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Conflict: cut the middleman

Hello guys,

Yesterday, I was working at this paediatric emergency service with a group of toxic nurses. The patient is 15 years old and has gender identity problems and is leaving in some kind of home for children provided by the state (don't know English name). I looked up her file and saw that 2 months ago she did not have any suicidal thoughts. She has a flu and this is why she's coming to ED.

The nurse I was working with comes to me with lots of anger and tension. She tasked me to do a psychological evaluation of the teenager in front of my chief (she's afraid she has suicidal thoughts). I think it's a good suggestion so I thank her and ask my chief what she thinks. The chief says "yes you can ask her a couple question". So I do that and thank the nurse for her suggestion.

Here you notice that I redirect the tasking as suggestion and ask my proper supervisor what to do: leadership redirection from her to me to my boss. And with the thanking I build collaboration

So I go and ask the teenager: she's not depressed nor has suicidal thoughts. Then I overhear both nurses talking about this case and I think I overheard them talking about reporting me through the reporting system of incidents (RECI).

So I go to them and say out loud: "Thank you for the suggestion". She asks me: did you do it? (tasking). I answer: Yes, don't worry about it

Being professional while re-building collaboration while still framing her as overworrying.

This woman is very insecure and low self-esteem. I don't know what kind of trauma she's been through. I'm talking about the nurse. 1 hour before the incident I complimented her on her new hair. So you can see that for insecure people, even if you build them up and is nice with them, they can always stab you in the back. Building good-will with defectors is difficult. That's why you want to have positive interactions with them publicly. You might not build good-will with them but they won't be able to frame you as a non-collaborator. You neutralise them. Make sure you are being seen with them having positive interactions. Asking them how they are, complimenting them, thanking them.

Now I ask my supervisor her advice. This was both smart and dumb. Smart because she told me it also happened to her that nurses were talking bad about her just nearby as they pretended she was not there. Smart because I build a mentor-mentee relationship. Smart because she gave me the advice to talk to her directly. Dumb because I could now be framed as a resident who has trouble getting along with nurses. Dumb because now I know Swiss people hate conflicts. For them it's a major problem. Dumb because my supervisor proposed me to be the mediator, so the problem would get overblown. I refused this of course.

So I ask the nurse if she has 2 minutes. First she plays the I'm busy. I say it's ok later. Later I see her smoking a cigarette with my supervisor and another colleague. So I'm guessing she went to know what was the issue. That's what they do in Switzerland: the chief do his little investigation around you to see what's really happening. In CH it's all behind your back.

Then we talk and I tell her what I overheard. She denies that they were talking about reporting me. She said that she thought that I was sarcasting when I said "thank you for the suggestion". I assure her I was not sarcastic and that I was sincere (true: it was a good suggestion, but poorly delivered). That I respect and value her opinion.

So it's all good and we go our ways.

During the shift change, I see the supervisors from both shifts talking together as I enter the room. I can feel they were talking about this.

Later on I thank my supervisor for her advice, that it was all a misunderstanding. It was semi-public as it was overheard by the nurses.

The other supervisor (of the upcoming shift) says that she has a poster in her bathroom about the Dalai Lama and conflict (now I know that she knows about the conflict, otherwise why would have she jumped in as she knew what I was talking about). That it's better to talk directly with the person.

It's a long post, so here is the summary.

Asking advice to my supervisor: now I know I can not trust her. As soon as I talked to her about it, I'm 90% sure she spoke with the nurse and the other supervisor. So she's not an ally. She gave me the advice I needed but her loyalty is not towards me. When you go to your supervisor it frames you as "not being able to deal with the situation", which was the case since I had to learn about conflict management. Now I know.

Talking directly to the nurse: that's the better approach I learned. It's to do it without emotions. Try to understand the other person. I think she gaslighted me. I don't know if they were talking about the reporting system or not. I do think she lied. However, I could have misheard and she played on that. So she might be a good liar or I misheard. What matters is that she saved face and we increased our collaboration.

Being witnessed by the nurses as having good relationships with my supervisors: now they know that I'm not scared to talk about it and that they support me.

My supervisor witnessing me solving the issue without her being a mediator: empowering for her as it advertises her leadership skills (my gratitude to her overheard by the nurses and the other supervisor). It makes her feel good about herself to witness her leadership skills being effective (through helping me successfully). It empowers her as I solved the situation for her (value-adding) and she does not have to deal with it anymore.

So basically, I learned that when you have a conflict, go talk to the other person as soon as possible and try to understand their point of view. Let them save face (leader-like) and move on. They might have insecurities and there might be a misunderstanding. It's better to do it before the other person talks with other people so it does not blow out of proportion. To go with: "Thanks for your help, do you have 2 min to debrief?" and talk in private with a friendly smile.

As I'm back with these toxic nurses, I get to learn more about social skills and power dynamics. Don't let the conflict become a group thing. Many people are insecure are happy to gang up on you for no reasons. Even if you treated them with respect and kindness. Low-quality/low-power people are low-quality for a reason. So I think it's smart to keep a comfortable power differential with them and neutralise their games. Not trying to be friends with them but still making them feel good. Keeping them at arms length while making them feel good about themselves.

Cheers!

Also, when I talked privately with the nurse she told me:

Her: I delegated to you to ask the patient about suicide whereas I could have done it myself.

Me: You did not delegate anything to me. That's my job. I thank you for having suggested this to me.

This is exactly what is endemic in this workplace. Nurses think they are doctors because they're given more autonomy than in other places. The problem is that we get an overlap of roles which breeds conflict. We delegate to nurse, they don't delegate to us.

For instance, now I go straight in the room with the patient and the nurse. I don't let them do their basic evaluation. I go straight so they cannot do my job in my place. I don't have to speak or anything. I just go straight in the room. Because otherwise the patient has already said everything and this also fucks up the doctor-patient relationship. And I just ask the same questions they asked. I let them take vital signs and listens to their questions. I put them back in their place but subtly. As they cannot criticise me for being effective and coming right away.

Very interesting situations, fun to chew on, and not easy.

Quote from John Freeman on January 23, 2022, 11:51 am

Now I ask my supervisor her advice. This was both smart and dumb. Smart because she told me it also happened to her that nurses were talking bad about her just nearby as they pretended she was not there. Smart because I build a mentor-mentee relationship. Smart because she gave me the advice to talk to her directly. Dumb because I could now be framed as a resident who has trouble getting along with nurses. Dumb because now I know Swiss people hate conflicts. For them it's a major problem. Dumb because my supervisor proposed me to be the mediator, so the problem would get overblown. I refused this of course.

So I ask the nurse if she has 2 minutes. First she plays the I'm busy. I say it's ok later. Later I see her smoking a cigarette with my supervisor and another colleague. So I'm guessing she went to know what was the issue. That's what they do in Switzerland: the chief do his little investigation around you to see what's really happening. In CH it's all behind your back.

Then we talk and I tell her what I overheard. She denies that they were talking about reporting me. She said that she thought that I was sarcasting when I said "thank you for the suggestion". I assure her I was not sarcastic and that I was sincere (true: it was a good suggestion, but poorly delivered). That I respect and value her opinion.

So it's all good and we go our ways.

During the shift change, I see the supervisors from both shifts talking together as I enter the room. I can feel they were talking about this.

Later on I thank my supervisor for her advice, that it was all a misunderstanding. It was semi-public as it was overheard by the nurses.

The other supervisor (of the upcoming shift) says that she has a poster in her bathroom about the Dalai Lama and conflict (now I know that she knows about the conflict, otherwise why would have she jumped in as she knew what I was talking about). That it's better to talk directly with the person.

I think overall you did very well, and I liked how you split the lessons learned in dumb/smart or good/bad about the approach . I think this is very important in general to fully grasp a situation and the implications.

A few ideas for other frames and approaches, especially if you want/need to involve the supervisor:

- One thing one could do is to not ask the supervisor for help, but to inform them that you try your best to collaborate with everyone (as she knows), however from your perspective there might be a problem with [Name].
Though while you try your best, as of now it's not something you can improve or solve, because it needs 2 to collaborate.

While you have tried to talk with [Name], it still might be a misunderstanding, so this is not meant to be a complaint, because you think it's unfair to talk bad about people who are not there at the moment (preframes [Name] as unfair if she does so), but a suggestion to keep an eye on.
You are always open to talk about issues and problems and happy to solve whatever problem there might be.

The supervisor will likely ask some questions, but it's not you telling her the problem, but her wanting you to tell her more about what happened. I think this can be an important difference in perception of the whole dynamic, especially if this talk happens embedded inside a normal conversation.

This approach preframes whatever complaint [Name] might come up with later, and likely neutralizes it if the supervisor is at least somewhat neutral herself.

It also tells the supervisor that even if there are issues, you are generally trying your best to solve it on your own, and only if it persists, you inform her, while not asking for her help, but simply to tell her news she might find important.

- Sometimes, after you tried to talk to [Name] and the (significant) problem persists, it might be a good idea to further suggest to your supervisor to get [Name] in there as well and have a talk right then and there, or slightly later, while making sure to let her know, this is only meant as an idea to tackle the problem quickly, you don't want to strain her time if it can be avoided.

- If the supervisor is aware of the sitution, or problems with [Name] that other people had with [Name], you might as well ask her for her opinion or suggestions in terms of your behaviour, while still avoiding the "please solve this problem (for me)"-frame.

                                                                                                                                                                                   

A general thought I had after reading:

On a scale from -10 to 10, how is your relationship with each one of them?

If we say:
     -10 = they utterly despise you and actively and constantly try to get you thrown out or harm you severely
        0 = neutral and professionally distant
      10 = they are your best friend and would risk a lot to prevent you from getting thrown out

This quick info could help in terms of judging the situation precisely and would help in further strategizing.
Of course you might not know their accurate friend-enemy-score - then in particular, it could help to make it a range like 2-5.

                                                                                                                                                                                   

Quote from John Freeman on January 23, 2022, 5:24 pm

Also, when I talked privately with the nurse she told me:

Her: I delegated to you to ask the patient about suicide whereas I could have done it myself.

Me: You did not delegate anything to me. That's my job. I thank you for having suggested this to me.

This is exactly what is endemic in this workplace. Nurses think they are doctors because they're given more autonomy than in other places. The problem is that we get an overlap of roles which breeds conflict. We delegate to nurse, they don't delegate to us.

For instance, now I go straight in the room with the patient and the nurse. I don't let them do their basic evaluation. I go straight so they cannot do my job in my place. I don't have to speak or anything. I just go straight in the room. Because otherwise the patient has already said everything and this also fucks up the doctor-patient relationship. And I just ask the same questions they asked. I let them take vital signs and listens to their questions. I put them back in their place but subtly. As they cannot criticise me for being effective and coming right away.

Here it might have been more effective to simply reframe with your last sentence, instead of the hard disagreement:

      Her: I delegated to you to ask the patient about suicide whereas I could have done it myself.
      You: "I thank you for having suggested this to me."

Or even complimenting her for something that she might not want to disprove right away through seeking conflict:

      Her: I delegated to you to ask the patient about suicide whereas I could have done it myself.
      You: "It was a good suggestion [Name], if only everyone were as empathic and observant."

 

 

If anyone has anything to critize, I'm happy to read it.

John Freeman has reacted to this post.
John Freeman

The nurse I was working with comes to me with lots of anger and tension. She tasked me to do a psychological evaluation of the teenager in front of my chief (she's afraid she has suicidal thoughts).

Thanking her and framing her tasking as suggestion was good but it still doesn't take away the fact that she tasked you.

This was bad behaviour on her part and there is a high chance she will continue to do it because in a way she got rewarded for her behaviour and not punished.

So you would have empowered yourself more if you had asked her why the psychological evaluation was necessary and other follow-up questions.

She asks me: did you do it? (tasking).

I answer: Yes, don't worry about it

The 'Yes, don't worry about it' put you in a position of following her tasking.

My suggestion is that you should have responded her with this.

You - Did I do What?

She - Explains the task.

You - If you are interested find the psychological evaluation report at XYZ place.

Or

You - If you didn't completely understand or need more clarity I will be happy to clear things up if I have time.

About the conversation in private.

Her: I delegated to you to ask the patient about suicide whereas I could have done it myself.

Me: You did not delegate anything to me. That's my job. I thank you for having suggested this to me.

This was handled well in my opinion. Saying "Thank you for your suggestion" alone wouldn't have worked because she will continue to "suggest" you how you should do your job and she can always fall back on the fact that whenever she tasked you, you were always grateful and she is confused by your sudden change in behaviour.

 

What do you think?

John Freeman has reacted to this post.
John Freeman
Quote from Growfast on January 24, 2022, 9:00 am

About the conversation in private.

Her: I delegated to you to ask the patient about suicide whereas I could have done it myself.

Me: You did not delegate anything to me. That's my job. I thank you for having suggested this to me.

This was handled well in my opinion. Saying "Thank you for your suggestion" alone wouldn't have worked because she will continue to "suggest" you how you should do your job and she can always fall back on the fact that whenever she tasked you, you were always grateful and she is confused by your sudden change in behaviour.

 

What do you think?

I see your point, and different approaches for different people, however I think it's a better strategy longterm to reframe it:

Yes she will likely do it in the future too, however how likely is it that she will simply stop it without any grudge if you tell her so, when the nurses actually all think it's their job, and the supervisors are enabling it? I might be wrong, but I doubt you can surpress it that way. It will simply cause a lot of unnecessary stress and conflict.

Reframing the tasking into suggestions comes with a mental shift, because suggestions are not necessary harmful, and you could then simply disagree. It keeps up a positive and very collaborative atmosphere.

You don't have to worry about her telling you what to do, because you can disagree with suggestions - as opposed to orders. So since John can disagree - what other than suggestions are they? Why blow them out of proportions into orders, when they are not?

And you can disagree very smoothly too, for example "I think XY is more urgent as of now, but thank you for your suggestion [Name]." This wont cause nearly as much conflict than trying to dominate or punish her.

You have a second pair of eyes and ears being observant about what formally is your job - without them getting paid for it even.
If you fuck something up, like forgetting to do something, you could even shift blame on them, for example asking why they haven't suggested it to you.

I think this works better in an atmosphere where inofficially they think they are in the right and are enabled by management, than trying to dominate them all. What do you think about this perspective?

John Freeman has reacted to this post.
John Freeman

Thanks for your feed-back Anon!

Quote from John Freeman on January 23, 2022, 5:24 pm

Also, when I talked privately with the nurse she told me:

Her: I delegated to you to ask the patient about suicide whereas I could have done it myself.

Me: You did not delegate anything to me. That's my job. I thank you for having suggested this to me.

This is exactly what is endemic in this workplace. Nurses think they are doctors because they're given more autonomy than in other places. The problem is that we get an overlap of roles which breeds conflict. We delegate to nurse, they don't delegate to us.

For instance, now I go straight in the room with the patient and the nurse. I don't let them do their basic evaluation. I go straight so they cannot do my job in my place. I don't have to speak or anything. I just go straight in the room. Because otherwise the patient has already said everything and this also fucks up the doctor-patient relationship. And I just ask the same questions they asked. I let them take vital signs and listens to their questions. I put them back in their place but subtly. As they cannot criticise me for being effective and coming right away.

Here it might have been more effective to simply reframe with your last sentence, instead of the hard disagreement:

      Her:I delegated to you to ask the patient about suicide whereas I could have done it myself.
You: "I thank you for having suggested this to me."

This is much better, thanks!

Or even complimenting her for something that she might not want to disprove right away through seeking conflict:

      Her:I delegated to you to ask the patient about suicide whereas I could have done it myself.
You: "It was a good suggestion [Name], if only everyone were as empathic and observant."

This is great as well! It is true that she deserved a compliment for her suggestion. Her problem is that she's so negative that it does not come across like that and comes across as an attack or a critic. The reframe here is powerful because it sets positive expectations for her to be more collaborative and positive.

Anon has reacted to this post.
Anon

Oops, I see now that I forgot to thank you, GrowFast. 😛 Thanks for your feed-back!

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