Carefronting: A Different Approach to Managing Conflict

By Rose O. Sherman, EdD, RN, FAAN

“Our ultimate freedom is the right and power to decide how anybody or anything outside ourselves will affect us” Stephen Covey

One of the most significant challenges that nurse leaders at every level in an organization face is the management of conflict. In today’s environment, nursing teams are composed of staff from different generations with divergent values, attitudes and beliefs. These differences can and do lead to conflict. If not managed well, conflict can become a patient safety issue in health care environments. Carefronting is an important new competency for nurse leaders that can help them to resolve conflict and create healthier work environments.

The term carefronting was coined by David Augsburger, a professor of pastoral care, more than three decades ago. Dr. Augsburger believes that conflict is to be expected. It is the way that it is managed that impacts relationships. In carefronting, personal needs are integrated with the wants and needs of others. The overall goal is to attain and maintain effective, productive working relationships. Carefronting is a method of communication that entails caring enough about one’s self, one’s goals, and others to confront courageously in a self-asserting, responsible manner.

Dr. Betty Kupperschmidt an Associate Professor of Nursing at the University of Oklahoma, has been a pioneer in bringing the concept of carefronting to nursing practice. She proposes the following basic tenets of carefronting:

Truthing It

When truthing it, leaders demonstrate the willingness and ability to listen to others with empathy and a desire to understand their viewpoint. It is desiring to be accurate in what is heard but also being honest with one’s own feelings and attitudes. It is demonstrating that you care about the relationship.

Owning Anger

Anger is often a natural part of conflict. When acknowledged in a constructive way, it can be a positive, self-affirming emotion and a demand. When one feels ignored or rejected, the normal response is anger. Letting the other person know that you are a person of worth and demand respect is important.

Inviting Change

Carefronting invites changes but does not demand it. When leaders invite change, they should focus on the behavior and not the person; on observations not conclusions; on descriptions not judgments; and on ideas and alternatives not on advice and answers. Change should be invited by carefronting in a caring manner, one which is clear but gentle and constructive.

Giving Trust

Trust underlies, connects and integrates human emotions. Trust is essential in work relationships. Leaders have to confront situations openly, frankly and responsibly with the viewpoint that the other person will assume his/her responsibility to be equally honest and frank.

Ending Blame

Assigning blame in a conflict inevitably evokes resistance and resentment. Carefronting ends the blame game. Leaders can then ask the following questions:

What is the respectful thing to do now?
Where do we go from here?
When do we start to discuss the conflict – If not now, when?
Who will end the blame and help work toward the professional practice environment we all deserve?

Getting Unstuck

Getting unstuck means owning the responsibility for one’s role in the conflict. It also involves refusing to waste any additional time in assigning blame.

Peacemaking

Nurse leaders who are peacemakers are caring people who take the risk to be present in conflict no matter how difficult. They value others and understand their own values. They also understand that there are multiple viewpoints in every conflict that need to be appreciated.

The use of carefronting is especially important in health care settings where team synergy and interdependence are required for high quality and safe patient care. Relationships on health care teams live within the contexts of conversations that team members have, or don’t have with one another.

Read to Lead

Augsburger, D. (1981). Caring enough to confront. Ventura, CA: Regal Publications.

Kupperschmidt, B. (2006a). Addressing multigenerational conflict: Mutual respect and carefronting as a strategy. Online Journal of Issues in Nursing. Click Here for Article

Sherman, R.O. (2012). Carefronting, American Nurse Today, 7(10), 72-74.