On one of her evening shifts, Nurse Sally Stevens, a registered nurse with 17 years of nursing experience, was caring for a new patient, a 46-year-old diabetic woman suffering from tremors due to an episode of lithium toxicity. After an IV was started, the patient, Miss Hawkins, developed some kidney complications, prompting doctors to bring in a kidney specialist. After reviewing her charts, the specialist ordered an IV containing dextrose.

Knowing that dextrose could negatively affect her patient’s diabetic condition, Nurse Sally expressed concern. In a non-aggressive tone, Nurse Sally said, “Doctor, Miss Hawkins’s blood sugar level was 315 at 4:00 p.m. I noticed you switched her IV fluids to dextrose. Do you want to switch fluids?” intravenous?”

Thanks to Nurse Sally’s ability to communicate effectively, Ms. Hawkins received the best medical care possible.

Therefore, the real moral of the fictional account of Nurse Sally’s story is that you really can get your needs and wants met, not through aggressive, direct confrontations, but through effective, positive, and assertive communications. Especially in the field of nursing, the ability to make an appropriate assertive response to a potentially negative and/or harmful situation is a critical skill, even a skill that can save lives.

And contrary to popular belief, you can communicate your concerns without permanently damaging your professional relationship. A “positive refusal” is the ability to offer an appropriate assertive response to a potentially negative and/or harmful situation. A positive flashback is executed by looking someone directly in the eye and saying in an even, stress-free tone what she wants or needs. (If you want to be really assertive, include the word “I”, like “I really need you to stop and check this out now…”)

practice makes positive

It is essential to sound confident when you are giving a positive response. Positive feedback doesn’t leave the other person confused or unsure about their needs, wants, or message! That said, a positive rejection is not delivered with a clipped tone of voice or an aggressive posture or facial expression.

Example to lose: “I wonder if we should double check the lab work before…”. Usage example: “I think we should double check the lab work before…”

Samuel Maceri, DNSc RN, and chair of the Tennessee Nurses Association’s Workplace Advocacy Commission, offered some advice on assertive communication for nurses during potential conflict situations: “When you call the doctor at two in the in the morning and you know you’re tired, you can say ‘I know you’re very concerned about Mrs. Johnson and I’m sure you’ll want to do something about this situation,’ then there’s a justification for disturbing your time and space goals.”

Unfortunately, you can only pull back positively when you have enough positive psychological capital, which means you are equipped with enough self-esteem, self-confidence, and self-efficacy to be able to handle yourself in a conflict situation. You must continually build this capital, so that it is there when/if you need it.

Positive Retracement Benefits and Fears

One of the benefits of using positive feedback is that you have a good chance of producing the results you want and need. Other benefits can include an immunization against burnout (by helping you lower your stress level) and building self-esteem and self-confidence. Additionally, it can help you build positive relationships with others and empower you to become a better patient advocate.

So why don’t people back down? Well, certainly fear is a primary factor. Other factors can be previous negative experiences (like nobody heard or misheard before), defense mechanisms (I can’t be responsible), as well as active avoidance of a response. Additionally, some nurses are operating in a negative organizational culture, and whatever psychological capital they once built up may now be depleted.

“There is a power game in any relationship,” Maceri notes, “although a doctor may have more experience, as a person, a doctor is no more a human being than a nurse. A nurse has the same level of human rights as anyone.” …it demeans us all when a nurse is unable to assertively and professionally assert herself in a responsible and firm manner.”

You’re Fine, I’m Not Fine: Submissive Communication

We can communicate more effectively with others when we learn assertive and non-aggressive communication techniques. Perhaps the best way to understand assertive communication is to see how it falls on a continuum of three categories: 1.) submissive (unassertive), 2.) aggressive, and 3.) assertive behavior.

The first category is unassertive or submissive behavior. People who often behave in a submissive manner show a lack of respect for their own needs and rights. Many submissive people do not honestly express their feelings, needs, values ​​and concerns. They allow others to violate their space, deny their rights, and ignore their needs. They rarely express their wishes, although it may be all that was needed to satisfy their needs.

Some people who exhibit submissive behavior express their needs, but do so in such a timid and apologetic manner that they are not taken seriously. If you hear qualifying phrases like: “Oh, do what you want” or “I really don’t care” or “I could be wrong but…” – What, in fact, you are the audience is a form of “verbal submission”. Non-verbal submission may include a shrug, lack of eye contact, an excessively soft voice, hesitation in speech, etc.

The submissive person communicates: “It doesn’t matter, you can take advantage of
from my. My needs are insignificant, yours are important. My feelings are irrelevant; yours matters. My ideas are worth nothing; only yours are significant. I do not have
rights, but of course you do.” Because the submissive person will often stifle their own needs, this very often leads to pent-up frustration and anger.

ADVANTAGES of submissive communication:

1. Submission is a way of avoiding, postponing, or hiding conflict.

2. Submissive people carry a much lower burden of responsibility. If things go wrong, it is rarely the fault of the submissive person.

3. Submissive people often seem so helpless that other people take care of and protect them.

DISADVANTAGE of submissive communication:

1. Repressed frustration and anger.

2. Nobody knows what you want, so they can’t give you what you want.

Getting what you want at the expense of others: aggressive behavior

At the other end of the continuum is aggressive behavior, commonly defined as behaviors that “move against” or “move with intent to harm.” An aggressive person expresses his feelings, needs and ideas at the expense of others. They almost always win in an argument, talk loudly, and can be abusive, rude, and sarcastic. Aggressive people typically insist on having the last word and tend to nag, dominate, and try to dominate others. They can also be very controlling. The aggressive person often feels that only her point of view is important.

Nonverbal communication in an aggressive person may include dominant eye contact (staring), pointing, fist bumping, loud talking, and invading “personal space.” They can use terms like “always” and “never” as exaggerations are common. “You” language (such as “You never do…”) is often used a lot.

ADVANTAGES of aggressive communication:

1. They are likely to secure material needs and desired items.

2. They tend to protect themselves and their own space.

3. They seem to retain considerable control over their own lives and the lives of others.

4. People will often not come to you with their problems or raise issues with you.

DISADVANTAGES of aggressive communication:

1. Often the aggressive person will suffer from fear. Often the most

Aggressive people are the most fearful. Many people behave aggressively not because they feel strong, but because they feel weak.

2. The provocation of counter-aggressive behaviors.

3. Loss of control, guilt and dehumanization.

4. Alienation of people. Again, people will not come to you with their problems or raise issues.

5. Poor health.

I’m fine and you’re fine too: assertive communication

This method of communication allows both parties to maintain self-respect,
pursue happiness and the satisfaction of their needs, and defend their rights and
personal space – all without abusing or dominating other people. True assertiveness is a way of confirming your own individual worth and dignity. And simultaneously, the assertive person confirms and maintains the value of
others.

Assertive people stand up for their own rights and express their personal needs, values, concerns, and ideas directly and appropriately. While meeting their own needs, assertive people do not violate the needs of others or invade their personal space. Use “I” language (“I’m trying to…”) instead of “you” language (“You never seem to…”), communicate with an open posture, maintain eye contact, and use distance adequate. , nodes of the head and lean forward to listen carefully to the speaker.

ADVANTAGES of assertive communication:

1. Assertive people like themselves. Often the extent to which you assert

you yourself determine the level of your self-esteem.

2. Assertiveness also fosters fulfilling relationships, releases positive energy toward others, and greatly reduces a person’s fear and anxiety. In addition, assertive responses weaken anxiety and tension.

3. Because assertion is results-oriented, your chances of getting what you want and need are significantly increased.

DISADVANTAGES of assertive communication:

1. Often the affirmation will cause disruption in one’s life. There is also pain associated with honest and caring confrontation, and it is often a personal struggle to modify your own habitual behaviors (especially for those who are changing from submissive or aggressive lifestyles).

In conclusion, it is important to note that there are times when assertive behavior is not the best option. You can convey your needs in a very positive way and still make the other person react in a hostile way. As in any healthy relationship, conflicts are bound to arise, and being your authentic self can sometimes be a painful experience. To be assertive you have to risk dissension and make yourself a bit vulnerable. However, once mastered, assertive communication will make a positive difference in your daily interactions with others.

In the end, the proper goal of positive coaching is to help nurses choose communication strategies and behaviors effectively, not to make nurses behave assertively in every situation. At times, it may be wise to give in to others and, conversely, it may be necessary for you to aggressively advocate for your needs and/or your patient’s rights. However, for the most part, positive push can be an effective, positive and successful means of communication for nurses working in today’s healthcare environment.