Nursing Skills: Confrontation
Nurses are renowned for being passive (and passive-aggressive) folks who tend to talk behind others’ backs and not confront anyone. I’ve read the theory proposed many times that this is because it’s such a female-dominated field. The reasons for it are not as important as learning how to solve the problem, though: nurses must learn the art of confrontation. Passive-aggression, ignoring the problem until we blow up, or simply discussing the person in question with other people does about exactly nothing to solve any issue. As with many interpersonal issues in nursing, the eventual victims are our patients.
Failure to confront can mean
- A colleague can continue being disruptive, causing a massive rift in an entire shift
- A physician’s erroneous orders are carried out
- Gossip rather than direct confrontation results in someone being totally ostracized (people eventually figure out that someone who gossips to you will also gossip about you)
Even patients need to be confronted sometimes. Someone told me a long time ago that the word confrontation can mean “truth-finding.” Thought about that way, sometimes nurses have an actual duty to confront patients. What about the patient who reeks of stale alcohol but denies any alcohol use? The family who smells of smoke and denies smoking around their asthmatic child? Failure to confront these behaviors will rob these patients of needed and possibly life-saving education and help.
But nurses do not like confrontation or, sometimes, it seems, direct communication of any kind. I don’t like it either. It usually seems easier at the time to just let things slide. That way nobody is angry at me and things seem smoother. It’s only later that I realize it would have been much better to say something about it to begin with. The first thing, then, is to speak up sooner rather than later.
Although it is important to act quickly, this must be balanced with restraint. If you speak up when you still angry, your message will be tainted by that. So, try to balance timeliness with cooling down. If it can’t wait, there’s nothing wrong with admitting that you are angry and doing your best.
What to say? Put yourself in the other person’s shoes. Would you like a laundry list of everything she’s ever done to upset you? A accusatory rebuke? Patronizing statements? If not, the receiving party probably won’t either. Avoid all of those things and use the classic “I” formula (“when you did this, I felt this way”), when applicable. It is also helpful to use clarifying questions (“when you did this, I interpreted it this way; is that what you meant?”). If it wasn’t, your problem is solved. If it was, at least you’ve opened the door to discussing it.
Approaching physicians can be trickier, but it is our job to, for example, wake up a surgeon at 3 AM about an order that seems dangerous or wrong or to ask the hospitalist if she truly wants a bolus of fluid for the CHF patient. Every nurse’s mileage may vary, but I have the greatest success not apologizing for bothering them. It is both of our jobs to take care of patients, and I’m disinclined to apologize for doing my job. I find it is best to get in and get out. Use SBAR and keep it as short as you can. Include what you are asking for as soon as you can. Physicians are busy. I’ve watched them take calls from other nurses before, and they are less annoyed about having their orders questioned than about having to listen to 5 minutes of preamble before the nurse gets to the point.
Patients? Use the facts. “I smell cigarette smoke on your clothing. Smoking around children with asthma can worsen the disease.”
The most important thing about confrontation is probably just to do it. Letting problems ride will never help.
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