Off the Charts

Photo from otisarchives4, via Flickr.

Medora McGinnis, RN, has written several previous posts for this blog. She is now a pediatric RN at St. Mary’s Hospital in the Bon Secours Health System, Richmond, Virginia, as well as a freelance writer.

What makes communication at work feel safe? We can all identify situations that “go south”—we feel instantly uncomfortable in the work environment (or anywhere, really) if we are accused, blamed, insulted, or overlooked. It’s easy to recognize when our communication is not safe, not going well, and not professional. So what makes it safe?

Effective communication can only take place when all parties feel safe; we must feel comfortable sharing our clinical insights without fear of the reaction we might get from the other party. While we can’t always know what their reaction will be, by learning to make it safe we can learn to talk with anyone about anything. New nurses in my hospital go through a six-month “RN residency” program in which we meet once a month for education, journaling exercises, and sharing. The book Crucial Conversations: Tips for Talking When Stakes Are High was used in our training to help us further develop our communication skills in the workplace. As a first-year nurse myself, I’ve found that some of the book’s ideas have played a big role in my learning curve.

Mistake #1: Watering down the content so the message doesn’t get across.

When things go wrong in a difficult conversation, we assume it’s the content of our conversation. In reality, it’s possible that we were so cautious with our phrasing that we didn’t get our point across at all. Honesty and openness help get the message across.

Strategy: When you reach a difficult spot, step out of the content and “build safety.” How are people responding? Are they hearing the words, or are they just becoming defensive? First, always apologize when appropriate. We can then take a moment to further that sense of safety by recognizing a shared purpose or mutual respect. For example, the nurse and the patient’s mother both want the patient to be safe; the physician and the nurse both want patient safety and comfort.

Mistake #2: Giving in—or “digging in”—when our purposes seem at odds.

Both of these are wrong responses to conflict. Do we give in when we are at odds with someone in the workplace? Or is the instinct to “dig in” and fight for your purpose, without necessarily listening to the other person?

Strategy: This is the perfect time to take a moment and build that sense of safety with the other person. Let’s recognize that we both want what’s best for the patient. “I understand that you are feeling frustrated” is a phrase that works wonders. Follow it with the recognition of the shared purpose and the steps to a resolution. A key here is to notice when safety is at risk: signs of silence, or signs of violence. Is the other party turning inward and becoming silent? Or are there physical signs that the other party is feeling trapped? Recognize these signs and focus on building safety.

Mistake #3: A lack of mutual respect.

If we aren’t showing respect toward each other, we end up trying to score points in the conversation. What makes you feel disrespected in a conversation? For me, this includes being talked over, interrupted, or even insulted. Sometimes it could just be a tone or an implication. So how do we create mutual respect in a conversation?

Strategy: First, explain what we intend to get across. “I think you do your job as our unit secretary very well, and I thank you for your hard work. However, as secretary, your job description doesn’t allow you to take a patient’s vitals.” This is clear and concise, and has a positive tone. We want to avoid explaining what we don’t intend to communicate. An example of this might be a statement like this: “I don’t want you to think that I’m saying we don’t appreciate you.” Doesn’t this leave a bad taste in your mouth? Focus on the positive.

In a healthy conversation, all parties must feel safe—safe to express their thoughts without fear of being attacked or belittled. We are each responsible for establishing this safety, and this can be done through establishing that mutual purpose and mutual respect.