Conflict in our project required ex

Conflict in our project required external facilitation to overcome challenges with team and/or team-operations leader relationships. During conflict, problem-focused approaches promote collaborative solutions that are associated with better outcomes and emotionally intelligent leaders use problem-focused strategies (Cummings et al. 2005, Morrison 2008). Our study indicated that we need emotionally intelligent leaders who can model objective, rational approaches to work environment challenges. In a recent study by Young-Ritchie et al. (2009), path analysis revealed that emotionally intelligent leader behaviour had a strong effect on structural empowerment (β = 0.54), which had a direct effect on affective commitment (β = 0.61). The researchers concluded that ‘when leaders invest time with staff, making visibility and relationships a priority, they are more likely to manage conflict better, to engage in dialogue promoting teamwork and collaboration and to promote staff development’ (p. 82).

Conflict and communications were closely related in our project, with ineffective communications leading to or resulting from conflict. Communications issues often had past history or trust/respect issues related to nursing power dynamics. Communications failures in healthcare settings are often a result of underlying power issues, such as hierarchical differences and power push-and-pull over roles and responsibilities (Marshall & Robson 2005). Communications failures have been linked with adverse patient events (Leonard et al. 2004). One study focused on building effective communications among interdisciplinary teams: transforming an unsafe culture to a safety culture. The success of the project depended on using a grass-roots approach to get buy-in, strong clinical leadership and senior leadership support (Leonard et al. 2004).
Conclusions

The present study highlights leadership’s critical role in transforming work place relationships through shared decision making. This study also confirms the importance of leadership competencies related to communications, conflict management, team-building and change management (Kleinman 2004, MacPhee & Bouthillette 2008). In addition to strong leadership at all levels, organizational supports are necessary for shared decision making sustainability (Erickson et al. 2003, Scott & Caress 2005). During our study, new waves of restructuring were threatening organizational/leadership support for the project. When there is economic turbulence and work environment anxiety and stress, shared decision making/CNP provides a way for organizations and leaders to positively shift culture and nurse outcomes, such as job dissatisfaction and burnout (Aiken et al. 2002).

All of the teams had trust/respect and past history issues related to nursing power dynamics and conflict appeared at the beginning of every project. Conflict among team members negatively influenced project work, but the conflict between teams and their operations leaders most hampered project progress and sustainability.

Limitations

The proposed SPO linkages need further testing and refinement with other site data. Other than communications issues with staff, we did not explore process steps related to team-staff relationships. The teams rarely discussed staff issues, although many of their quick win projects included staff input and/or participation. Because conflict existed among teams and between teams and operational leaders, there was probably underlying conflict with staff that we did not adequately explore.

More in-depth within-case analysis is needed to describe specific leader and organizational attributes that made the biggest difference with respect to outcomes. We spent less time on SO connections because of previous research, but we should substantiate these connections with our own case data.
Implications for nursing management

Project work (participatory change management) related to workload issues provided nurse project teams and their operations leaders with opportunities to engage in shared decision making. In the absence of formal CNP structures, such as shared governance models, project activities can serve as a ‘start-up’ mechanism for nurse–nurse leader engagement.

Before initiating nurse–nurse leader projects, we recommend in-person discussions with different leadership levels to ensure leadership commitment to project team work. We also recommend dedicated time during orientation for leaders from all levels to meet with the project team and staff to confirm their project commitment and their willingness to provide access to organizational empowerment structures, such as information and resources. During our orientation, we focused primarily on project team relationships and the establishment of team communications and meeting ground rules. We tried to do our orientation in 1 day. It would have been a valuable investment of time to extend orientation to include time for leaders, staff and project team members to discuss the project goals and expectations of each other. These open discussions at the beginning of the project might have offset some of the conflict that arose during orientation and throughout the project.

We discovered that conflict management was one of the pre-eminent steps in the shared decision making process. We recommend that any project should begin with an examination of potential/actual conflict among team members and between teams and their operations leaders and organizations. Conflict management tools should be introduced at the very beginning of orientation before proceeding with other process steps, such as developing communications. This would have heightened awareness of potential or actual sources of conflict. Unresolved conflict made it difficult for leadership/us to transition responsibility to team members and conflict compounded over time.
Acknowledgements

We would like to thank the Provincial Nursing Workload project sites, project teams, staff and leadership. We would like to acknowledge the support and direction of the Provincial Nursing Workload Steering Committee. Special thanks to members of our working group, Ms Patricia Weir and Ms Karen Jewell.