When confrontation is needed

Miranda Cassity | 02/07/2017

How to prepare for those difficult conversations.

Miranda Cassity

Sometimes, it seems we’re turning into a generation of nurses that no longer has face-to-face conversations, but rather writes others up behind their backs. It’s extremely juvenile behavior and a time-waster for management. It would be much more appropriate for two adult nurses to handle these situations themselves, but that would involve confrontation—and none of us likes confrontation.

Think back to the last time a colleague confronted you at work. How did it make you feel? Were you uncomfortable? Was it awkward? Did you feel like you were “in trouble”? Worse yet, were you told that your manager wanted to talk to you only to wait several agonizing hours before he or she actually did?

Or maybe you were the one who had to do the confronting. It’s difficult to initiate these awkward conversations. How do you go about it without appearing threatening? Will my co-worker be mad at me? Will he or she think I’m a jerk? Maybe I shouldn’t say anything, but if I don’t, nothing will change. Confrontation is often necessary, but why do we experience such high anxiety when it happens?

Communication vital
In our profession, it is vital that we know how to communicate with each other. Sometimes we need to have difficult conversations, so we need to learn how to have them. Usually, they occur when patient safety is compromised or care falters. Or maybe you’re in a supervisory position and find it necessary to speak with an employee about complaints you’ve been receiving about his or her attitude.

When I’m on the receiving end of a conversation like this or I know I’m about to go in front of the firing squad, feelings of mediocrity wash over me, my work performance suffers, and my attitude quickly goes downhill. Instead of focusing on the task at hand, I find myself worrying about what my manager thinks I might have done now. Because my mind is elsewhere, I make more mistakes and am less likely to catch them. As a result, patient care may suffer.

But until that conversation happens and the issue is resolved, we continue to have wounded feelings. Everyone does—patients, other nurses, physicians—but we often fail to acknowledge them. That’s why I’m writing about this, in hopes that, by acknowledging my own struggles in this area, I can help shed light on a huge issue that we’ve turned our backs on for far too long.

Needed: Self-awareness and confidence
Developing self-awareness at the very beginning of our nursing careers is essential. We need to be cognizant of how our words and actions affect others, whether they are patients, physicians, fellow nurses, nurses aides, respiratory therapists, environmental service aides, or linen technicians. No person is more important than another. It takes all of these people and more to make a unit function properly.

As nurses, we are expected to uphold the standards—including the caring standard—of our profession. Others are aware of our professionalism. As Gallup polls indicate over and over again, nursing is the gold standard when it comes to trust and caring, of ethics and honesty. We need to be cognizant of how we are doing, which is why it’s so important that self-awareness be at the forefront of our minds.

Self-awareness and confidence go hand in hand. How to gain both should be taught in nursing school, but this is not always the case. As nurse educators and leaders, we need to help student nurses and newly graduated nurses acquire confidence. When an assertive nurse addresses a nurse who lacks self-awareness and confidence, the non-confident nurse’s insecurities become apparent. Feeling threatened, he or she reacts to the situation rather than responding to it. With proper education and experience, however, the nurse who is being addressed would respond in another way, and the situation would play out much differently.

A nurse who lacks confidence gains it through becoming self-aware, by observing others, and by learning from feedback—both positive and negative—from preceptors, mentors, and other colleagues. Just as parents seek to build confidence in children during their early years, more seasoned nurses should seek to build confidence in their less-experienced colleagues. 

Improve self-awareness through journaling
Whether you are a nurse who has been practicing for a long time or a young nurse just starting your career, reflective journaling is a great way to become aware of your own actions and perspectives. Because most of our non-nurse friends just wouldn’t understand, we avoid talking with them about our feelings or things that happened at work. As a result, we don’t process those feelings.

Through journaling—by writing about our experiences in a diary of sorts—we come to recognize how they make us feel. A nurse’s journal is not meant for others to read. Rather, it is a place to let out our feelings and frustrations and to safely sort through what happened and what could be done to make things go better next time. Journaling creates an outlet for this self-debriefing to occur.

Teach by modeling, learn by observing
Oftentimes, management doesn’t know how to properly initiate difficult conversations, and less-seasoned nurses lack the life experience that is needed. That’s where nurses who have more experience, maturity, and perspective can play a vital part—by serving as role models—and they should take advantage of opportunities to do so. Novice nurses learn the culture of a nursing unit by watching what seasoned nurses do. As seasoned nurses, it is our duty to handle these situations professionally and with civility.

Professional role modeling is an effective way to promote a culture of civility in the workplace. Seasoned and novice nurses alike look up to professional role models. They help mold the unit’s ethical standards. They collaborate effectively with other team members and are able to admit when they have done wrong. Skilled in the practice of self-reflection, they take ownership of mistakes.

When appropriate behavior is modeled effectively, it becomes the standard for the workplace, and others are inspired to emulate it. For nursing students, clinical preceptors are often effective role models. By observing how they handle conflict on a unit, students aspire to do the same, which is why preceptors need to make sure they handle conflict and confrontation effectively.

When confrontation is needed
To resolve an issue, direct communication should be civil and professional. Polito identifies six objectives to keep in mind when initiating a difficult conversation. Doing so helps reduce awkwardness and achieve better results.

Prepare: Make sure the information you plan to discuss is accurate. Do not approach a conversation based on hearsay or gossip. Have your facts straight.

Remember your purpose: What is the end goal of the conversation you plan to initiate? What do you hope to accomplish?

Practice: Role-playing a conversation ahead of time helps calm nerves and improve delivery.  

Manage your emotions: Calm yourself. If you cannot control your emotions during a conversation, you can’t expect the person you’re confronting to control theirs.

Listen: Pay attention to what your co-worker says in response to what you say. Is he or she providing information you were unaware of? Maybe your perspectives are inaccurate.

Be timely: It does little good to address a situation that needs attention a month after it happens. By that time, multiple shifts have come and gone, and details have been forgotten.

If we start educating our future nurses now on how to have these conversations, we help shape the future of nursing for the better. Yes, we can switch from the write-up-happy culture we presently have to one that confronts and corrects mistakes in a civil and professional manner at the time they happen.

When that occurs, we will no longer come across as confrontational to co-workers and those we supervise. We will no longer feel awkward about having these conversations, and when our actions—or inactions—are the focus of these conversations, we will not come away with an attitude of mediocrity. More importantly, as we learn to effectively communicate during times of high stress and to resolve conflicts on a timely basis, the care we provide our patients will improve.

Editor's note:
Miranda Cassity will present "Implementing Crucial Conversations in a Fast-Paced, High-Stress Environment," at the Creating Healthy Work Environments conference slated for 17-19 March 2017 at the JW Marriott in Indianapolis, Indiana, USA. The theme of the conference is “Building a Healthy Workplace: Best Practices in Clinical and Academic Settings.” 

Miranda S. Cassity, BSN, RN, a staff nurse for six years at a county hospital and Level 1 trauma center in Indiana that serves an underserved and underinsured population, is a preceptor on her unit for new and graduate nurses. She is presently working toward her master’s degree at the University of South Alabama and is looking forward to being certified as an acute care and family nurse practitioner.

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