Respiratory Therapy Conflict Resolution and Application in the Workplace

Editor’s note: This text-based course is an edited transcript of the webinar, Respiratory Therapy Conflict Resolution Application in the Workplace, presented by Mira Rollins, OTR/L. Any errors in transcription or editing are the responsibility of Continued.com and not the course presenter. It is recommended to download the course handout to supplement this text format.

Learning Outcomes

• Discuss how to apply a conflict resolution matrix to clinical operations conflicts.
• Identify their personal communication style the best conflict resolution techniques for that identified style.
• Identify three personal specific areas of opportunity to improve their current conflict resolution style.

Conflict is...

Conflict is not necessarily a severe disagreement or clash. I wanted to start the first nugget of information, with that often, conflicts do not get resolved at all, or we inherently feel that conflict is negative. However, it does not have to be. That is the number one thing you should start thinking about mulling over as we review the rest of the content. Number two, conflict is not necessarily, serious discord or strife. When I looked up the definition of conflict, this was one of the definitions, I do not want to disagree with Webster, but I do not believe that conflict necessarily, has to be severe discord or strife. It can be, but it does not have to be. A better working definition of conflict is when two people or two parties sharing the same space, resources, or concerns have different opinions, perspectives, or preferences. With that definition, it can radically change how you approach, deal with solve conflicts. Conflict can be natural. It is necessary. 

Mindset Matters

I honestly believe that if you have a wrong, incorrect, negative mindset about a matter, it will affect any strategy that you implement. We see this with our patients. We have seen two patients with the same diagnosis, similar situations, with different outcomes. What is the difference? What has been unlocked for one, not the other? Often, we see a different mindset, positive over negative, the thinking that I can versus I cannot, or I am doomed. Mindset matters in everything, even in conflict resolution. The first mindset shift I want some of you to adopt is that there is no unsolvable problem. Frequently, when I go over conflict resolution strategies in a specific situation, I converse with someone who, no matter what strategy or technique, pounces on it and say, "It is not going to work." You are right. If you take that mindset into conflict, it will not work. 

The first thing is that there is no unsolvable problem. The worst boss you have ever had, the most horrible coworker, the rudest patient, it is not unsolvable in your dealings with them. Secondly, you cannot wait to feel comfortable before you navigate or handle conflict resolution. If you are waiting for this perfect situation, set of scenarios, perfect ending, perfect feeling that "Okay, now is the right time," it will never come. You cannot wait to feel comfortable addressing your boss about your raise because discomfort will always exist. You cannot wait to feel completely comfortable before you talk to this abrasive coworker because you will never feel comfortable. 
The mindset of knowing that I will have to push past the discomfort and still handles the conflict is the mindset that you must adapt. 

There will not be one solution that gives every character in the story precisely what they want, even you. There is no perfect solution. Take your time figuring out that one perfect situation before you engage in conflict resolution. Number two, you are not helpless. You have options. Those options might be including having a conversation with human resources. It may even lead to changing departments or leaving a particular job, but you are not helpless. You have options. Also, you have a choice on how you respond. My 13-year-old is dealing with anger management issues and, as a teen, is having a problem accepting this too. He feels that people make him mad. I am telling him, as I also am for you, that the window may be small, but there is always a window of opportunity you have between the catalyst, the thing that is causing the conflict, and your response. With practice, that window can grow larger because you will be able to implement these strategies in any situation, no matter how great or small.

Conflict Resolution Requires...

A recent survey found that 61% of employees delay or avoid initiating a conversation they should have with a coworker or supervisor. That is, six out of ten people at your office right now are delaying or avoiding a conversation they know they need to have with a coworker or supervisor. At any given moment, on any given day, six out of ten people are stuffing, suppressing something they need addressing. They have unmet needs and unmet expectations. Suppose 60% of everyone walking around offices interacting today feels they need to be heard or have unmet needs and expectations. In that case, it creates a negative workplace culture. We want to be part of the solution rather than this 60%. We want to be part of this 40% that lets maturity rise to the top as we effectively handle communication.

In speaking with these conversations, conversations should be planned. This is not a prerequisite course, but they are, I would say, partnering in like good supplemental courses. There is another course that I taught on this platform about basic conflict resolution. I think we went into a little bit more conversation strategies and things of that nature. If you would like, after this course, go back and revisit that particular one (Effective Conflict Management Between Multidisciplinary Teams).

Conversations Should Be…

In speaking about how to handle conversations, conversations should be planned. I will not stop the doctor in the hallway to tell him how he spoke with me earlier. That is not planned. He is not ready for it. I gave him no warning, and then I may not have vetted through all that I wanted to say. Whenever possible, ensure that the conversation with the person you are in conflict with is planned, not spur of the moment. It increases your potential for success. Conversations need to be practiced. Yes, practice. We are the culture that takes one selfie a hundred different ways because we want to get it right. If we can invest that much time in a selfie that we will post to the gram, then in that case, we can invest a small amount of time getting in front of the mirror, riding in our car, vetting through the things that you want to say, the conversations you want to have, anticipating what the other person might say—having this dialogue practicing conversations. Conversations need to be concise. Sometimes we want to have vent space with everything we feel with the person we conflict with. Sometimes what gets lost is what you need.

There needs to be a balance of feelings and facts. I am almost at an 80/20 percentage now that I think about my most effective conversations. I want to tell the person the impact of their interaction or what they said or did to make me feel, but I spend 80% of my time telling them the facts of the situation and what I would need afterward. It is much more effective. I have learned because I am a "feelings" kind of person that, I have had to practice being more concise in my communication. Making sure that we are balanced of facts and feelings, and having a "we" versus "me" approach saying that this is what the department would benefit from. Also, this could benefit the patient and be something the caregiver could use. When conversing about a conflict, make sure you are not the only character in the story but how it would benefit other key people. 

This is a huge one, ensuring that whenever you are having a conversation, you only initiate it within a level five, on a scale of one to ten, with ten being the peak of anger and one being a baseline. As with our vitals, with our O2 Stats, like as a therapist, I take those vitals I see where they currently are because before I start standing exercising with the client, I want to feel confident that when that oxygen saturation drops, I have somewhere to go safely. It will be okay when that heart rate rises because I started within a safe parameter—the same thing in handling conflict.

When you are upset with your boss, it is not the time to have a closed-door meeting because if you sit in that chair at an anger level of seven, you will rise. You do not want to be that close to a ten. When you have some safe calculated parameters, you only want to handle conflict so that if you get more emotional, upset, and charged, it will not be into the unprofessional territory. That is safe communication whenever you are at that one, two, or three. You make him push it to an emotional level of four or five, but make sure that your emotions are regulated, not above that anger or frustration level of five, because it could end badly if not checked. Then you want to sift. By sifting, I mean mentally or even out loud, saying everything you want. However, picking out the critical, key, and professional things you want to say leaves all the others out. Once you sift it, which makes it very important to practice, you can sift your energy and emotions. When you sift out the most important things, the professional things, the condensed things, it will also help you shift your energy from anger to maybe now through the sifting process. I am frustrated, whereas I am red hot mad. These are simple strategies that, as we build, get into specific scenarios we will implement into those cases.

Say This, Not That

• Head UP: That’s not my job
• Head ON: I would like to help but I don’t have the availability

The first thing, instead of saying, that is not my job when you say something like that, that is a head up, that is going right in at the person, negative energy going head up, that often will make the conflict rise. We want to hit the issue head-on, meaning very directly, calculatedly, and professionally. The head-on way to address this conflict is not to say that it is not my job, which it may not be. We are going to say instead that I would like to help you, but I do not have the availability. Now this sends out a message that it is not that I do not want to help, I am not being a team player, but I have limited resources on my time availability. It will end in the same result. I will not do your job, but it sends a different message.

• Head UP: You’re rude
• Head ON: I appreciate your directness, but it sometimes comes across as abrasive

Let's try another one. You are rude. How many people, doctors, nurses, families, and patients do you want to say flat-out you are rude, but we are not doing that. Our successful conflict management is going to go head-on. We will say, I appreciate your directness, but it sometimes comes across as abrasive. Frequently when someone is rude, what they do not have, is a very good method of sifting. We talked about it. They sometimes tell the truth, but not in a very timed or professional way. Oftentimes a problem is not exactly what someone says, but it is how they say it. In those instances, one example is to say, I appreciate how direct you are, but it sometimes comes across as abrasive starting the conversation from there.

• Head UP: I don’t like you.
• Head ON: We seem to have competing personality styles. I would like to discuss how we can work to complement one another better.

How about this one? I do not like you. How many people, doctors, nurses, therapists, patients, and family members, do you want to say that to? However, we are not. We are going to allow maturity to rule. We are going to say we seem to have competing personalities. I would like to discuss how we can work to complement one another better. That opens up the floor to say, you can also tell me some things that compete with your personality. Let's talk about that. Now, it also gives you the leverage to say, here are a few things that compete with my personality. What would work better for me would be. Now this goes back to that mindset where some of you say it will not work. If I came to that coworker or that boss, even with this head-on approach, it would not work. However, mindset matters. Instead of not having the conversation, I challenge you to practice the conversation and implement some of these head-on strategies

• Head UP: Dude, do your job!
• Head ON: There are a few incomplete tasks that are assigned to you. Can we go over those because they are causing delays in other areas? 

Next is, dude, do your job. Earlier, we talked about people wanting to pass things on to you, and you have to tell them that that is not your area of responsibility. What about when a coworker is not holding up their end of the responsibilities? It is saying, do your job. Instead of saying do your job, we are going to say, there are a few incomplete tasks that are assigned to you. Can you go over those? Can we go over those because they are causing delays in other areas. Now you can word this how you want, but the spirit of your communication should be in this head-on way versus the head-up. What we are doing in this head-on approach is we are clarifying expectations of the system of accountability.

• Head UP: You don’t know what you’re doing.
• Head ON: When you get the opportunity, can we discuss an observation and a small concern I have regarding one of your treatment methods?

How about this one? You do not know what you are doing. Have you ever felt that someone needs to be more competent or totally in an area where they are not practicing in their expertise or skillset? What do you say? We are not going to say you are not competent, but what we are going to say is, when you get the opportunity, can we discuss an observation that I made? Let's have a short conversation so that we can discuss one of your treatment methods. Again, you might not say it the way I organized it here, but what you are going to be communicating is number one, giving them a chance to have the conversation with you, not in real-time, not in front of the patient, not in front of other people, but when it is convenient for them. Then also, give them a heads up on what you will be discussing and then allow them the time to think that when you do come together to talk about it, it will not be in front of people. It will not be embarrassing. They will know what you are talking about.

• Head UP: I don’t like that patient. I don’t want to work with him.
• Head ON: I’ve tried various techniques of treatment style with this patient, but none have been effective. I believe another therapist may get a better response and participation from him. 

Here is another one. I do not like that patient I do not want to work with them again. I know ten patients have probably come to your mind. What we want to communicate is something more along these lines, I have tried various treatment style techniques with this patient, but none of them have been effective. I believe another therapist may get a better response and greater participation from them. Now what we have communicated is not your lack of tolerance, not your personality, I do not like this person, but you are saying I have tried, it shows effort, but now you are saying that it is impeding this patient's progress because we are not getting the results, that I think he can get because of a personality clash. This keeps it patient-centric.

• Head UP: My shift is over. I can’t do that right now.
• Head ON: My shift ended at 6 pm. It’s now 6:15 pm. I’m unable to stay late today, but if you still need it done tomorrow, I can help then.

My shift is over. I cannot do that right now. I know I have been caught with my purse on my shoulder and my keys in my hand. What do we say? My shift ended at 6:00, and it is now 6:15. I am unable to stay late, but if you still need it done tomorrow, I can help then. This is one example of how you can communicate that you are willing to help, but sometimes boundaries need to be respected. You may not say this exact verbiage, but how do you communicate a willingness to help but a way to respect your boundaries? Both can be done.

• Head UP: Why are you worried about my patient?
• Head ON: Thanks for the advice. I will consider it. However, for right now, I feel confident to proceed with my current treatment.

Or how about this? Why are you worried about my patient? You have a coworker that has their nose all in your business and your files when they should not be. What are we going to say? Thanks for your advice. I will consider it. What does that communicate? It communicates your openness being humble, to receive from your coworkers and your teammates, but it also articulates your competence, that you got this how can you communicate openness to receive but also your confidence in what is currently going on, your competence, your skillset, both can occur. 

Words That We Fear Saying

• “NO”
  • I appreciate the offer, but I can’t right now.
  • I don’t have the availability or capacity right now.
  • I don’t believe I’m the best person to complete that.
  • Unfortunately, I won’t be able to do that.

Here are some other things that cause conflict. When we are afraid or hesitant to say certain words, The first is "No." Many of us need better boundaries. We feel taken advantage of by our team. We get more of the work, the more challenging patients. We find ourselves taking on responsibilities and committees because we do not feel confident to say no. Saying no allows you to give your best yes to other tasks and responsibilities. Or you can say, "Unfortunately, I will not be able to do that." That is a clear no because I heard somewhere that no is a full sentence. It is not incumbent upon me to always validate my no. Sometimes saying, I am sorry, I will not be able to do that is having the confidence and the courage to say no when appropriate. 

• “I DON’T KNOW”
  • I am not certain but I can find out by …..
  • That’s outside of my specific expertise, but I know who has that information.
  • I will look into it and get back with you by …….
  • Here’s what I know about that situation.

Or how about this? I do not know. We feel that in our current position, especially as supervisors or team leads, we should know everything, but we do not. We will talk about some things you can confidently say when you do not know. How about this? I do not have the availability or the capacity right now. To be honest that it is not that I do not want to help you. I do not have the resource or time right now to do it. I do not believe I am the person to complete that. That is not where I excel, or that is not an area that I feel confident in. Like I believe that someone else in the department, you may know that specific person, is better at that. It is important that we say no to some things so that we can say yes to the best things for us. When it is an "I do not know the situation," saying I am not certain, but I can find out gives me some time between your question and answer. Sometimes you do not give accurate information when you feel compelled to answer on the spot. It would be better to say, right now, I do not know, but give me a day or two I will get you the resources. Alternatively, that is outside of my specific expertise, but I know who has that information. I will look into it and get back to you by this time. Alternatively, here is what I do know about the situation. All of these communicate a willingness to assist the person in getting the information, even if you do not have it at that moment. 

• “I NEED HELP”
  • I would appreciate your expertise on this subject.
  • Despite several schedule adjustments, I still could use extra support on this project.
  • Do you have availability to assist me with …

Then there is, "I need help." Much conflict happens when someone attempts to do something without having the proper resources or out of their scope because they are afraid to say, help me. What can we do in the spirit of conflict resolution when it comes to saying no, telling people that we appreciate the offer, and thanking them for believing you can do this, "Thank you for acknowledging my skillset." Thank you for thinking of me. I appreciate it, but I cannot right now. Literally saying thanks but no thanks. Regarding saying, "I need help," I would appreciate your expertise on this subject. Despite several schedule adjustments, I could still use extra support on this project.

As a manager, it was always great for me when my employees would tell me what they had already done because I was more willing to help. Even think about the last time you had a student. Maybe that student was like, "Hey, I have tried these situations, these techniques, these strategies, but I still want to pick your brain on this." When someone says, I do not know, versus, this is what I do know about it. Can I get your help because I have already tried these things? We are more open to giving that leverage of assistance. The same thing happens when you need help, being able to articulate what you have already done. People are more willing to help in those situations. 

Categories of Healthcare Conflict

• TERRITORY
  • Perception of infringing on one's job, schedule or workspace
• TONE
  • Perception of inappropriate communication of needs
• TECHNIQUE
  • Perception of lack of competency, efficiency, or compassion

We are going to review some things that were in the previous presentation that conflict in healthcare. This is bridging all up to about six or seven specific scenarios that we are going to get into in a few minutes. Most conflicts in healthcare occur because of territory, technique, or tone. It is when there is a perception, it is very important that we understand, that conflict occurs not because of your intent but because of the impact of your words or your actions and how they impacted a person. Unless we understand that it is not what your intent was that we have to deal with, but what the impact what that person perceived it. When we are talking about territory conflicts, this is the perception of infringing on one's job schedule or workplace.

An example is the RT who is taking over shared space, the office area with their things, or if you have a person that is PRN who comes on weekends every time you come back on a Monday, they have changed some things or told the patient's family something different, then what was communicated, it is a territory infringement. Alternatively, it could be a technique. This is the perception of a lack of competency, efficiency, or compassion. This is when someone does not like what you are doing or how you are doing it or when you do not like how someone is doing something or how they are doing it or the specific thing that they are doing or not doing. The last one is a perception of inappropriate communication or needs. Any healthcare conflicts or any conflicts can fall under one or more of these specific categories. However, typically one of these three is the predominant one. We will go into some scenarios, see which of these categories we would place it in, then discuss some very practical techniques and strategies to address them. 

Territory

Scenario 1 

• There are work culture and treatment method differences causing major disagreements.
• “We did it this way at my last hospital.”
• “We do it this way here” mentality.
• Lots of resistance from travelers to assimilate and adopt the culture of the new hospital.

In scenario one, there are work culture treatment and method differences, causing significant disagreements. Let me give you some examples of what we mean. This is when someone has the attitude of, we did it like this at my last hospital, or I will do it like that here. 

Alternatively, someone else is coming in doing something different, but someone else is saying, this is the way we do it here mentality. There may be much resistance from travelers or new people to assimilate or adopt the culture of the new hospital that they are working in. 

Territory Resolution Strategies

• Clearly establish roles and responsibilities
• Be aware of schedules
• Be aware of systems 
• Be an active member of the team

Of the three, it might be a bit of technique, but more than technique, and it is a territory issue. Whenever there is a territory conflict, we want to establish the roles and responsibilities clearly. Who is supposed to do what? If we had to check a nice neat box, what department, what person, what coworker, what supervisor, whose responsibility is this? When there is ambiguity in roles and responsibilities, we see lots of conflicts. That might be one of those practical takeaways for you. If you are a director or supervisor somewhere, do you have clearly outlined roles and responsibilities for your department, or are you being proactive? If you are an employee, you notice that many conflicts happen because there is much ambiguity along the lines of roles and responsibilities. That might be a conversation you plan with one of your supervisors. That is a very proactive strategy. We need to be aware of schedules like, what is the therapy schedule for this person? When do they get their meds? When is there a swallow study? When is lunch? When is checking to see if you know the residents by the CNAs? Are they clean, dry? Knowing these schedules, we know that in healthcare, one domino being pushed affects every other one.

We can prevent or decrease conflict in the territory when we know the schedules of a specific patient or how the hospital or the skilled nursing facility, whatever the schedules are in place. Then we need to be aware of systems. Often systems are as, if not more important, than schedules. How are things done here, ensuring that we respect those systems in place? Next is being an active team member. This says that if I am involved in what goes on here day to day, I will not feel like I am on an island. When you feel like you work in a silo on an island, you will feel deserted. Even if you are an RT that comes to different floors and you do not have a home base, you still need to find out how to integrate yourself to that when you come on that floor, they do not necessarily see you as a visitor, but are part of their team. When that happens, it is going to decrease the territorial conflicts that you have. Now let's go back to the scenario and get some specific strategies.

• As a Traveler/Contractor:
  • Considerate yet Confident Contributor
  • Move from Orientation into Discovery Period
  • Don’t make yourself known but make your presence felt
• As a Full Time/Permanent Employee:
  • Be Welcoming
  • Tell the Why with the What
  • Prioritize Policy over Preferences

If you are a traveler, a contractor, or a new employee, you want to be considerate yet a confident contributor. That means I will be considerate of the system and how things work here. I will not come in ignoring or trying to change everything in this environment because if I do, I will create unnecessary territory battles. I am also going to convey that I am a confident contributor. Yes, I am new to this hospital, but I am not new to RT. I know what I am doing. I will not shrink or try to bottle up my confidence and skill set, but I will be a confident contributor, not here as a warm body, but as helping the environment to keep things going. How can you balance that by considering the systems in place and showing that you are confident in your skillset that you want to move from an orientation checklist to a discovery period? Orientation shows you where the closet is and the code to the closet. It might show you how to get down to the dining hall, all that is important. 

What if you are a full-time or permanent employee in the situation? You want to be welcoming. That is very simple. I have worked in many different buildings where new people are not welcome and need assistance. They are not made to feel like they are wanted. When that environment is set up, the contractor or the traveler often goes into defense mode. They start doing their own thing, their way, because of the environment that was initially projected on them. 

How can you be welcoming? Also, tell the why, not the what. Understanding why something is that way and why a system is in place will increase their compliance. I am not suggesting that you have to explain the entire workings of your department, but whenever you sense that someone is not in agreement or has a question, be humble and mature enough to give a background on the why and then prioritize policy over preference. If it is a policy, we are supposed to do it this way, whether legally or because it is what the boss said or whatever. That is policy, but then there is a preference. People want their preferences honored. As long as it gets done, you will see a radical shift in territory battles wherever you can uphold someone's preference. However, when it is policy, of course, we need to manage that. If it is a preference, let's go ahead and let it be. 

Equally as important is your time, which you invest in discovering the culture. You want to watch how people work, watch how things play out. You want to get into the already established rhythm. If the rhythm is this, you want to avoid coming in at this rhythm, or if the rhythm is that, you want to get in at that rhythm, almost a Double Dutch. You watch what is going on. Once you watch it, that is the rhythm you want to come in at. If you need to change some things, it is only after you have established yourself as a part of the team who respects what was already in place. 

Next, do not make yourself known, but make your presence felt. This means you are going to avoid coming in with this foolish mentality of "this is what I know. I am here to get you all back on track and to show you some things" because you will not be integrated or accepted well. Instead, you will create territory battles. You want to make your presence felt that is very different. By your presence felt, that means going back to that confident contributor, where people can look around and say, since Mira joined the team, she has only been here three weeks, but she is made this improvement. She is helped us in this way. We are getting many more patients seen. You are establishing that you are a confident contributor. Rather than someone coming saying, I will put all my preferences on how I do things on an already established system. 

Tone

Scenario 2

• A new RT approaches a physician to double-check an order for COPD medication before administering the medication to its intended patient. The physician interprets the question as a sign of distrust in his expertise & publicly lashes out at the RT, and reports his dissatisfaction with the RT to the RT manager on duty.

A small amount of territory is working here, but the main one, the most significant percentage, of the one at work here is tone. In this situation, I want you to consider the frequency. How often does this happen? If you have worked with the doctor before, he or she has never done this before, which is a weird one-off. It may not be a big deal to address it. You can tell the supervisor, "Hey, this is what happened. He overreacted. I will, you know, make sure not to do this or that next time." However, if this is a trend, we need to implement more specific strategies.

• Consider:
  • Frequency
  • Factors Conflict
• Chain of Command:
  • Lowest Level Possible
  • Understanding the Formal and Informal Chains

Also, consider the factors. What is going on? Was there a medication error with another patient that was not yours? Since then, the doctor has been very, very distrusting of your whole department. That is a factor that you need to consider. Or was it with you that you disagreed before on a recommendation or something you made? What is the history surrounding this? If we only deal with conflicts, at the level of the conflict, without understanding the iceberg effect, then conflict resolution will not be successful. What are the factors? We also need to know the conflict chain of command. Whenever possible, how can we handle conflict at the lowest level possible? In this situation, it is having a conversation with the doctor, yes, having a conversation, making sure that we are at that level, 1, 2, 3. In this situation, we need to go further down from where we have thought about it, planned it, and emotionally regulated it before having a conversation. 

Alternatively, we can understand the formal and informal chains of command. By formal, I mean nothing has happened if you talk to your supervisor, but he continues to take this approach, disrespecting and embarrassing you. 
What is the formal chain of command? We are hesitant to go up this chain of command, but I want to encourage all of you that there are policies and HR procedures for a reason. If you have attempted to handle it at the lowest levels, you went to the doctor, you talked to your supervisor no one is doing anything, then here is one of those options that makes you not this helpless victim, but you may want to look into the system, of what is the HR chain of commands, in situations like this. However, look at the informal. What if this doctor has a nurse that has worked with him for 20 years? Everyone knows he or she has his or her ear. Go to the nurse and say, "I have been working with Dr. G., who is chewing me out. It is getting more frequent. What do you think I can do? What are some strategies? Would you mind talking to her?" Things of that nature are those informal chains of command. That discovery you looked at the place's culture might be helpful for you.

Scenario 3

• RT is trying to pacify an aggressive family member whose loved one is on the ventilator with a poor prognosis. The family complains to the nurse manager.
• Avoiding Aggression
  • Practice crucial conversations
  • Consider timing, technique, tone
  • Listen. Wait. Restate. Validate.
  • Provide appropriate outlets
  • Don’t push back but lean in
  • Define and display directness
  • Create opportunities to coach

We have all had this where you have an aggressive family member, and their loved one is on a mechanical ventilator with a poor prognosis. The family complains to the nurse manager about some of your treatments and how you are doing something that is tone. We want to look at ways to avoid aggression. Here are some ways to practice your crucial conversations and provide appropriate outlets. We want to listen to the family member, wait, restate, and validate. Even though she is level 10 sounding off, how can you hear through how she is saying something to what he or she is saying? How can you listen, wait, restate?

Territory

Scenario 4

• Physicians change ventilator settings without notifying the RT or writing orders, which may/may not make a difference in patient care. RT finds out from routine Q4 vent checks.
• Possible Solutions:
  • Respectfully ask to be notified
  • Increase communication cadence
  • Increase your interaction with the MD to increase confidence
  • Investigate to determine if its “procedure” vs “personal”
  • Determine if its “negligence” or “nuisance”

Scenario three is some technique, but it is more territory. I have changed these settings, and this is my patient. What are you doing messing with them? Here are some possible solutions. Respectfully asked to be notified about the changes. Again, having the professional maturity and courage to go to the physician has a fact, little feelings conversation. You should tell them why you need to know due to what it could cause using calculated facts over feelings conversation with the doctor. Increase your communication cadence. Here is a significant point that I am getting ready to tell you. Conflict resolution is not how you directly handle conflict or the words you say, but more the environment you set that can decrease the likelihood of conflict. That is a huge takeaway. 

What strategies or systems do you need to put in place that change the environment, so things of this nature will not happen as much? A possible situation here is increasing your communication cadence with this doctor, letting them know this is an update on the person. 

If you are sending him notes, communicating through a specific app you all use for internal communication, or seeing the doctor in the hallway, give him an update. How can you most effectively increase your communication with this doctor? Not on this one patient but with all their patients? Now you are creating an environment of trust with this doctor that may not have been there before. You are painting a picture of collaboration competence. When he or she sees competent collaboration, they will be less likely, to go tinkering with your settings. 

Increase your interaction with the MD to increase confidence. A similar thing also investigates to determine if it is procedure versus personal. By procedure, I mean this doctor's procedure. If she does this to everyone, then you would implement a different set of strategies, versus she is only doing it to you, because if she does it with everyone, then the issue is with her that would implement a certain way to approach it. If she only does it to you, then you need to find out what it is about you, your skillset, or previous interaction that has her interacting with you that way, and find out not just the situation but looking at those iceberg things underneath. Next, determine if it is negligence or a nuisance. If this doctor did something wrong because the scenario said it may or may not cause problems with patient care. Suppose it is negligence that needs to be handled properly, and the proper way depends on the level of the situation and on the policies in place at that particular hospital, clinic, or skilled nursing facility. However, if it is a nuisance, sometimes conflict resolution says, I will let this one go. Now that is not avoiding conflict. That is not what I am suggesting. I want you to pick your battles. Sometimes you have to say, is this important enough to address? Depending on the frequency and level of harm it would cause, it would be up to you to choose if this is something you need to address. 

Technique

Scenario 5

• New RT tapes an endotracheal tube using a different technique than the seasoned RTs. The seasoned RTs are negatively discussing this technique in private conversations that ultimately get shared with the new RT.

They're over there gossiping about you. You find out about it. This is a technique. Let's talk about some strategies to mitigate technique conflicts.

• Technique Resolution Strategies
  • Be proficient and efficient at what you do
  • Be able to articulate the why of what you do
  • Seek an understanding of other roles and responsibilities

The first one is to be proficient and efficient at what you do. The more you show confidence and competence, the less people are likely to question what you do. Number two is to articulate the why of what you do. Now, this is only sometimes you do something new. You should be forced to prove that this is right. If there is a conflict, be humble enough to say, "Hey, this is why I am doing it this way." Seek an understanding of other people's roles and responsibilities, looking at their technique and why they feel theirs is better.

Here are some more strategies and ways to think about this scenario. Number one, the evidence speaks. if you want to say, "Hey, this is a journal article, it is a new procedure, it is working." Be confident enough to know where to go to get information backing up your technique. Results speak. Say, "I have tried this technique for the last five of my patients. It is more comfortable, and I have seen better quicker results" Instead of saying, "I can do it the way I want to," say instead, "Here is the evidence and results to support it. I am creating an environment of collaboration, not competition. Being able to say, "Hey, I heard there were some concerns. Here is why I am using this. What are your concerns about it?" being able to, even though they were gossiping about you, you be the mature voice of reason, creating an environment of collaboration. Then consider if it is preference, practical, or principle. Sometimes we fight battles because that is the energy, then how can we change that? Alternatively, sometimes it is practical, yes, you can do it this way, or I can do it this way. Both are correct, but there is one that is quicker, faster, and more cost-efficient. If you say, "Yeah, even though I like this way, I see how this is more practical." Be willing to grow and be lifelong learners, but also humbly show why I do it this way—again, being able to get that ebb and flow of standing your ground when you know something you are doing is right to show other people why, but also to adjust and learn if there is an opportunity to do so.

Identifying Caregiver “Types”

When our caregivers manage many emotions, they are often not at their best. We want to hear how they are saying it and what they are saying. I typically put caregivers in three different buckets. 

The “Squirrel”

• Weaknesses
  • Visibly Overwhelmed
  • No Systems
  • Start but only Partially Completes Many Tasks
  • Emotional, Often Teary
• Strengths
  • Admits Being Overwhelmed, Thus Easy to Identify and more Receptive to Ideas and Suggestions
  • Small Changes and Strategies Make Big Changes
  • Have Basic familiarity with Most Necessities
  • Expressive and willing to Process through emotions

The first one is the squirrels. They are visibly overwhelmed, back and forth, all out of sorts. You have seen them like they physically look frazzled sometimes. The good thing about these caregivers is that they admit to being overwhelmed. They are easy to identify and are receptive to ideas. One weakness is that they do not have systems. They are all over the place. However, the positive thing is that because they have no systems, any small change or suggestion you can make will create huge benefits. They are very receptive because of small changes in ideas, and they are like, I never thought about that, thank you. A weakness is that they start but only partially finish things, and they are very emotional. It is another weakness. However, you get to hear and understand their issues because they are expressive.

How to Help the Squirrel

• Fix the Low Hanging fruit first
• Operate well with Check Lists
• Need Assistance Prioritizing (tasks and feelings) • Support Groups
• Scheduled Weekly Meeting or Phone calls
• Needs to hear, “Can you work on this task first?”

How can we help a squirrel? Fix the low-hanging fruit, the easy things we can fix for them. They operate with checklists. They are all over the place. They do not have systems. If you can give them a checklist of things that they can do, it eases their anxiety. They need assistance prioritizing what is most important. It is good to have suggested support groups because they will often catch you as an RT and give you all their concerns which do not even concern you. In a support group, they get to vent. That is the appropriate place for it to air out everything. Schedule weekly meetings because they need frequent touchpoints. They need to hear, "Can you work on this one task right now/first?"

The “Deer"

Weaknesses

• Visibly Overwhelmed (but may appear apathetic or “lazy”)
• Paralysis Analysis
• Slow to Make Decisions
• Reserved. Decrease Conversations

• Strengths
  • Admits Being Overwhelmed, Thus Easy to Identify and more Receptive to Ideas and Suggestions
  • Familiar with Multiple Options
  • Increased Comfort when Decision is “Finally” Made

The deer is the opposite of the squirrel. They are not moving at all because they are overwhelmed. They are visibly overwhelmed. They have what I call "paralysis analysis," and they do not want to make decisions because they are like, "If I make the wrong decision, I will make the wrong decision."  One good thing is that they research and research. They are familiar with options they are very reserved. However, they listen.

How to Help the Deer

• Pros and Cons Discussion Format
• “No Perfect Suggestion”
• Needs Dates and “Deadlines”
• Needs Streamlined Options, Not all the Options
• Testimonials
• Needs to hear, “I support that Decision.”

How we help the deer is that we give the pros and cons. We tell them there is no perfect suggestion, do not wait on the best, on the optimal, the number one, a hundred percent correct, but go on the best suggestion they need to hear, "I support the decision."

The “Lion”

• Weaknesses
  • Appears “on top of things” but may be concealing burn out
  • Needs to be “in control”
  • Can make decisions in Haste
  • Appears angry, rude, or inpatient
• Strengths
  • Slightly less “emotional” than other types
  • Involved. Present. Timely.
  • Decisive
  • Communicates their emotions and feedback

Now to the lion, the lion is the one that is going to chew you out because you did not do something for their mom or their husband. The lion does this, not necessarily because they are rude, but because they feel this is their way of protecting their loved one. When I am not here, even when I am nowhere to be found, they will ensure that Mom is taken care of because the staff knows who I am and how I am. A lot of the anger the frustration you see is because of them trying to protect their mom or their husband. 

How to Help the Lion

• Meeting with those “in charge”
• Frequent Communication
• Seek their option, even on smaller matters
• Give resources and ask to circle back after reviewing
• Needs to hear, “We appreciate your input. That was helpful.”

How can we help the lion? Lions often want to meet with those in charge. They want to feel that the top people know what is happening. Sometimes they meet with you as one of the staff RTs, but when can they meet with the Director of RT from time to time? It may seem unnecessary for you, but lions like to meet with, for example, the Rehab Director. It is okay, and it is not personal—provide frequent communication. Give them information, information, communication, communication. Let them know that their opinion matters. Give them resources, and tell them you appreciate and welcome the input. Those are a few ways to mitigate those over-the-top responses from the lion.

Summary

• Conflict resolution is not just the words you say but the environment you set and the “energy” you bring.
• Conflict is not avoidable, but volatility is.
• Conflict resolution is not “stuffing” or “stifling”
• Successful conflict resolution requires level appropriate intentional steps.
• Conflict resolution is a skill that must be refined and a muscle that must be strengthened.
• You can not determine someone’s response, but you can increase the odds of creating a response you can live with.

Remember that conflict resolution is not your words but the environment you set and the energy you bring. Conflict is not avoidable, but volatility is. How can you set systems in the environment to decrease the likelihood of volatility? Conflict resolution is not stuffing or stifling like I will not say anything, but finding a method, when, and how to say it. Successful conflict resolution requires level-appropriate intentional steps. It is also a skill that must be refined and muscle that must be strengthened. Lastly, you cannot determine someone's response, but you can increase the odds of creating a response you can live with. 

References

Doyle, A. (2021) “Top Soft Skills Employers Value with Examples”. The Balance Careers. July 22, 2021. https://www.thebalancecareers.com/list-of-soft-skills- 2063770

Goleman, D. (2008) Working with Emotional Intelligence. Bantam Doubleday Dell Publishing Group.

Maxwell, J. (1997) Becoming a Person of Influence. HarperCollins Leadership.