Navigating Conflict: A Model for Nursing Home Social Workers

Abstract

With growing numbers of older people entering nursing homes (NHs), NH social workers will continue to handle the bulk of complex human behavior problems, yet there is increasing concern that NHs employ social workers who lack conflict management skills (Kirkpatrick & Brinson, 1986; Vinton & Mazza, 1994). NH social workers serve in a variety of roles requiring a broad repertoire of skills, including one that is all too often ignored: managing interpersonal conflict. Conflict is a condition inherent to all human interaction, and it is common in the NH setting (Nelson & Cox, 2004). In fact, a growing literature paints the NH as especially virulent (Nelson & Cox; Painter, 1999). Here, we illustrate why it is crucial to prepare NH social workers to handle conflict. To this end, we present a resident-centered conflict resolution model that will help guide NH social workers to the best tactic for given types of situations. THE CONFLICT DYNAMICS OF NH SOCIAL WORK Conflict is triggered when one party perceives its interests as being blocked by another or when both parties covet something that they cannot see how to share. Three factors specific to NHs aggravate conflict: (1) fundamentally competing care-related ideologies and priorities, (2) factors emerging from the NH's organizational and regulatory structure, and (3) the mental and emotional status of the residents and their families (Nelson, 2000; Nelson & Cox, 2004). Research has confirmed that NH social workers are assigned the greatest responsibility for resolving conflicts at a rate that exceeds that for nurses (Vinton & Mazza, 1994). In fact, one study revealed that directors of nursing formally manage irate family members in only about 6 percent of the cases, whereas social workers intercede 43 percent of the time (Vinton, Mazza, & Kim, 1998). Social workers also mediate a good deal of interstaff conflict. In a study assessing 20 areas of the NH social workers' core influence, social workers ranked settling staff disputes fourth overall, trailing only making changes in care planning resident care, and deciding resident transfer issues (Kruzich & Powell, 1995, p. 219). However, social workers' capacity to advocate for residents is inherently limited by their status as facility employees. This often creates a conflict of interest between residents' informed preferences and the facility's efficiency needs (Nelson, Netting, Huber, & Borders, 2001a). Such rifts lead to hierarchical conflict between the social worker and management or functional conflict between the social worker and coworkers. During a normal day, social workers may coordinate admissions, facilitate resident councils, develop care plans, work out financial resources, arrange for transportation, and purchase personal items (Kruzich & Powell, 1995). Although these tasks seem innocuous, almost any of them could lead to conflict, and others virtually guarantee hostility. Consider how social workers must intervene in problematic sexual affairs or may have to prohibit or limit smoking by lifelong smokers. Here, social workers' people-changing responsibilities (Lauffer, 1984) invite resistance, especially when the social worker strives to do what is best for the resident, but that conflicts with the resident's desire for autonomy. Social workers often stand alone in the middle of heated ethical controversies about providing intimate care within a very rigid health-business model (Neuman, 2000). Still, social workers are more likely to achieve their diverse goals as they stimulate the various other staff members to participate (Allen, 1997, p. 124). Effective social workers build partnerships that are based on open communication, which is critical if the team is able to examine focal problems cooperatively from perspectives of shared interests. Effective social workers influence decisions to optimize resident preferences while getting their teammates to understand the sociopsychological implications of treatment regimens and to accept, at some point, the resident's right to noncompliance. …