THE BOOK ON CONFLICT Judith Briles' book, " Zapping Conflict in the Health Care Workplace," the top seller in the Nurses Book Club Society in 2003, was revised and reprinted last year. For more information, go to www.judithbriles.com.

Back in the 1970s, a nurse saved Judith Briles' life by recognizing her symptoms and rushing her to the hospital. Briles has been returning the favor ever since.

The award-winning author (23 books), keynote speaker, professional development trainer and consultant often talks to nurses about the unhealthy symptoms she sees in health care work places and what they can do to treat them.

Briles has conducted studies on women in the work place since the mid-1980s. The most recent study showed that 71 percent of the women interviewed reported some type of sabotaging behavior by another woman - an increase of 42 percent.

She cites several causes for so much conflict: Constant change in the health care arena, lack of leadership and communication skills and frustration over wanting to solve problems collaboratively, yet not having the time due to nursing shortages.

"The collaborative model is where we want to be, but we're not there yet," Briles said.

If not recognized and corrected, these "red-ink behaviors" lead to a toxic work place and lower productivity, increase errors and affect staff retention and patient satisfaction.

"Eventually, the good people leave and you're left with those who have rotten behavior or attitudes and that's horribly damaging to the work place," Briles said.

"When I talk to nursing audiences about these kinds of conditions, what I think surprises them most is that they are not alone in experiencing this kind of behavior," Briles said. "They hear that their own experiences are universal and that there are solutions that are effective."

The first step is to recognize sabotaging behavior.

"A saboteur is usually someone with low self-esteem and confidence who consciously or unconsciously undermines or destroys another's personal or professional integrity," Briles said. "With a woman, it's usually covert [backstabbing] behavior."

It can be something as simple as spreading gossip, taking credit for someone else's work, leaving someone out of the information loop or talking inappropriately about someone within earshot of an authority figure or patient.

"A woman's reaction to this kind of behavior is usually to hope it's an isolated incident, to keep quiet or to grumble about it to a friend or co-worker," Briles said.

"That can lead to a domino effect, with everyone upset but the person causing the mayhem. Keeping silent only condones the behavior and allows the person to keep doing it. The only way to change it is to confront the offender."

Arrange to meet the person in a neutral place soon after the incident. A face-to-face meeting takes more courage, but is essential for the best communication.

"Ask the person if it was their intent to . . . take credit for your work or discredit you with the manager, or whatever ¨ and wait for the answer," Briles said. "This will make her squirm and tell her you are on to her game.

"I tell nurses that the best way to keep from being the target of sabotage is to be competent and be confident."

Be aware that this type of behavior occurs and know how to recognize it. Read professional journals, invest in some leadership, assertiveness or confidence-building training. "These are practical and portable skills you will use throughout your career and life," she added.

Briles ranks people skills as one of the most important traits of good health care workers.

"It's just as critical to have these in the work place as clinical skills," she said. "One hospital administrator told me that she was putting behavior at the head of her hiring list. Her reasoning was that if someone has a license, you can teach them the necessary clinical skills, but you can't change a bad attitude."