Aigul S. Abdyzhalieva^1*, Victor E. Savin², Tologon Ch. Chubakov¹,  Kalima T. Mamatova¹, Raikhan S. Rozyeva¹

¹Kyrgyz State Medical Institute of Post-Graduate Training and Continuous Education named after S.B. Daniyarov, Bishkek, Kyrgyzstan

²Bishkek State University named after K. Karasaev, Bishkek, Kyrgyzstan

Abstract

Objective: To analyze the causes and styles of conflict resolution in professional activities of nurses working in medical and preventive organizations of the healthcare system.

Methods: Overall, 392 nursing professionals working in medical and preventive organizations took part in the research. To address the purpose of the work, we used a questionnaire of sociodemographic characteristics and a list of different styles of organizational conflict resolution developed by Rahim Organizational Conflict Inventory (Rahim 1983).

Results: The results indicate that the most common causes of conflict among nurses are unfair pay (31.1%), lack of respect for subordination (26.5%), and human behavior (26.5%). The nurses’ preferred conflict management styles are cooperation, which scored the highest mean score of all conflict management styles (4.16 (0.96)) points, and avoidance and accommodation styles were in the second place. The mean scores of these two styles were almost at the same level (3.75 (1.23) and 3.71 (1.39)) points.

Conclusion: Conflicts in professional activities of nurses in the Kyrgyz Republic are a serious problem in medical and preventive organizations. The main styles of conflict resolution used by nurses are cooperation, avoidance and accommodation.

Key words: Conflicts, causes of conflict, conflict resolution, conflict style, nurse

Introduction

Conflict is a lack of agreement between two or more parties, which may be specific individuals or groups of individuals. Each party makes every effort to get its point of view or goal accepted and prevents the other party from making the same (1-4). Conflict arises in the life of any organization because an organization is a group of people whose activities are consciously coordinated to achieve common goals. (5-9). This type of disagreement from time to time arises in healthcare organizations, like in any other organization. Healthcare organizations play a vital role in achieving the goals of health systems and this characteristic distinguishes them from other organizations which activities are not related to public health (10-12). The complexity of the conflict structure makes recognizing and managing conflict a complex process and requires appropriate skills for professional work. The ability to understand the nature of conflicts, to differentiate their components and to work towards their resolution is an important component of the professional profile of managers of healthcare organizations and health authorities (2, 13, 14). In healthcare organizations, failure to manage conflict is a major cause of stressful work environments, physical plays, patient and staff dissatisfaction, poor quality of care and increased costs (15-17).

Graphical abstract

Kenneth Thomas - Ralph Kilmann (18, 19) identified the following ways of managing conflict: cooperation, competition, avoidance, accommodation, compromise:

1.            Cooperative strategy - accepting the differences in views between the parties and the desire to understand the opponent’s point of view, discuss the reasons for the situation and find a solution that satisfies the interests of the both parties.

2.            Competitive strategy - the desire to satisfy one’s personal interests while displacing other participants in a conflict situation.

3.            Evasion strategy is the avoidance of solving the situation, the desire to delay the time or a complete lack of desire to solve the conflict.

4.            Accommodation strategy is a muting, suppression of the conflict, satisfaction of the goals and interests of the other party, the refusal of confrontation.

5.            Compromise strategy is a temporary reaching an agreement, willingness to make concessions to each other.

Nurses, being the largest group of health workers in any healthcare organization, are not immune to conflict (20-24). Conflict among nurses has been recognized as a global serious problem in healthcare organizations. It can arise as a result of several elements such as complexity in the organization, different role expectations, interdepartmental competition, constraints in decision-making process, competition for limited resources, unclear work boundaries and personality differences (10, 25- 27).

If conflict is not handled properly, it can significantly affect employee morale, increase turnover and even lead to litigation, ultimately affecting the overall wellbeing of the organization (28- 30). da Silva Ferreira et al. (31) in a recent literature review indicated that the implementation of proposed conflict prevention and management strategies in the nursing sector addresses interpersonal tensions and plays a key role in improving the organizational climate and quality of patient care. By developing the culture of open and effective communication, where nursing professionals can constructively express their concerns, healthcare organizations create a more collaborative and harmonious working environment. Prioritizing staff well-being and job satisfaction not only improves the organizational environment but also raises standards of patient care, contributing to positive health outcomes and a more humanized and positive hospital experience (31).

Objective: To analyze the causes and styles of conflict resolution in professional activities of nurses working in medical and preventive organizations of the healthcare system.

Heart, Vessels and Transplantation 2025; 9: doi: 10.24969/hvt.2025.544

How nurses resolve conflicts                                                                                                                                  Abdyzhalieva et al.

Methods

Our research paper was designed as a descriptive survey study. The study involved 392 nursing professionals (deputy nursing managers of healthcare organization, head nurses, senior nurses and nurses) working in healthcare organizations (public hospitals, family medicine centers, private hospitals, etc.).

All nurses provided informed consent to participate in the survey. The approval of Institutional Ethics Committee was obtained.

Baseline characteristics

We collected the following demographic, educational and  professional  data: age, gender, marital status, educational level, place of work, position at work, and length of service of nurses (see below).

Questionnaire

We used a questionnaire of sociodemographic characteristics and the Organizational Conflict Inventory developed by Rahim Organizational Conflict Inventory (19). The questionnaire presented by us additionally included 13 items that asked about age, gender, marital status, educational level, length of service of nurses and the main causes of conflict situations in healthcare organizations. In the questionnaire, the participants did not choose one cause of conflict but all causes of conflict that they encounter in their professional activities.

The second questionnaire includes 34 items defining conflict resolution styles. It should be noted that we reduced the number of items in the questionnaire recommended by Rahim (32) by one item due to the same content of the questions asked: item 9 was removed because item 20 contains approximately the same question. The magnitude of the indicators of different conflict resolution styles was determined on a 5-point Likert scale. The items of the questionnaire were rated as following:  1 - never, 2 - rarely, 3 - sometimes, 4 - frequently, 5 - constantly. The questionnaire contains five subscales: cooperation (items 1,4,6,14,27,28,34), avoidance (items 3,7,21,22,31,32,33), competition (items 8,9,10,17,23,26,30), accommodation (items 2,11,12,15,16,24,29), compromise (items 5,13,18,19,20,25) (Appendix 1). To analyze the scales, the mean scores obtained on each of the subscale are considered. Of all the subscales, the one with the highest mean score is considered to be the preferred style of conflict management and resolution (19, 32-34).

Statistical analysis

Statistical analysis of the obtained data was performed using SPSS 16.0. with calculation of arithmetic mean (M), standard deviation (δ), mean error of arithmetic mean (m), reliability coefficient (Student’s t-test). Differences were considered statistically significant at p < 0.05.

Results

Out of 392 participants, 387 (98.7%), were women, 5 (1.2%) were men, 320 (81.6%) were working in a public hospital, 55 (14.0%) in a family medicine center, 17 (4.3%) in other institutions. The category of nursing specialists is represented as follows: the share of practicing nurses was 61.4%, senior nurses - 31.6%, head nurses - 5.6%, deputy heads of healthcare organization in nursing - 1.2% (Table 1).

Table 2 presents the main causes of conflicts in the professional activities of nursing specialists. The most frequent causes of conflicts in nurses are unfair pay (31.1%), non-compliance with subordination, ethics and deontology (26.5%), human behavior (26.5%) and unfair distribution of privileges, awards, bonuses and other incentives (14.7%) and low level of professionalism in some nursing professionals (12.7%).

The causes of conflicts that scored the lowest were improper work organization (5.1%), striving for position and fighting for position (1.2%) and ineffective communication (3.3%). The share of these causes of conflicts in other authors’ studies was relatively low (31, 35).

We analyzed the ways of conflict resolution by nursing professionals in their professional activities (cooperation, competition, avoidance, accommodation, compromise). Table 3 presents the average assessments of the types of conflict resolution in the activities of nurses.

As can be seen from Table 3, the nurses’ preferred conflict management style is the cooperation style, which scored the highest mean score of all conflict management styles (4.16 (0.96)) points, while the avoidance and accommodation styles took the second place. The mean scores of these two styles were almost at the same level (3.75 (1.23) and 3.71 (1.39)) points. Compromise style is the fourth most preferred style by nurses (3.30 (1.11)) scores. According to our data, the style that is least frequently resorted to by nurses in conflict situations is competition (mean score - 2.86 (1.26)) points. 

Table 4 presents the results of the analysis of conflict resolution styles and compared them depending on the socio-demographic characteristics of nursing professionals. The cooperation style was resorted to men more often than the other styles by participants of all age ranges, they were competitive that women and less likely to compromise. For participants of all age ranges, the avoidance style took the second place followed by adaptation, compromise, and the last style chosen was the competition style.

In terms of education levels, nurses with secondary and tertiary education chose the cooperative style to a greater extent and the competitive style to a lesser extent. The second most preferred style was the avoidance style among nurses with secondary education and the accommodation style among nurses with tertiary education. Next, specialists with secondary education chose the accommodation style, then the style of compromise and competition, and specialists with tertiary education - avoidance, compromise, competition, respectively.

Our data show that regardless of the positions held, the participants are most committed to the cooperative style and least committed to competition. According to the data presented, the proportion of nurses with 10 years of professional experience and above who have chosen the cooperative style is slightly higher than employees with professional experience up to 10 years. But nevertheless, employees with 1-5 years of experience and 6-10 years of experience are also more committed to the collaborative style and they scored the lowest on the competition style.

Discussion

The most frequent causes of conflicts between nurses in our study were unfair pay, non-compliance with subordination, ethics and deontology, human behavior and unfair distribution of privileges, awards, bonuses and other incentives and low level of professionalism in some nursing professionals.

According to da Silva Ferreira R. et al. (31), the main causes of conflict among nurses were found to be work overload, poor communication, inconsistencies in the performance of professional procedures and misallocation of resources (31). Another paper reflects the same causes as in the previous article, except for conflicts related to work overload (35). It should be noted that most nurses working in intensive care units experience moderate to high levels of conflicts. Among conflicts, competitive and intra-collective conflicts were the most frequent and moderately experienced types of conflicts (36).

In contrast, according to our data, the causes of conflicts that scored the lowest were improper work organization, striving for position and fighting for position  and ineffective communication. The share of these causes of conflicts in other authors’ studies was also relatively low (31, 35).

Summarizing our  data on causes of conflicts, it can be noted that such reasons as unfair pay and unfair distribution of privileges, awards, bonuses and other incentives lead to conflicts between administration and nurses, while the other reasons lead to conflicts both within the team and between nurses and patients.

Analyzing the conflict resolution results, we found that when conflicts arise, nurses most often chose more favorable styles (collaboration, accommodation, avoidance and compromise), trying not to cause repeated disagreements.

According to some authors, effective conflict management strategies, such as establishing clear communication channels, ongoing conflict resolution training, creating a collaborative environment and implementing supportive professional interventions, are considered essential to mitigate conflict and promote a healthy team climate (7, 11, 31, 36, 37). It has been proven that nurse managers with higher levels of psychoemotional intelligence are more likely to use cooperation and compromise styles of conflict resolution (38). It is interesting to note that the results obtained by Demeubaeva et al. (39) showed that the most preferred style of behavior of hospital nurses in conflict conditions is accommodation, compromise, followed by withdrawal from the conflict. According to their data, in contrast to the results of studies by a number of authors, cooperation as a style of conflict resolution did not show a significant relationship. This fact requires attention, as cooperation is the best option for maintaining a benevolent and comfortable environment in a healthcare organization (39).

When we analyzed types of  conflict resolutions according to sex, age, education and position level and level of experience, there were no significant differences, however following trends worth noting;   male nurses were more prone to collaborate, compete and less  compromise than women ones; the collaboration was characteristic for all ages, followed by avoidance, adaptation, compromise and lastly competition;  nurses with secondary and tertiary education preferred to cooperate  rather than to compete,   nurses with secondary education also  avoid conflict situations, while  nurses with tertiary education chose  accommodation style, and  specialists with secondary indicated accommodation as first  choice, followed by  compromise and competition, and specialists with tertiary education - avoidance, compromise, competition, respectively; all nurses irrespectively of the position held at work and nurses with more longer experience were committed to cooperation and similarly

Study limitations

Our study has limitations as its descriptive design and a relatively small sample size for comparative analysis of conflict resolution styles according to socio-demographic and professional characteristics.

Further larger studies involving more nurses with determination of sample size necessary to prove mean difference should be addressed to determine the conflict resolution styles distribution according to socio-demographic characteristics and also study with  selection of representative sample to make the results generalizable to all  city or country should be pursued. It should be noted that these studies in the Kyrgyz Republic were conducted for the first time, and a comprehensive analysis and obtaining reliable results in the field of conflict resolution in nursing require further comprehensive researches.

Conclusion

The results of a sociodemographic survey of nursing professionals in a healthcare organization indicate that unfair pay, lack of ethics and deontology, unfair distribution of privileges and interpersonal reasons were found to be the main causes of conflicts in healthcare organizations. According to our data, the preferred style of conflict resolution is cooperation, followed by avoidance, accommodation, compromise and competition. Analysis of sociodemographic characteristics showed that older nurses and those with secondary and tertiary education tend to choose the cooperative style. Employees with professional experience of 10 years and more also choose the above styles. Using this style of conflict resolution, nursing professionals make every effort to find alternative and unconventional solutions.

Ethics: All nurses provided informed consent to participate in the survey. The approval of Institutional Ethics Committee was obtained

Peer-review: External and internal

Conflict of interest: None to declare

Authorship:  A.S. A., V.E.S., T.Ch.Ch., K.T. M., and R.S.R. equally contributed to preparation of the manuscript and fulfilled authorship criteria

Acknowledgement and funding:  None to declare

Statement on  A.I.-assisted technologies use:   Authors declared they did not use artificial intelligence in preparation of manuscript

Availability of data and material:  Contact authors of article for collaboration queries. In case authors share data, fair use with acknowledgement of authors, data source, citation and collaboration rules apply