalized, each side attempts to fix the blame, retaliation is sought, and finally the point of the original disagreement is lost as each party fights to win.

But to diffuse conflicts before they escalate, a certain skill set is required. This involves 5 main communication styles: reflection, deflection, inquiry, feedback, and deferral.

If a person is frustrated about a delay in the healthcare system, acknowledging and validating their frustration rather than arguing with them can soften their anger and prevent the situation from turning into a fight; this is an example of reflection. Diffusing the situation through active reflective listening might actually lead to hearing the fear in their voice over the anger, and dealing with fear can be much easier than dealing with anger. “Whether they’re mad, sad, glad, or scared, match it and they’ll tell you more,” she advised. “Miss it by judging, advising, quizzing, or placating, and you’ll never find out.”

Deflection is a partial agreement. If a mother says she’s frustrated about delays in her son’s care, try saying, “You’ve got a point; if we had more pediatric oncologists who specialize in his type of cancer, we’d be able to get him into treatment even faster.” That way you do not place blame on either party.

Inquiry is a great response to “vague anger,” she said. If a patient complains to a supervisor that a nurse was rude, that supervisor should try to pull out the specifics of that encounter by asking what exactly the nurse said or did. “If you don’t get the specifics, you’re just going to end up in one of those patterns,” she said. These details might help the supervisor realize that the nurse was only following protocol, but her message might have been more effectively delivered.

Feedback is useful when a person approaches someone in the workplace with heightened anger. If someone calls the oncology department swearing on the phone, for example, simple reflection won’t cut it. “Feedback basically tells the person, ‘Sir or Ma’am, I feel really uncomfortable with the harsh language you’re using before giving me a chance to explain what we can do for you today,” she said. “You may have to repeat this up to 3 times.”

Deferral should be used when dealing with heightened anger on top of clinical symptoms. “Just give me a minute to get your chart; I’ll be right back with you,” can provide the time needed to get someone else in the workplace to help handle and diffuse the situation.

Finally, consider your lasting legacy in the workplace, and how you want to be remembered among your coworkers, she said. If a situation escalated, ask yourself the following: Did I advise too much? Did I judge too much? Did I quiz too much? Did I fail to set limits?

“Do this instead of doing what most people do, turning to a coworker and saying, ‘I just dealt with the biggest jerk on earth,’” she said. “Unfortunately, that just prompts our coworker to say things like, ‘You think you dealt with a big jerk? Listen to this.’ You may think you’re just having fun, but this kind of communication in the workplace ends up wearing everybody out over time.”

Last modified: August 10, 2023

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