nursing leadership:  having difficult conversations

NU

RSING

LEADER

SHIP: 

HAVIN

G

DIFFIC

ULT

CON

VERSATIO

NS.

Karren Kow

alski, PhD,

RN, N

EA-BC, FAAN

G

rant, Project D

irectorColorado

Center for N

ursing Excellence

Public Health

Nursing

Webinar

July 29,2010

OBJ

ECTIVES:

1.Describe com

munication and

why poor com

munication can

be problematic in the

workplace. 2.Explain three types

of comm

unication filters.

3.Define human

reactions seen during a conflict or diffi

cult situation.

4.List comm

unication tools used in working with peers and staff to provide constructive feedback.

COMMUNICATION

Words 7%

Tonality 35%

Facial & Body Language 58%

HUMANS COMMUNICATE:

Thoughts Ideas Opinions Feelings Emotions

POOR COMMUNICATION LEADS TO:

Relationship Breakdown Misunderstandings High levels of emotion Judgement High Drama Incivility

IN THE WORKPLACE: Very little focus

placed on communication

Yet it is essential for smoothly functioning teams

GOLEMAN’S FRAMEWORK FOR EMOTIONAL COMPETENCIES

COMMUNICATION FILTERS1. MENTAL STATE Frame of Mind

Optimism vs. Pessimism Affects information processing Affects ability to focus on “present

moment”

Assumptions Intentions and Hidden Agenda Judgments of Self & Others Belief systems

2. EMOTIONAL STATESNegative feelings about job, co-workers etc.InsecurityThreatsStressFEAREgo Needs (for approval, perfection, need to be right)

Unhealed Wounds

EMOTIONAL STATES (CONT) Positive feelings: (tend to be more

resourceful, easy going, open to change)

JoyDelightHopeHumor/laughter

3. CURRENT STATE OF THE RELATIONSHIP Positive relationships are the foundation of Human Enterprise

Quality of relationships effects

productiveness of the team Unresolved conflicts destroy

teams

Definitions: Relationship - the state of being

related or connected or bonded together

Conflict - competitive or opposingaction of incompatibles: antagonistic state or action, opposing needs, drives, wishes or demands

Confront - to face especially in challenge; meet or bring face to face

AWARENESS MODEL

Difficult person Difficult situation

Conflict Empowerment:Being bigger than the situation in

which you find yourself It’s a Choice

STIMULI FOR UPSET OR REACTION:

OUTSIDE Trigger: an action by another person or by yourself

The responding Feeling is Inside “You Make me Feel so ….. 

AUTOMATIC REACTIONSStress or Fear (buttons are pushed)

Unconscious – fight or flight Create list of responses/reactions

Panic, Defensive, Frustrated, Resentment, Defensive, Victimized, Sabotaged, ThreatenedAnger, Negative, Self-righteous, Attack, Annoyed Blamed, Sarcastic, Freeze, Clam up, Withdraw,Counterattack, Walk, Denial

PATTERNS OR COW TRAILS

Raised adrenalin Leads to: Assumptions – we act on them Examples:

Fused in my car (other drivers)

We can go through life reacting to:

External World vs.

Responding Creatively

IN REACTION FEEL BLAME “You make me Feel

……. “

THINK JUDGMENT “I think You’re a Jerk”

WANT DEMAND “Why don’t you get a life?”

Awareness Model

Awareness Model (continued)

identify feelings or sensations I’m feeling refer to your perspective of the situation,

check assumptions I think identify what you want from the

relationship or situation I want How I’d like to work together is

Communication Practice Session

WHEN CORRECTION IS NEEDED: ARC STATEMENT

A = Action the person has taken

R = Reaction from the administrator/leader

C = Consequences or impact on other team members

Can you see how this negatively impacts the team?

ARC STATEMENT

REFERENCES American Association of Critical-Care Nurses (AACN)

& VitalSmarts. (2005). Silence kills: The seven crucial conversations for healthcare. San Francisco: The American Association of Critical-Care Nurses.

Druskat, V., & Wolff, S. (2001). Building the emotional intelligence of groups. Harvard Business Review, 79(3), 81-91.

Jason, H. (2000). Communication skills are vital in all we do as educators and clinicians. Education for Health, 13(2), 157-161.

Morreale, S., Spitzberg, B., & Barge, K. (2001). Human communication: Motivation, knowledge, & skills. Belmont, CA: Wadsworth.

Nemeth, C.P. (2008). Improving Healthcare Team Communication: Building on Lessons from Aviation and Aerospace. Aldershot, UK. Ashgate Publishing.  Ltd.

Patterson, K., Grenny, J., McMillian, R.; & Switzler, A. (2002). Crucial Conversations: Tools for Talking When Stakes are High. New York, NY; McGraw-Hill.

Patterson, K., Grenny, J., McMillian, R.; & Switzler, A. (2004). Crucial Confrontations: Tools for talking about broken promises, violated expectations and bad behavior. New York, NY: McGraw-Hill.

Porter-O’Grady, T. (2004a). Constructing a conflict resolution program for health care. Health Care Management Review, 29(4), 278-283.

Porter-O’Grady, T. (2004b). Embracing conflict: Building a healthy community. Health Care Management Review, 29(3), 181-187.

QUESTIONS and ANSWERSKarren Kowalski, PhD, RN, NEA-BC, FAAN

Contact via email: karren.kowalski@att.net

Nursing Continuing Education credits are available for

30 days following the live presentation. In order toreceive your evaluation form and nursing contact hourcertificate please email your: name, state, emailaddress to: Patti White, MAPHN atpattiwhite105@gmail.com

Acknowledgements

New England Alliance for Public Health Workforce Development

Boston University School of Public Health

Massachusetts Association of Public Health Nurses (MAPHN)