By Megan M. Krischke, contributor
October 18, 2012 - Nearly every work environment has stressors, difficult interpersonal dynamics and office politics, and in health care these issues are often intensified because of the life-and-death nature of the work.
Nurses are under stress due to shift work, the emotional nature of caring for patients and because they are often asked to do more with less. All of these factors can lead to tensions among co-workers. It is important for nurses to be aware of the dynamics in their environment and to learn how to handle tense situations productively while avoiding unnecessary drama.
Susan Shapiro, a corporate director at Emory Healthcare and assistant dean at Emory University's school of nursing, said that nurses should become aware of the strengths and weaknesses in their communication styles.
“When it comes to being successful in complex organizations, probably the most important skill that a newer nurse can work on is self-awareness,” commented Susan E. Shapiro, PhD, RN, FAAN, associate chief nursing officer for nursing research and evidence-based practice for Emory Healthcare and assistant dean in the Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta, Ga.
“You need to understand your own reasons for doing things,” she explained. “Why are you in nursing? What do you want from the work you are involved in? This will give you clues as to why certain situations frustrate you. It is also important to know the strengths and weaknesses of your communication style.”
“We can’t control others’ behaviors and responses, only our own,” Shapiro continued. “When I feel frustrated and as though I’m not getting my message across, I spend a lot of time thinking it through and talking with trusted colleagues to figure out how to communicate more effectively.”
The perspective of Kelly Hancock, MSN, RN, NE-BC, executive chief nursing officer (CNO) for Cleveland Clinic Health System and CNO for the Cleveland Clinic main campus, is that leaders have a significant responsibility for minimizing hospital politics.
Kelly Hancock, executive CNO for Cleveland Clinic Health System, encourages nursing leaders to make sure frontline staff is heard and tensions are dealt with effectively.
“It is really up to the leader or the organization to make sure that everybody stays focused on the mission and to provide staff with skills for dealing with these stresses,” Hancock said. “At the Clinic we have a training program called Crucial Conversations that gives employees the skills they need to communicate clearly and to hold one another accountable.”
“Additionally, we work to ensure that the voice of the frontline staff is being heard,” she added. “One of the ways we do this is through shared governance councils.”
Shapiro said that although nurses are often sensitive to critical feedback, they need to learn skills for hearing and responding to correction. She added that it is often better not to say anything and to take time to reflect and consider how to use the feedback to be more successful.
If nurses get involved in a situation where tensions are mounting and the conversation is no longer productive, she suggests calling a time out. A time out pauses the conversation so both parties have time to think and then reengage in a more neutral space.
Diane Reinhard, CNO for Craig Hospital, says there is a correct way to communicate your concerns and be heard by nursing leadership.
“If it isn’t your drama, don’t get into it,” suggested Diane Reinhard, RN, BSN, MBA, MSCIS, CRRN, NE-BC, vice president of patient care services and chief nursing officer at Craig Hospital in Denver, Colo. “You don’t have to choose sides; you are an adult in a very serious profession.”
If you do find yourself at the center of a tense situation, Hancock suggests going to your immediate supervisor.
“Find out what you can do to alleviate concerns and redeem yourself. Perhaps your supervisor could help you create a development plan to help manage the issue, whether clinical or relational,” she said.
“Always carry yourself as a professional,” Reinhard advised. “If you have a legitimate issue that needs to be discussed, move up the chain of command to get it dealt with. If you can come into a room, not being dramatic, stating the facts, being very clear, your leaders will listen and you will be remembered as someone who can articulate your needs in a professional way. If you are dramatic, you will lose respect and credibility.”
Reinhard offers this outline for communicating your concerns clearly:
• Be respectful and professional
• Present the facts
• State your issue or concern
• Explain how you would like to see it resolved
Wherever there are people working together, there are going to be miscommunications and tensions. Some organizations, however, provide a more positive workplace than others.
When considering a job in a new organization, both Reinhard and Hancock recommend taking a half-day to shadow someone working in the role you are considering.
“Ask questions of the staff: How well does the unit get along? What is the turnover rate? How well does the nurse leader model positive behaviors? Are you able to bring up concerns?” recommends Hancock.
“During an interview, ask about the organization’s policy on bullying and horizontal violence. If the interviewer seems not to know what you are talking about, that is a red flag,” added Shapiro.
“For someone who has the freedom and ability, travel nursing can provide a break from being enmeshed in a political environment,” remarked Reinhard. “Additionally, if the stress on the unit is largely being caused by staffing issues, hiring some travelers can help relieve that stress.”
Hancock concludes with the reminder that everyone has to take responsibility for creating a positive workplace.
“We need to get back to why we all became nurses,” she stated. “We all have to act as role models and foster a culture that supports high quality care. You have to put some onus on yourself.”
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