Each day, nurse managers face conflict on the job. These run-ins with others are what some people call “crucial conversations.” The term has gone mainstream thanks to a popular book, Crucial Conversations: Tools for Talking When Stakes Are High. Here are some effective communications strategies to help you through some of the trickiest scenarios at work.
Sticky situation: A colleague takes a shortcut. “Nurses may think they have to pick their battles, but that’s not true--and it doesn’t cut it in health care,” says David Maxfield, vice president of research at VitalSmarts. “Creating a culture of safety and quality in a hospital means that employees can’t overlook concerns about patient care.”
The bottom line: Don’t wait to address issues that put patients in jeopardy, says Maxfield. If a colleague skips hand-washing between patients, bring it to her attention. What you say can be simple. For example, “I noticed that you forgot to wash your hands.” If you are concerned that a conversation might turn into a battle, find ways to demonstrate respect and remind the other person that you care about the same things she does. State your mutual purpose. “Remind her that you are trying to help her patients,” says Maxfield.
Sticky situation: There’s been a misunderstanding. When there is ambiguity, people often think the worst of a situation, says Maxfield. Has someone misinterpreted your intention? Resist the urge to get angry or repeat what you just said. Maxfield suggests using a tool called “contrasting” to clear up misunderstandings.
In contrasting, you use a don’t/do statement that addresses the other person’s concerns--often, that you don’t respect them. Then you follow with a statement that clarifies your real purpose. This helps bring a sense of safety back into the conversation.
Here’s an example:
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[The don’t part, or what you don’t mean] “The last thing I wanted to do was communicate that I don’t value you, your schedule, or your work.
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[The do part, or what you do mean] “I think your schedule and what you do are very important. What we want to do is make the process more efficient for everyone…”
Then you can resteer the conversation back to where you want it to go.
Sticky situation: Dealing with an abusive physician--or other disrespectful colleague. Rude, condescending behavior needs to be addressed--especially if the person gets volatile. If a physician is being rude to nurses, it’s because someone is letting it happen. Although it can be difficult to confront someone in a seat of power, it can be done. Start by introducing the facts to the offender. “Relay the exact words, tone of voice, and circumstances of the event,” says Maxfield.
Managers also might try “mirroring” back to the physician. If the physician is fuming, acknowledge it. Without judgment, say, “You seem upset.” This can help diffuse some of the hostility in a situation.
Sticky situation: Talking about physician preference items. Supply costs and other financial issues are becoming the topic of more crucial conversations, says Amy Gartley, RN, BSN, MBA, administrative director of specialty care services at MaineGeneral. “Historically, we got surgeons whatever supplies they needed, but hospitals can’t afford to do that anymore. These issues can be sensitive because it may sound like we are questioning their judgment,” says Gartley. “But just sharing information, starting with facts, is a great place to start. Often, surgeons don’t understand the cost implications of having duplicate preference items because they haven’t seen the data.”
The conversation can start with, “You know, doctor, I’d like to sit down with you and have a conversation about implants. I think it would be helpful for you to see the cost data.” Using data opens the door to discussion without bringing assumptions and judgment.
“Without skills and training, nurse managers--like all employees--can get caught up in the emotion of a situation--and they might avoid the discussion altogether,” says Gartley. “There is a perception that managers don’t have time to have these types of conversations, and these talks do take time upfront. But over time, crucial conversations really do change the culture, and they can be timesavers in the end.”
Sticky situation: Handling a performance issue. To develop a culture of accountability, leaders have to walk the talk. This means holding staff accountable for behaviors that are negative or not up to standard. In this case, a conversation skill that may be helpful is what Maxfield calls “CPR,” which stands for content, pattern, and relationship.
Take, for example, employees who consistently turn in their reports late. “Ask yourself, ‘What is the heart of the problem?’ Is it that they are late or is that their tardiness is part of a larger pattern? Or is it that you are feeling disrespected? If you only talk about the “content”--the late report--you will not deal with the larger, “relationship” problem. A possible script for managers: “When you make commitments to me and you break them, it makes it hard for me to trust you. And I need to trust you.”
Sticky situation: Giving feedback to your boss. Lead with the facts, not emotions. Maybe it feels like your boss hasn’t got your back, and you want to say something about her lack of support. Not sure what to say? Try a few statements on for size. Use the Goldilocks test, which means making sure that what you say isn’t “too hard” or “too soft.” For example:
Too soft: “I know it’s probably just me, but it seems to me like I don’t have a lot of support here.”
Too hard: “Just when did you decide to become such a chicken with management?”
Just right: “I don’t think you’re intending this, but I feel like I don’t have the support I need from you.” Then insert one or two facts to back you up.
Sticky situation: When processes change. Like many hospitals, MaineGeneral is exploring ways to combat the nursing shortage. One strategy being considered is 12-hour nursing shifts. “Having conversations with staff around this area can be very emotional because the change may impact their routines and family,” says Gartley. “There are many opinions on this issue, and our front-line managers are struggling with how to keep nurses informed on why we’re considering this while still recognizing staff concerns.”
Gartley has encouraged her managers to spend time with each employee individually to hear each person’s opinions and concerns. Senior leaders are also attending department meetings. “I believe we need to be honest and show employees where the money goes so they understand our situation. When an organization is facing a big change, you really need to communicate in every form possible,” says Gartley.