Theoretical construction of nurses’ work situation conflict: a system hierarchical model

Conflict is a cross-species, cross-period and cross-cultural social phenomenon. Katz and Kahn (1978) showed that there is a possibility of conflict in organizational life in the study of social psychology organizations [1]. Conflict, work and organization are closely intertwined [2, 3]. With the development of the economy and society, the work content of people in today’s organizations is increasingly complex and diverse, as are the ensuing differences in values and beliefs, resulting in an increase in conflict in the working environment of organizations [4]. Conflicts at work can negatively affect an individual’s mental health. Studies have shown that conflict in the workplace has a significant impact on health and well-being. Conflict is a social stress that causes stress responses (e.g., increased respiration rate, increased alertness), and when these responses persist, mental and physical exhaustion may lead to health deterioration [5, 6]. In addition, long-term exposure to conflict may reduce self-esteem and self-efficacy and cause psychosomatic illness or burnout [6, 7]. Therefore, the study of conflicts at work is very important.

However, there are many definitions of conflict at work in organizations. For example, conflict is defined as the process of opposition between individuals and groups with respect to resources, beliefs, values, or practices [8‐11]. Other studies have pointed out that conflict is the incompatibility between two or more individuals or groups [12], including the state of implicit conflict within an individual or group and the state of explicit conflict between individuals or between groups [13]. There are also many types of conflicts. For example, conflicts at work are divided into relationship conflicts and task conflicts [14, 15]. Studies have also divided conflicts into relationship conflicts, task conflicts and process conflicts [16, 17], and other studies divide conflicts into nontask organization conflicts [18], role conflicts [19, 20], and work and family conflicts [21, 22]. Therefore, most of the research on conflict types in the work process is scattered, and most studies focus on the conflicts between people. Some researchers have indicated that the overall composition of different types of conflicts should be considered [23, 24]. Conflicts types in the work process need to be further explored.

According to the definition and types of workplace conflict, this study will adopt the following theories to explain the occurrence of conflict. (1) Seeking positive self-view and social identity theory. People usually affirm themselves by improving, protecting and enhancing their self-view [25, 26] and usually use various strategies to convince themselves or other related people that they are valuable, attractive, capable and ethical [27‐29]. Social identity theory asserts that people define themselves as independent individuals based on their own characteristics and preferences but consider themselves and others based on the identity of specific group members [30]. The theory posits that people are usually willing to identify with groups that contribute to positive self-awareness to strive for a positive sense of identity [31, 32]; when this sense of identity is ignored by or different from those adopted by others, prejudice, hostility, and competition will occur [33, 34]. Therefore, in the work process, when employees’ positive self-identify is threatened or the recognition of personal characteristics and values is low, conflicts between people arise. (2) Interdependence Theory. The theory holds that individuals in a social system—a duality, a group, or an entire organization—depend on each other to obtain positive consequences and avoid negative consequences, and the interests of individuals are interrelated or perceived to be related, which has an important influence on their subsequent behavioural choices, emerging interaction patterns, and the ultimate degree to which the individual meets expectations [35, 36]. Individuals in the organization have the motivation to choose whether to maximize collective benefits through cooperation or to maximize individual benefits by choosing to act individually [37]. Whether an employee chooses the public interest or pursues the maximization of personal resources will have a continuous impact on employee behaviour and will be accompanied by the emergence of resource-based conflicts of interest. Conflict of interest arises for resources in the work process, which means that employees within the organization may have unfair cognitive conflicts in obtaining resources and resource allocation in the organization. (3) Social cognitive theory. The theory asserts that people are motivated to have accurate views and insights about themselves, others, and the surrounding environment and that people seek cognitive consistency and social recognition of their understanding and beliefs. In the process of work, the understanding of and belief in tasks or things are not unanimously recognized, which will cause opposition [8, 38]. Similarly, people have the need to maintain consistency between their own perceptions and the surrounding environment recognized by society; when inconsistencies occur, social cognitive conflicts will occur, which explains the conflict caused by the incompatibility or divergence between the individual’s understanding and interpretation of the objective facts and the objective facts themselves [38]. The diversity of information and the preference for certain things or groups in the work environment increase social cognitive conflicts [39, 40]. For example, spillover theory may lead individuals to experience workplace conflict due to family or work demands [41], and individuals will have different roles in society at the same time; when the various roles assumed are incompatible or inconsistent in cognition, role conflicts will arise [20]. (4) Cognitive dissonance theory. Proposed by social psychologist Leon Festinger [42], cognitive dissonance refers to a feeling of psychological discomfort experienced when an individual holds two or more inconsistent beliefs, ideas or values at the same time. In particular, when individuals engage in certain behaviours that conflict with their own beliefs or values or find that some environmental information conflicts with their existing beliefs, ideals, and values, they will experience cognitive dissonance. In other words, when the information provided by the social environment is inconsistent with the individual’s thoughts and opinions, cognitive dissonance will occur, and the individual will experience a state of cognitive conflict.

Based on the above theoretical findings, the theories of seeking a positive self-view and social identity mostly explain the explicit conflicts of emotions, values, personal characteristics and other interpersonal relationships between individuals, while the analysis of the implicit conflicts within the cognitive level is insufficient. The theory of interdependence explains the conflicts in the distribution of interests between individuals and units and between individuals. Social cognitive theory and cognitive dissonance theory explain the implicit cognitive conflict caused by the inconsistency between external environmental information, values, beliefs and self-cognition, which expands and explains the scope of the conflict at a certain level but does not pursue a more comprehensive discussion and analysis of the cognitive conflicts generated in the work process; at the same time, it ignores the interaction and transformation of implicit cognitive conflicts and explicit conflicts of interpersonal relationships.

Based on the above definition of conflict and the theoretical explanation of workplace conflict, this research puts forward the concept of work situation conflict to describe the types of conflict individuals face at work. Work situation conflict refers to the incompatibility between individuals, between individual cognition and external environment information and between the roles they assume that occurs in an individual’s work situation. Research shows that nurses face considerable conflict at work [43]. This study will explores nurses’ work situation conflicts as well as their types, along with their causes and consequences. The working situation of nurses refers to the scenes of the working process of nurses, such as environment, events, psychological states, etc. According to the definition of work situation conflict, nurses’ work situation conflict is the types of conflict that nurses face in the scenes of the working process. Therefore, this research raises and discusses the following questions: (1) What are the types of workplace conflicts and the relationship between them? (2) What are the situations where work situation conflicts occur? (3) What are the consequences of the conflict?

This study used participatory observation and interview methods to study nurses. This study was approved by the Institutional Review Board of the Beijing Normal University (Approval no. 202205310061). And this study took nurses as the research object and recruited 15 interviewees in Beijing, Shandong, Jiangxi, Guangdong and Fujian Provinces of China through online recruitment. Participants included 1 man and 14 Women, aged between 25 and 37 years, with between 4 and 18 years of nursing experience. The basic information of the interviewees is shown in Table 1.

(1) Self-edited interview outline (Semi-structured questionnaire): the interview outline contained 3 original questions: □What are the conflicts at work? How do they manifest? □Under what circumstances do conflicts occur at work, how long do they last, and how are they dealt with? □How do these conflicts affect you? On the basis of the above questions, the researcher continued to ask questions as the interview proceeded (supplementary file).

(2) Researcher himself: in qualitative research, the researcher him- or herself is the research tool. To increase the sensitivity of the theory, the researcher is familiar with the research literature and related theories in advance.

(1) Field observation. From May 2021 to August 2021, the researcher conducted eight field participation observations in three hospitals in Shandong and Beijing. Among them, the researcher spent five days in a ward of a hospital in Shandong, observed the interactions between nurses and patients, patients’ families, doctors, and leaders, and had informal dialogues with nurses. The researcher observed three times in two hospitals in Beijing, each for three hours, without communicating with nurses, but witnessed verbal conflicts and unfriendly attitudes between nurses and patients and deeply experienced the intensity and pressure of nurses’ work. The participatory experience increased the researcher’s sensitivity to research questions and laid a foundation and supplement for follow-up interviews and data analysis.

(2) Preparation of an outline for the interview and conducting the interview. A semi-structured interview outline was designed (see Research tools) for the research questions, research subjects signed an informed consent form and gave interviews, and the researcher continued to ask questions during the interviews. During the interview, with the consent of the interviewee, the whole process was recorded, and the interview recording was transcribed and sent back to the interviewee for verification to ensure that the information was true and correct. During the interview process, the researcher verified with the interviewees their perceptions based on the problems found in the field participation observation to ensure that more detailed research materials were obtained.

(3) Data collation. Fifteen nurses were interviewed, and one of them was a preinterview. The purpose of the preinterview was to verify the accuracy of and supplement the interview outline. A total of approximately 17 h of interview recordings were obtained. After transcribing the recordings, the researcher wrote down his own thoughts, and together with the records of the participatory observations, a total of more than 240,000 words of text were obtained.

A grounded theory approach was adopted. Grounded theory aims to use systematic steps to collect and analyse data based on research questions and finally arrive at a theoretical approach [44]. Grounded theory is suitable for generating theory from data [45], its main function is to generate middle-level theory, and it can also be used for theory revision. The main operating procedures are to generate concepts from data and log in level by level, constantly compare data and concepts, find the connections between concepts and concepts, systematically encode data, and construct theories. Some researchers believe that researchers’ personal experience should be reasonably used before applying grounded theory for theoretical research, and the knowledge in researchers’ minds should not be too idealized as a “whiteboard”, and the researchers themselves are part of the data collected in the research [46]. Grounded theory emphasizes that researchers should keep an open attitude, but they should not be deprived of relevant knowledge in their minds, and they should be highly sensitive to data and objectively view and reflect on their subjective intentions [46, 47]. Therefore, this study needs to construct the theoretical framework and structural elements of nurses’ work situation conflict according to the concept of work situation conflict, which is very suitable for the grounded theory method.

Grounded theory methods were used, the theoretical framework was formed from the data through the three-level coding process of open login, associated login and core login. Through continuous-comparison analysis methods, continuous comparisons were made between research materials, literature and theories. The method of continuous comparison ran through the entire analysis process until no new categories could be added and theoretical saturation was reached. At the same time, the researcher wrote down his own thoughts during the analysis process and created a memo for each case. The main operating procedures were as follows: first, open login, in which the researcher had an open mind and focused on discovering local concept categories in the data; second, associated login, in which the researcher discovered and established the relationships between the concept categories and the relationships between the concept categories and the data; finally, core coding, in which the researcher chose a “core category” for the discovered concept category, connected the subordinate categories, and promoted the development of the theory.

Data encoding. The data of this study include interview data, the researcher’s analysis data and records of participatory observation. The materials were compiled into PDF format documents, with the page numbers marked, to compose the research materials. The main material analysed was the interview data, and the researcher’s records as the secondary material were regarded as an aid to the analysis of the interview data. Examples of coding code numbers are W1 and W2, where the first letter represents the interviewee and the number after the letter represents the case number, for a total of 15 interview analysis cases (supplementary file). See Table 2 for examples.

In this study, the transcribed text was sent back to the interviewees for inspection and verification, and the “Assessment Form of The Interviewees’ Data Inspection” was filled in to evaluate the consistency of the transcribed text with the content said by the interviewees during the interview. Each respondent evaluated the degree of compliance as “very consistent”, and the degree of compliance reached 98 ~ 100%. For the interview text, the interviewee did not hope the researcher to rewrite or conceal the part, nor did he need to supplement or explain the part. This helped to ensure the validity and reliability of the data. And this study used the principle of theoretical saturation to verify the validity and reliability of the case. When the 12th interviewee was analysed, no new original concepts appeared. At the same time, we continued to analyse the text of the three interviewees, and there was no new original concept on the theme of interest, indicating that the data had reached theoretical saturation.

Through the comparison, induction and analysis of text data, 12 conflict manifestations of nurses’ work situation conflict were obtained. According to the content and characteristics expressed by the 12 conflict manifestations, they could be classified into five types of situation conflict: interpersonal conflict, self–task conflict, conflict of interest, occupational status conflict and family role conflict. At the same time, based on the original concepts obtained from the original data and the conflict performance of each element, the five types of situational conflicts could be classified into five levels: social level, unit level, family level, interpersonal level, and task level. That is, occupational status conflict was classified as social conflict, conflict of interest was classified as unit-level conflict, family role conflict was classified as family-level conflict, self–task conflict was classified as task-level conflict, and interpersonal conflict was classified as interpersonal-level conflict.

Interpersonal conflict refers to the conflicts that occur between individuals due to differences or incompatibility in emotions, personality, communication process, and task execution process in the work situation. It mainly occurs at the level of interpersonal relationships between people. Interpersonal conflict is a conflict situation of explicit relationships, which mainly includes conflicts with leaders, conflicts with colleagues, and conflicts with clients.

Work situation conflict is the incompatibility between two factors that arises in the work situation. This type of conflict includes not only the conflict involving incompatible relationships between people but also the conflict involving inconsistency between individual cognition and environmental information and the conflict of incompatibility between the different roles that individuals assume. In the work situation of nurse, the conflict between people and the environment is mainly the conflict between social, unit, task-related information and individual cognition, while the conflict of incompatibility of different roles assumed by individuals is mainly the influence of the roles assumed in the family on the roles assumed at work. From the analysis, it was found that the work situation conflict involves 12 conflict manifestations of 5 specific situation types, and these 5 specific situation types occur at different environmental levels. At the same time, according to the theoretical explanations of relationship conflict and cognitive conflict, it was found that the 12 conflict manifestations of 5 specific situation types belong to the theoretical categories of incompatibility between people and the inconsistency of cognition between individuals and environmental information. Therefore, the theoretical work situation conflict systematic hierarchical model was further constructed (see Fig. 1) to explain the relationship between work situation conflict and the various levels and the relationship between work situation conflict and the relationship system and the cognitive system.

(1) The relationship between the types of work situation conflict and the theoretical level.

The conflict types of different work situations reflected different incompatibility and showed different conflict characteristics. First, the object of the conflict situation involved conflicts with others and with the environment. Conflicts with others were mainly manifested at the interpersonal level, that is, the incompatibility between people (with leaders, colleagues, and clients). Analysis of the data found that this kind of incompatibility between people mainly involved verbal abuse, quarrels and arguments, hostility, or physical confrontation between people in the work situation. These effects were mainly due to the poor communication between people during the task execution, repressed emotions, personality problems, bad relationships between people, mutual misunderstanding and incomprehension, mutual dissatisfaction and accusations, a sense of being wronged and of responsibilities being shirked, and unfriendly attitudes towards each other. This was an external explicit conflict, so the interpersonal conflict that occurred at the interpersonal level in the work situation was regarded as a conflict in the relationship system. The conflict with the environment was mainly the conflict between individual cognition information and environmental information. According to the analysis of the data, the environment in the work situation mainly had four levels: society, work unit, family and work tasks. The individual conflicts at the four levels are mainly manifested in two aspects. First, the conflict between the individual and the environment was mainly manifested in the inconsistency and incompatibility of the three levels of information between the individual’s understanding and the environment information. This type of conflict specifically included inconsistencies or incompatibility between what the individual recognizes (thoughts, opinions) and society’s recognition and respect for the profession, the unit’s income distribution, the unit’s fostering of career development, the unit’s idea and management system, work requirements, work tasks, and work intensity. Second, the incompatibility between the roles assumed by individuals, mainly at the family level, specifically includes the incompatibility between the roles assumed by individuals in the family and the roles they assume at work and family events that conflict with work situations. These two aspects were implicit conflicts within the individual, so the conflicts that occurred at the social, unit, family, and task levels in the work situation were considered to be conflicts in the cognitive system.

Second, the conflict in the cognitive system could lead to the conflict in the relationship system between the individual and others in the work situation. For example, it is found from the data analysis that the perceived unfairness of task assignment in the work situation could lead to verbal conflicts with colleagues and leaders; after nurses recognize the unfair competition in job promotion, unfriendliness and unsuccessful cooperation may arise among colleagues; recognizing that the unit had unfairly allocated bonuses resulted in verbal friction with colleagues (doctors) or showed hostility; after the work intensity exceeded a nurses’ capacity of the physical and mental, depressed emotions arise, which led to verbal conflict caused by a negative attitude towards the client; since the recognition of the status of doctors in society was relatively higher than that of nurses, there would be conflicts of accusations from leaders and doctors directed at nurses on the unit; etc.

Finally, the conflict of the cognition system and the conflict of the relation system in the work situation could be transformed into each other under certain conditions. The conflict of the cognition system was an implicit conflict within the individual; this repressive implicit conflict would affect the individual’s emotions and lead to explicit conflicts with others. The conflict between individuals and others was externally explicit conflict; after this kind of explicit conflict occurred, it would cause dislike of the surrounding environment, which would be transformed into an implicit cognitive conflict. For example, in the data analysis, the verbal friction caused by the accusations and prejudices of the leaders or colleagues (doctors) further increased the inconsistency between nurses’ perceptions of their professional status and the public’s perceptions; after conflict with clients (patients or patients’ family members), the unit’s methods of handling the conflict sometimes caused nurses to have cognitive conflicts in which the unit’s management system was inconsistent with their own ideas.

(2) The relationship between the types of work situation conflict and nurses’ career development and mental health.

Conflicts in the work situation had an impact on the nurses’ career development and mental health, which was mainly manifested in the nurses’ emotions in the work situation, attitude towards the profession, sense of value and sense of meaning. First, conflict at the interpersonal level led nurses to have negative emotions about work, decrease and lose enthusiasm for work, not want to work, and have lower work efficiency. The most obvious example among the interviewees is W13. After suffering from a bad relationship with colleagues, unprovoked accusations and conflicts with the leader, she developed huge negative emotions, did not want to work, had no enthusiasm for work and was very inefficient; she felt that her whole person was hollowed out (researcher analysis of the data). Second, the conflict at the social level was mainly due to the public’s disapproval and disrespect of nurses’ professional status, which led to the loss of professional meaning, sense of value, and work enthusiasm. For example, when W11 first started working, she had great respect for the work of nurses. After realizing that nurses were not as noble as she thought and that their status was not as high as she thought, she doubted the meaning and value of the work, gradually lost their enthusiasm, and became numb. When W14 realized that the public’s recognition and respect for nurses was not as high as he thought, he felt worried about the future of nurses’ careers and reduced his sense of professional honour (researcher analysis of the data). Third, the conflict at the unit level mainly affected the reduction in professional expectations, loss of enthusiasm, laxity, and lack of self-motivation, and it was easy to complain to the unit and sometimes even led to resignation. For example, when W10 first started working, she still wanted to be promoted; when she felt that it was not so easy and the promotion process was unfair, she became lax and unmotivated. W12 realized that the unit did not have such a large development platform, nor did it have too many development opportunities, and at the same time, the unit had a “weird” system, she did not feel the future career development prospects (researcher analysis of the data). Fourth, the conflict at the family level mainly affected the doubt about the value of the profession because the job was not compatible with family life, the nurse felt ashamed as a family member and might choose to resign or become detached at work for the sake of the family. For example, when W9 could not take care of her family due to work, she had doubts about her career: “What is the purpose of doing this job?” W15 felt that she owed her family because she did not have time to accompany her children and family members; as a result, she transitioned from a busy, high-paid and well-developed position to a relaxed, poorly paid and basically undeveloped position (researcher analysis of the data). Fifth, conflict at the task level mainly affected career enthusiasm and expectations, as well as personal feelings about careers, such as reduced enthusiasm for career, loss of career interest, inability to see the future of the career, and even physical and mental exhaustion, resulting in burnout. For example, for W4, irregular working hours and high work intensity led to insomnia, decreased energy, not wanting to go to work, emotional breakdown (crying), and low work efficiency. W7 felt that the difficulty of the work task exceeded the scope of her ability and was troubled by the work, which consumed considerable energy. She had the idea of resigning and felt that the work made her like a “robot”, which led to a sense of relative burnout. W12 felt that the work tasks were procedural, not challenging, and had a low sense of professional accomplishment, similar to “boiling a frog in water” (researcher analysis of the data).

This study had certain limitations. First, this research used nurses as the research object, and the gender ratio was uneven, which had a certain impact on the generalizability of the research results. Future research can conduct research on different occupations to compare with this research and expand it. Second, this research used participatory observation and interviews to obtain research data and adopted qualitative analysis methods. Compared with fieldwork survey methods, the degree of in-depth study of the subject’s life world was insufficient. Moreover, as a research tool, the researcher was limited to his own knowledge, vision, energy, etc., and there might be omissions in the summary of the element information of work situation conflicts. Future research can go deeper into the work of the research object to observe and interview nurses to obtain more comprehensive information. Third, this research was based on a qualitative research method, which explored the work situation conflict of nurses in participatory observations and interviews with 15 nurses. Future research can use quantitative research methods to develop measurement tools for work situation conflict to expand the findings to the entire nurse community.