Trainee perspectives

Managing conflict in the ED – a trainee perspective

By Dr Felicia Cox – ACEM trainee

Felicia Cox photo for blog post
Dr Felicia Cox – ACEM trainee

 Let’s be honest, if you work in the emergency department you’re not a stranger to conflict. With patients who present in physical or emotional distress, staff fatigued with erratic sleep cycles and empty stomachs, and a system that can be inflexible… interpersonal conflict in the workplace seems to come with the territory. Working as an emergency registrar I find this to be one of the most difficult and stressful aspects of the job. So if we can’t avoid it, what can we do at getting better at managing it? I spoke to Chrystal Gray, a clinical psychologist, about how to develop our skills at managing tricky situations once they arise.

So we have found ourselves in a situation of conflict. What sort of strategies could a trainee use to de-escalate conflict in the workplace?

There are several ways to approach this. A focus on collaboration with the other party is probably the most likely to result in sustainable change, but it is also the most time intensive. This means to focus on identifying common goals, while also acknowledging and validating the other parties’ interests.

If collaboration is unsuccessful, compromise can be a used as a temporary solution. This can be useful if the cohesiveness of the group is the desired outcome, but is unlikely to be an effective long-term solution. When there are limited resources or the stakes are high, it may be necessary to competitively pursue a desired outcome at the expense of group cohesiveness.

Not all situations are suitable for compromise. How can trainees work on displaying their assertiveness in appropriate situations? 

The first step is to identify your needs in the situation so this can be communicated clearly. It’s essential to appear calm during interactions so take some time to self-regulate if needed. It’s also important to remember that your point of view is likely to be better received when you clearly reflect and validate the other parties’ point of view.

It’s easy to feel rattled after an episode of conflict in the workplace. How can we re-focus and get back to work without letting it affect our performance?

Conflict instinctively triggers the fight or flight response. The first step is often just to notice that this has occurred and notice the different sensations in the body (e.g., increased heart rate, perspiration). Some people find physical strategies such as going for a walk or running their hands under cold water more calming and for others slow breathing is more effective.

Our mind can also become “hooked” by the thoughts or memories of the event and this can perpetuate the fight or flight response. In the same way that you would name a story or essay, name the conflict in your mind so that you can acknowledge the thoughts without becoming hooked and distracted by them.

How do you work with a bully in the workplace?

If it’s appropriate and safe, it can be helpful to assertively communicate with the person involved to ensure that they are aware of the impact of their behaviour. If the desired outcome is not achieved, the next step is to escalate the issue according to local policies and procedures. If an investigation is likely, victims of bullying should note down the details of each event and witnesses.

Do you have any strategies to help staff be a negotiator between two parties with opposing agendas?  

It can be helpful to have a third party involved to outline the critical issues and facilitate breaks if either party becomes too aggressive. If parties aren’t able to assertively communicate their own ideas, the negotiator can intervene to reflect each parties’ perspective. A negotiator might also point out areas of agreement between the two parties with the aim of moving towards a collaborative solution.

Felicia Cox, Emergency Registrar

Chrystal Gray
Clinical Psychologist
BPsychSc (Hons), MPsych (Clinical), MAPS

Gray Matter Psychology

About Felicia Cox


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