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Communication Challenge # 4: Answer
Dear Wishing for More Collaboration,
Thanks for a super topic to explore and a wonderful wish!
You know, I’m always amazed at how powerful some toxic behaviors are. In my classes or workshops on organizational conflict, communication, leadership, etc., there always seems to be one or two notorious people. Everyone in the organization knows them. They may be physicians, nurses, or administrative leaders. They have a tendency towards aggressive or passive-aggressive behaviors, and no one knows quite what to do. They are a small number of people with a large amount of power. Let’s consider some potential opportunities for assertiveness in this scenario.
Addressing the Mumbling
Assertiveness is a valuable skill and, when we are adept and supported in being assertive, there are many opportunities for personal growth.
For instance, during the call:
Dr. Smith, I’m having trouble understanding you. Please slow down and speak more clearly without yelling. We have the following Betadine options, which one would you like?
Addressing the Yelling
Yelling is usually an aggressive and ineffective way to communicate. It is hard to be assertive in an aggressive situation, especially if there is an unequal power dynamic, such as with a physician or supervisor. Nevertheless, we are undergoing a sea change in healthcare and difficult steps are necessary to eliminate this form of communication.
For instance, during the call:
Dr. Smith, stop yelling at me. It is inappropriate, and I can’t understand you. Please lower your voice and tell me what you would like to do for our patient.
A similar approach could be adopted during a face-to-face incident:
Dr. Smith, stop yelling at me. It is inappropriate. Please lower your voice and tell me what you would like to do for our patient.
In addition to using a clear and firm voice in all of these examples, your body language for such a face-to-face confrontation can make a difference. One type of body posture that I find helpful if someone is invading my personal space is called the ‘mediator’s stance’. To do this, pivot slightly to the side and bring both arms up, elbows slightly bent and palms at an angle as if to say “stop”. This defines your personal space without blocking the aggressive person. In a sense you get out of their way and still maintain a non-defensive, non-threatening, strong posture.
Addressing the Chronic Dynamic
Depending on how safe you feel, there is an opportunity to provide some feedback to this physician, build a relationship, and set limits for future interactions. I think you have all of the information you need to initiate the process and, with a little reflection, could offer a lifelong gift to the doctor.
You might start out a conversation:
Dr. Smith, I have a concern that I would like to talk with you about regarding our communication. Would you be willing to sit down with me privately for 5 or 10 minutes later today?
I’ve been reading about assertiveness and am developing that skill. In the process, I’ve realized that some of our interactions over the years have had an unhealthy tone. I’m talking about phone and face-to-face conversations where I have perceived you to be yelling at me at times and not speaking clearly at others. I find now that I dread having to communicate with you and know that this is not professional. I’d like us to be communicating more respectfully. What thoughts do you have?
He may or may not be receptive to this, and only you can gauge whether you feel safe enough to take any of these steps.
It is important to note that the organizational culture plays an extremely important role in creating and sustaining a safe environment in which nurses can develop their assertiveness. The Joint Commission’s new requirement for addressing bad behavior went into effect January 1, 2009, and will help create cultures that support assertive intervention. In the meantime, learn all you can about assertiveness and look for opportunities to observe, practice, and role model related behaviors.
Beth
Share your thoughts with Beth.
Beth Boynton, RN, MS, is a nurse consultant and author of Confident Voices: The Nurses’ Guide to Improving Communication & Creating Positive Workplaces. She specializes in communication and conflict issues that impact nurses and other healthcare professionals. She is a professional coach, speaker, and trainer and provides related assessment and support for organizational development. She is an adjunct faculty member with New England College’s graduate program in Healthcare Administration, publishes the free e-newsletter: Confident Voices for Nurses: The Resource for Creating Positive Workplaces, and writes a regular column for the ANA-Maine Journal.
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Communication Challenge # 4:
Staff RN wants help dealing with aggressive
and passive-aggressive behavior.
Here is a scenario presented by a staff nurse who wants a more
collaborative relationship with a physician who has a pattern of
abusive behavior.
I am a staff nurse on a med/surg floor. I'm trying to develop my
assertiveness and am hoping you will have some ideas for this
situation. There is one physician who is very difficult to deal with.
He has yelled at me a number of times during phone conversations
and sometimes in person.
I dread taking care of his patients because I don't want to deal with him. I'm not the only one, either. We all cringe when we hear him get off the elevator. One example is that I never know what kind of Betadine solution he wants to use for procedures, (we have several options), and when he calls in to get things set up, he mumbles. I don't dare interrupt him, and so I try really hard to make sure I understand him. It seems like I'm always prepared with the wrong solution.
He and I have both worked in the same area for many years, and I wish things were less stressful and more collaborative between us. Any suggestions?
