Nurses’ Perceptions About Conflict Management Strategy of Head Nurse

Conflict is one of the factors that affect the performance of nurses. Nurse’s conflict management is closely related to the role of leaders in creating a conducive and productive work environment. The purpose of this study was to describe the perception of implementing nurses on the management of ward head conflict in a hospital in Bali. This research is a quantitative descriptive study with a cross-sectional approach. The respondents involved were 71 nurses using purposive sampling technique. Collecting data using a questionnaire about conflict management that has been valid and reliable. The results of the research on the perception of implementing nurse on the conflict management of head nurse from dominating strategy were the “Not Good” category (56.95%), the collaboration strategy was “Good” (85.75%), the avoidance strategy was “Not Good” (44%), the accommodate “Good” (82%), and the compromise strategy “Good” (87%). The majority of implementing nurses perceive that the head nurse uses a compromise strategy in managing conflict in their work area, and the least perceived is that the leader uses a conflict avoidance management strategy. The head nurse is expected to be able to use appropriate conflict management strategies to resolve conflicts in his scope of work, because in general all strategies have their respective advantages and disadvantages to overcome a problem.


INTRODUCTION
Conflict is one of the factors that affect the performance of nurses in carrying out services in hospitals. In nursing organizations, conflict naturally occurs and is a phenomenon that might happen due to the resources involved interpersonally related and having differences (Marquis & Huston, 2015).The COVID-19 pandemic has also become a source of conflict for head nurses, such as the regulation of using new health protocols in carrying out nursing care, the large number of patients, the change from a general hospital to a COVID-19 referral hospital, limited tools and technology, and limited human resources. Therefore, the head nurse needs to make efforts to resolve the conflict by using appropriate conflict management strategies. Nurses' conflict management is closely related to the role of leaders, specifically, the head nurse is to create a conducive and productive work environment. The head nurse must be able to identify the conflict that occurs and facilitate conflict resolution constructively in the shortest possible time (Gulo, 2019). Learning to handle the conflict constructively by emphasizing a win-win solution is one of the skills in management, which is conflict management (Nursalam, 2015).
Conflict management is efforts required to be carried out to prevent, avoid, reduce risks, and resolve conflicts, so it does not interfere with organizational performance (Kementerian Pekerjaan Umum dan Perumahan Rakyat Badan Pengembangan Sumber Daya Manusia, 2016). The main goal of conflict management is to build and maintain cooperative cooperation with subordinates, peers, superiors, and outsiders (Anwar, 2018) The results of the conflict management process or outcome conflict are win-lose, win-win, and lose-lose solutions (Huber, 2010).
There are five strategies to manage a conflict, namely avoiding, dominating or competing, accommodating, collaborating, and compromising (Wienclaw, 2017). These five strategies cannot be used simultaneously to face conflict. However, each strategy can be used in a suitable situation (Wijayanti, 2019), because each strategy has its strength and weakness.
Most nurses perceive that their heads used a compromising conflict management strategy. This statement is in accordance with Tuncay's research. It is stated that managerial nurses aged 24-29 years prefer to use the compromising strategy (Tuncay, 2018). As a process, perception does not seek to find something that must be true and correct, but perception is only an interpretation. The research results by Purba and Fathi also obtained that the conflict management strategy of the head nurse was perceived by the executive nurses at RSUP H Adam Malik Medan are the compromising strategy (44%), where the conflict resolution is temporary because the collaboration strategy is not resolved (Purba & Fathi, 2017). This statement is also supported by research by Sportman and Hamilton, which states that conflict management in the nursing profession is generally a compromising strategy (Sportman & Hamilton, 2007). Therefore, the researcher is interested in examining nurses' perceptions of the conflict management strategy of head nurses in a hospital in Bali. The results of this study are expected to describe nurses' perceptions of the conflict management strategy of head nurse in Bali and provide suggestions for head nurses to always use appropriate conflict management strategies according to the existing situation and conditions.

METHOD
This study is a descriptive quantitative study using the cross-sectional approach. It is conducted in a hospital in Bali from August to September 2021. The sampling technique used was purposive sampling, with 97 nurses as target respondents (this study involved 71 respondents). The respondents in this study are the executive nurses in a hospital in Bali that is willing to take part in the research. The data was collected using conflict management questionnaires that had passed the validity and reliability tests (Kaspiana, 2019). In addition, it has also received ethical and approval ethics in research, specifically autonomy, beneficence, justice, and confidentiality. The data were analyzed using univariate analysis. The data conducted was categorical, namely ordinal. Thus, the data was presented in the form of a frequency distribution table.

RESULT
This study involved 71 respondents in a hospital in Bali. This chapter will discuss the results of nurses' perception of conflict management of head nurses based on the conflict management strategy that includes competing, collaborating, avoiding, accommodating, and compromising.

Nurses' Perception of Conflict Management Strategy of Head Nurse
The data of nurses' perception of conflict management of head nurses in a hospital in Bali in 2021 based on the five conflict management strategies are presented in table 1 below. The results of this study showed that most nurses perceive their leader or head nurse as using a compromising conflict management strategy, with an average score of 4.37 and a percentage score of 87.30% in the "Good" category. Furthermore, it is followed by Collaborating strategy. Nurses perceive their leader or head nurse using Collaborating conflict management strategy well. It is proven by nurses' perception of collaborating conflict management by head nurse obtained the second-highest score, with a percentage score of 85.75% in the "Good" category. Meanwhile, the executive nurses at least perceived that their leaders used avoiding conflict management strategies, with an average score of 2.0 and a percentage score of 44%, in the "Not Good" category.

DISCUSSION
The result of this research showed that most of the nurses assumed that the head nurse used compromise as the conflict management strategy in order to resolve conflicts in the working environment and followed by the collaboration strategy in second place after compromise. This result, supported by Purba's research, stated that executing nurses would assume their leader used compromise conflict management strategy most of the time (Purba & Fathi, 2017). Hendel's research result also concluded that compromise conflict management strategy is the strategy chosen by managerial nurses in resolving conflicts that occur most of the time (Hendel, 2015). Compromise strategy places someone in a moderate position, which balances the interest of themself and the other. This is the most commonly used strategy as it uses a take and give approach. Compromise is suitably used in a conflict that involves parties with different purposes yet has the same power (Utami, 2016). The main power of compromise strategy is on the process that is democratic, and no party will lose or sacrifice. Thomas-Kilmann (2008) stated that compromise strategy can be done in these situations, such as: a) When goals are important enough but do not worth the effort or potential distractions involved in using assertive mode; b) When the problem is too complex; c) When the goal need to be reached under certain amount of time; d) As a back-up strategy when collaboration and competition failed to be done (Thomas-Kilmann, 2008).
Collaborating conflict management strategy is an assertive and cooperative conflict management style. Marquis and Houston stated that collaborative strategy is the best strategy and the most effective one to resolve a conflict for a good long-term benefit (Marquis & Houston, 2015). The result of the literature review by Mardiyanthi stated that some factors caused someone to use collaborating strategy, one of them is position (Mardiyanthi, Sjattar, & Irwan, 2019). Managerial nurses would usually consider collaborating as the main option to resolve a conflict (Chang, Chen, & Chen, 2017), meanwhile people who do not have any significant managerial position would tend to avoid any conflict (Lahana, 2017). This is caused by the sense of responsibility a manager has is bigger than the one who does not have any position for the company or the department. Moreover, education and joining conflict management training can influence someone to choose the right strategy. The nurse who joined conflict management training will use collaborating strategy most of the time (Chang, Chen, & Chen, 2017).
This study also obtained the head nurse conflict management strategy that the executive nurse least is avoiding strategy. Avoiding management conflict strategy is an unequivocal and uncooperative style of conflict resolution (Dahsyan & Keshk, 2014). When avoiding, someone does not immediately pursue his interest or others. This avoiding strategy here can be the act of avoiding problems diplomatically, delaying resolving problems until appropriate time occurs or simply withdrawing from a situation that is condemned (Thomas-Kilmann, 2008). Even so, this strategy is a good approach in certain situations, because every strategy in conflict management has its own advantages and disadvantages. Marquis and Houston (2015) stated that avoidance strategy can be effectively used when: a) The cost to conflict resolution outweighs the benefits; b) Conflicts can only be resolved by other parties; c) The problem or conflict will be resolved by its own and would not harm the community (Marquis & Houston, 2015).

CONCLUSION
The result of this research stated that most nurses assume the head nurse uses a compromise conflict management strategy most of the time which is in the "Good" category with the percentage score 87.3%, and then followed by the collaborating conflict management strategy that is also categorized "Good" with percentage score 85.75%, accommodating conflict strategy that in a "Good" category with percentage score 82%, competing strategy got "Not Good" category with percentage score 56.9%. The least perception by the nurse on the head nurse is avoiding conflict management strategy with percentage score 44% with "Poor" category.

ACKNOWLEDGEMENT
The writers would like to thank those parties who participated in the study and the director of the hospital who had given permission to conduct this research.