Journal of Nursing Management, 2015
Conflict management style of Jordanian nurse managers and its relationship to staff nurses’ intent to stay ZAID AL-HAMDAN
, HAYAT NUSSERA
and RAMI MASA’DEH
Assistant Professor, Faculty of Nursing, Jordan University of Science and Technology, Irbid, 2Nurse In-Charge, Farah Hospital, Amman, and 3Assistant Professor, Applied Science Private University, Amman, Jordan 1
Correspondence Zaid Al-Hamdan Faculty of Nursing Jordan University of Science and Technology PO Box 3030 Irbid 22110 Jordan E-mail: [email protected]
com, [email protected]
AL-HAMDAN Z., NUSSERA H., MASA’DEH R.
(2015) Journal of Nursing Management Conflict management style of Jordanian nurse managers and its relationship to staff nurses’ intent to stay
Aim To explore the relationship between conflict management styles used by nurse managers and intent to stay of staff nurses. Background Nursing shortages require managers to focus on the retention of staff nurses. Understanding the relationship between conflict management styles of nurse managers and intent to stay of staff nurses is one strategy to retain nurses in the workforce. Methods A cross-sectional descriptive quantitative study was carried out in Jordan. The Rahim organization conflict inventory II (ROCI II) was completed by 42 nurse managers and the intent to stay scale was completed by 320 staff nurses from four hospitals in Jordan. The ANOVA analysis was carried out. Results An integrative style was the first choice for nurse managers and the last choice was a dominating style. The overall level of intent to stay for nurses was moderate. Nurses tend to keep their current job for 2–3 years. There was a negative relationship between the dominating style as a conflict management style and the intent to stay for nurses. Conclusion The findings of the present study support the claim that leadership practices affect the staff nurses’ intent to stay and the quality of care. Implications for nursing management Nurse managers can improve the intent to stay for staff nurses if they use the appropriate conflict management styles. Keywords: conflict management, intent to stay, nursing leadership Accepted for publication: 14 April 2015
Introduction Health-care organisations are multidisciplinary entities with employees and customers at multiple levels (Almost 2006); some degree of conflict in these large and complex organisations is inevitable. Organisational conflict is generally viewed as disagreement among individuals working together within an organisation. It can range from differing views about responsibility and resource allocation to the overall direction of the organisation (Vivar 2006). Conflict is one of the major DOI: 10.1111/jonm.12314 ª 2015 John Wiley & Sons Ltd
challenges facing nurse managers and depends primarily on the conflict management styles used (Sullivan & Decker 2009, Al-Hamdan et al. 2011). The purpose of this paper is to describe the nurse managers’ conflict management styles and the staff intent to stay in Jordan.
Overview of the literature In the literature there is no single universal definition for conflict. Fisher (2000, p. 168) defines 1
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it as ‘a social situation in which there are perceived incompatibilities in goals or values between two (or more) parties, attempts by the parties to control one another, and antagonistic feelings towards each other’.
Conflict management styles Conflict itself is not inherently positive or negative; it is the style used to manage it that results in either a positive or negative impact (Al-Hamdan et al. 2014). Different operational definitions capture dissimilar conflict management styles in interpersonal and organisational contexts. These definitions reflect similar constructs, but different assumptions, which include the construction of specific terminology for this (Blake & Mouton 1964, Thomas & Kilmann 1976, Rahim 1983). Rahim’s (1983) framework of conflict management styles, is one of the most well known (and commonly used) in the literature. According to Rahim (1983), interpersonal styles of conflict management are classified into five categories according to the relative extent to which participants are concerned about self and others. These five styles can be defined as: avoiding, compromising, integrating, obliging and dominating (Rahim 1983). ‘Avoiding’ results from low concern for self and others and involves reducing the importance of issues and attempting to suppress thought about them (Rahim 2011). Avoiding is refusing to address and to engage actively with the conflict. ‘Compromising’ is moderate concern both for oneself and others (Rahim 2011); it involves intermediate levels of both assertiveness and cooperation and focuses on quick and mutually agreeable decisions that partially satisfy both parties. ‘Integrating’ shows concern for self and others when one works with another to find a solution that satisfies both. ‘Obliging’ is when one has low concern for oneself and high concern for others (Rahim 2011); it involves unilateral concessions, unconditional promises and offers of help. Obliging is characterised by cooperative but unassertive behaviour. ‘Dominating’ is when one imposes one’s will on others and involves threats and bluffs, persuasive arguments and positional commitment; it is an aggressive, uncompromising approach to conflict that is power-driven (Rahim 1983, 2011). One may exhibit a number of conflict management styles, and no single strategy is likely to be characteristic of a manager. The nurse manager’s style can vary, based on the contextual factors including the situation, individual characteristics, socio-cultural 2
attributes (e.g. religious background) and past experience (Al-Hamdan et al. 2011, 2014).
Intent to stay Many definitions of intent to stay are found in the literature. For instance, McCloskey and McCain (1987, p. 20) defined it as ‘the nurse’s perception or probability to stay at the current job’. More recently, intent to stay is defined as ‘nurses’ thoughts and attitude towards staying with their existing employer’ (Kovner et al. 2009, p. 82). Comparing and contrasting the different definitions, intent to stay can be understood as behaviour and attitude that is contemplated but has yet not occurred. The definition of intent to stay adopted here is that of McCloskey and McCain (1987). Nurses’ intent to stay has been associated with many variables, which can be grouped under organisational factors, work role factors and individual factors (Nedd 2006). Organisational factors that affect nurses’ intent to stay include leadership style, organisational policies, supervision and support, empowerment and satisfaction (Nedd 2006). Tourangeau and Cranley (2006) identified the strongest determinants of intent to stay as age, job satisfaction and years of experience. The individual factors that have been studied in nursing research related to intent to stay and nurses retention, include, but are not limited to: gender, age, race, education level, marital status, job position, kinship relationship and family income (Tourangeau & Cranley 2006, AbuAlRub 2010). A recent study in Jordan showed that intent to stay and age were positively associated; older nurses are more likely to remain in their present job than younger nurses (AbuAlRub 2010). Today, all health-care organisations set goals and targets to improve the quality of care provided to patients. As nurses are the main frontline personnel interacting with patients, the quality of nursing care is particularly important. Health-care organisations require highly skilled and trained staff nurses to provide effective and efficient care and nurses’ intention to stay is identified as an important issue in nursing due to the numerous negative impacts of high nursing turnover. Two studies in Jordan have examined the variables affecting the intent to stay, such as job satisfaction, supervision and work environment; individual characteristics; organisational commitment; work and non-work social support; organisational climate; safety climate and team work; and organisational culture (Mrayyan 2008, AbuAlRub 2010). ª 2015 John Wiley & Sons Ltd Journal of Nursing Management
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policies to engender a no-blame environment, especially but not uniquely for new employees. Some hospitals may need changes regarding human resource management, education and work incentives in order to improve working conditions. Cummings et al. (2010) have concluded that efforts by organisations and individuals to encourage and develop transformational and relational leadership are needed to enhance nurse satisfaction, recruitment, retention and healthy work environments, particularly in a worsening nursing shortage.
Ethical approval Ethical approval was given by the Scientific Research Board of the Jordan University of Science and Technology. Approvals from the hospitals were obtained prior to the data collection, and participation was voluntary.
Sources of funding There was no funding for this study.
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Cowden T., Cummings G. & McGrath J. (2011) Leadership practices and staff nurses intent to stay: a systematic review. Journal of Nursing Management 19, 461–477. Cummings G.G., MacGregor T., Davey M. et al. (2010) Leadership styles and outcome patterns for the nursing workforce and work environment: a systematic review. International Journal of Nursing Studies 3, 363–385. Fisher R.J. (2000) Intergroup conflict. In The Handbook of Conflict Resolution(M. Deutsch & P.T. Coleman eds), pp. 166–185. Jossey-Bass Publishers, San Francisco, CA. Hayajneh Y., AbuAlRub R., Athamneh A. & Almakhzoomy I. (2009) Turnover rate among registered nurses in Jordanian hospitals: an exploratory study. International Journal of Nursing Practice 15 (4), 303–310. Hayes L.J., O’Brien-Pallas L., Duffield C. et al. (2006) Nurse turnover: a literature review. International Journal of Nursing Studies 43 (2), 237–263. Hendel T., Fish M. & Galvon V. (2005) Leadership style and choice of strategy in conflict management among Israeli nurse managers in general hospitals. Journal of Nursing Management 13, 137–146. Hendricks J. & Cope V. (2013) Generational diversity: what nurse managers need to know. Journal of Advanced Nursing 69 (3), 717–725. Hofstede G. (2001) Culture’s Consequences: Comparing Values, Behaviors, Institutions and Organizations Across Nations. Sage, Thousand Oaks, CA. Kovner C., Brewer C., Greene W. & Fairchild S. (2009) Understanding new registered nurses’ intent to stay at their job. Nursing Economic 24 (2), 81–97. Kunaviktikul W., Nuntasupawat R., Srisuphan W. & Booth R. (2000) Relationships among conflict, conflict management, job satisfaction, intent to stay, and turnover of professional nurses in Thailand. Nursing & Health Sciences 2 (1), 9–16. Lambert A., Lambert E. & Ito M. (2004) Workplace stressors, ways of coping and demographic characteristics as predictors of physical and mental health of Japanese hospital nurses. Journal of Nursing Studies 41, 85–97. McCarthy G., Tyrrell M. & Lehane E. (2007) Intention to ‘leave’ or ‘stay’ in nursing. Journal of Nursing Management 15 (3), 248–255. McCloskey J. & McCain B. (1987) Satisfaction, commitment and professionalism of newly employed nurses. Journal of Nursing Scholarship 19 (1), 20–24. Mrayyan M.T. (2008) Hospital organizational climates and nurses’ intent to stay: differences between units and wards. Contemporary Nurse: A Journal for the Australian Nursing Profession 27 (2), 223–236. Nedd N. (2006) Perceptions of empowerment and intent to stay. Nursing Economic 24 (1), 13–18. Pines E., Rauschhuber M., Norgan G. et al. (2012) Stress resiliency, psychological empowerment and conflict management styles among baccalaureate nursing students. Journal of Advanced Nursing 68 (7), 1482–1493. Rahim M. (1983) A measure of styles of handling interpersonal conflict. Academy of Management Journal 26, 368– 376. Rahim M. (2011) Managing Conflict in Organizations, 4th edn. Transaction Publishers, Westport, CT.
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randomly from each of the three pools one hospital (two private) for the study.
Participants and sampling The population included all nurse managers and their staff working in clinical units (i.e. cardiac care unit, emergency room, intensive care unit, medical unit, operation room, paediatric and surgical units) at the targeted hospitals who had direct contact with patients during the data collection period. Nurses working in the outpatient clinics, infection control departments and continuous education departments do not have direct contact with patients, thus they were excluded from this study. The target population was 57 nurse managers and 1490 nurses. Convenience sampling was used to recruit all nurse managers and their staff who were on-duty during the data collection period.
Measures The Rahim organisation conflict inventory II (ROCI II) consists of 28 items on a five-point Likert type scale (5 = strongly agree, 1 = strongly disagree), which reflect conflict management styles based on individual disposition. These items operationalise the five styles: integrating (seven items), obliging (six items), dominating (five items), avoiding (six items), compromising (four items) styles. The five conflict management styles reflect different combinations of concern for self and concern for others (Rahim 1983). Content validity of the Arabic version of the instrument was established by the author of the instrument and the instrument has been used by many researchers in Jordan (Al-Hamdan et al. 2011, 2104). The reliability coefficient and contrast validity ranged from 0.60 to 0.83 in previous studies (Rahim 1983). The Cronbach’s alpha coefficient of the scale used in this study was 0.65. This questionnaire was distributed to the nurse managers by one of the researchers over the course of a month. The McCain intent to stay scale (McCloskey & McCain 1987) was used to measure the intention to stay. This scale is rated on a five-point Likert scale (1 = strongly disagree, 5 = strongly agree). The Cronbach’s alpha coefficient of the scale was 0.86. Intent to stay in the current role is taken from the sum of the five items of the scale. The content validity of the Arabic version of the scale used in this study was established by AbuAlRub (2010). The reliability coefficient was 0.88 of the orginal paper (McCloskey & 4
McCain 1987). This questionnaire was distributed to the nurses by one of the researchers. Approval for using these instruments was granted by their original authors (who were contacted via email). In addition, demographic data related to the participants such as their age, gender, marital status, years of experience and educational level were also collected.
Data collection procedure The questionnires were distributed to the nurse managers and the staff nurses at different times. The completed questionnaires were deposited in sealed boxes provided at each unit and collected 2 weeks later. The researcher gave the same code for the staff nurses and the nurse managers who work at the same units, thus linking the two groups together. A pilot test was carried out on four nurse managers and 30 staff nurses to test the procedures and responses. There were no required changes, but pilot participants were excluded from this study. Data collection took place in the period between October and December 2013.
Data analysis The Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, USA) 17.0 for Windows was used to analyse the quantitative data. A significance level (P-value) of