Purpose: This presentation was initiated as a performance improvement effort aimed toward improving the work culture in a high-acuity and high-stress environment. With the full implementation of this program, the authors expect to improve attitudes toward, and effectiveness in, holding difficult conversations that are necessary between co-workers.
Relevance/Significance: Oftentimes necessary conversations are missed as a result of nursing staff feeling uncomfortable toward initiating difficult or uneasy subjects. Staff nurses need to have a way to address their concerns with others when issues arise. When nursing staff do not address issues, frustrations and tempers rise which is a leading cause of nurse burnout. Patient care outcomes are negatively affected, and there is an overall decreased job performance.
Strategy and Implementation: Evidence shows that educating nursing students on how to initiate difficult conversations can improve nursing confidence and assertiveness (Hunta & Marini, 2012). Use of role play effectively allows the student to voice any concerns in a safe environment prior to an actual situation arising. The authors proposed training of new hire nursing staff within a high-acuity emergency department at a Level I trauma center in the Midwest. This educational activity would train staff on how to effectively implement and engage in difficult and critical interpersonal conversations. The educational activity will be delivered during the orientation to the emergency department which typically lasts for eight to twelve weeks. The educational activity is designed to aide staff in learning techniques on how to initiate, and remain professional during, difficult conversations. Lecture and role play have been shown to increase recollection and performance (Lewis et al., 2013). These techniques will be used during the duration of the staff orientation period. This will occur in one-hour group sessions with their preceptors on multiple work days. In order to provide time to implement and practice what they have learned, there will be several days in between educational sessions. Participants will be educated on word choice and self-awareness which will be reinforced by department preceptors involved in the program.
Evaluation: Post-orientation data will be collected for participants involved in the program. A self-reported positive change in attitude and practice will be expected after the activity. The participants will complete a short-term post-orientation evaluation where qualitative and quantitative data will be gathered. The initial cohort of participants will then be followed and reevaluated over the first year of their employment. It is expected that the long-term evaluations will show a self-reported positive change in practice and comfort with holding critical conversations with constructive outcomes.
Implications for Practice: Evidence suggests that after implementation of such a program, the authors could increase staff assertiveness by 11% and increase self-esteem by 16% in the department. With favorable evaluations, the authors wish to broaden the educational activity to current staff within the emergency setting which would increase opportunities for collaborative and interdisciplinary learning experiences with physicians and other healthcare providers and ultimately improve patient care.