The American Association of Critical Care Nurses (AACN) standards state that nurses must be as competent in their communication skills as they are in their clinical skills because effective communication fosters the psychologically safe work environment where collegial teamwork can thrive. Additionally, the American Nurses Association (ANA) standard of professional behavior states any form of horizontal violence is unethical practice and passive-aggressive communication falls under this umbrella.
Currently, a passive-aggressive style predominates. Nurses are lacking a critical skill: the ability to handle conflict and speak assertively with confidence and professionalism. Without this skill, nurses doubt themselves and are prone to making mistakes, thereby putting themselves, their colleagues, and their patients in danger. In a psychologically unsafe and emotionally unsupportive environment, humans cannot think straight, let alone access the critical thinking skills that are essential to providing quality nursing care.
This presentation reviews the process by which nurses gained the confidence and skill to confidently address experiences and behaviors that had previously left them feeling undermined or uncertain. Understanding why these behaviors occurred diminished their effect. Knowing how to respond built confidence and hardwired muscle memory. And analyzing scenarios of how other nurses effectively handled similar situations inspired nurses to be dauntless in their communication.
DESCRIPTION
Fifty-three trauma nurses self-assessed their communication skills in three categories: novice, moderate and expert. Only 25% were expert communicators and more than 50% were still at the novice level.
By guaranteeing their psychological safety through anonymity, these nurses were able to identify an important conversation that they had been avoiding. They then identified the reasons they had been avoiding the conversation. Through coaching, these reasons were addressed and overcome using specific communication models to create a script for the conversation. The primary communication model used was the Describe, Explain, State, and Consequence (D-E-S-C). They then rehearsed these conversations with their coaches and selected partners.
EVALUATION
After hearing all the reasons that their peers self-silenced, nurses realized that their professional role as a nurse and patient advocate required them to be dauntless and take the risk of speaking up. Further discussion of how self-silencing supports passive-aggressive communication and the development of horizontal violence in their culture followed. Realizing that the reasons for avoiding conversations are largely universal helped the nurses overcome previous biases and fears, as did the desire to become accomplished patient advocates.
DISCUSSION
The crux of communication at the professional level is that nurses value their own social safety in peer relationships over patient safety. The desire to be accepted by their colleagues frequently voided the need to ask questions, address a perceived error, or create a situation that could have been perceived as uncomfortable or painful. The confidence gained through developing communication skills by exploration of the models and rehearsing skills in coaching sessions motivated a shift in conscious values. When the environment is perceived as safe and accepting, nurses are far more likely to speak up in a way that contributes to excellent teamwork and protects their patients.
See more of: Evidence-Based Practice Sessions: Oral Paper & Posters