asertiveness skills

7/23/2019 Asertiveness Skills

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PROFESSIONAL DEVELOPMENT

Interactions with colleagues occur in many different

situations: managing or being part of a team, imple-

menting or being required to implement change,del-

egating and receiving delegated tasks.Any of these situa-

tions may give rise to tensions. In this article, we aim to

highlight certain difficulties with colleagues that can ar ise

through an inability to assert ourselves in an appropriate

and effective manner.We will also look at ways in which

we can change our behaviour.

The outcome of an exchange with a colleague can

leave us feeling dissatisfied, abused, impotent or even

guilty. Feelings of impotence can result through the frus-

tration of having acquiesced to an undesirable outcome.

Guilt can be the result of being overly forceful or inap-

propriately aggressive to achieve a desired outcome.

In short, if we have achieved our goal, it may have cost

a deterioration in our relationship. But what causes this

type of problem and how can we change? In hindsight weoften think we could have handled a given situation bet-

ter.However, hindsight would be better replaced by fore-

sight. Assertiveness can be the key to change. We need

to develop an ability to say ‘yes’ and ‘no’, or agree and

disagree in an appropriate manner.

AssertivenessAssertiveness enables you to express yourself with confi-

dence,without the inappropriate use of aggressive, passive

or manipulative behaviours (Bishop, 2000).

At the core of assertiveness is the recognition that both

you and the person you are communicating with have

basic rights (Bishop, 2000).

AggressionWhen aggression is used as a form of communication, we

are ignoring the rights of the other person. This is the

key difference between aggressive and assertive behav-

iour.Aggressiveness might develop as a strategy because it

has worked in the past.Alternatively, it may be something

that we have witnessed in others when trying to assert

their authority. However, as noted by Paterson (2000), it

is a short-lived strategy.

PassivenessIn contrast to an aggressive communication style, when

an individual adopts a passive approach, they are ignoring

their own rights. For example, this may be someone who

finds it difficult to say ‘no’ to colleagues because they feel

that they ought to agree to the requests of others.

Passive aggressionThis is a combination of aggressive and passive styles of

communication.Paterson (2000) notes that this strategy is

used when aggression is disguised. Classic examples

would be of someone grudgingly agreeing to a request or

sighing and muttering inaudibly before walking away.

The importance of verbaland non-verbal skillsIn order to conduct ourselves in an appropriately

assertive manner we must develop effective verbal and

non-verbal communication skills.Taken in isolation, the

content of what we say is not enough.The words need to

be conveyed with appropriate use of tone and volume.Attimes, certain words or phrases may need to be stressed.

In face-to-face encounters, body language is a vital com-

ponent of effective communication. Not only do we

need to sound confident, but our body language must

match the content of our delivery to achieve an ‘air of

confidence’.We must also listen and be sensitive to the

views or points made by the individual or individuals

concerned. Furthermore, we need to acknowledge the

constraints imposed on others when we are pushing to

reach a desired outcome.

Developing assertiveness skillsHaving defined assertiveness and the difference between

assertiveness, aggressiveness, passiveness and passive-

British Journal of Community Nursing Vol 10, No 6 281

Assertiveness: making yourself

heard in district nursingSally Lawton, Fiona Stewart

Sally Lawton is Senior Lecturer in Nursing - Palliative Care,Roxburghe House, NHS Grampian, and Fiona Stewart isManager, Simulated Patient Programme, Medical School, University of Aberdeen Email: [email protected]

ABSTRACTBeing assertive is not the same as being aggressive. Assertiveness is a tool

for expressing ourselves confidently, and a way of saying ‘yes’ and ‘no’ in

an appropriate way. This article explores issues concerned with

assertiveness in district nurse settings. It outlines helpful techniques to

develop assertiveness, such as the broken record, fogging, negative

assertion and negative inquiry.

KEY WORDSAssertiveness Communication District nursing

rnal of Community Nursing. Downloaded from magonlinelibrary.com by 147.197.016.213 on October 12, 2015. For personal use only. No other uses without permission. . All rights res




agg ressiveness, we

want to highlight

some techniques that

can be used to

improve our assertive-

ness skills.

Firstly, we need to

examine why we are

reluctant to be

assertive. It might be

that we do not under-

stand the concept fully

and associate it with

aggressiveness, selfish-

ness or not appearing

to be ‘nice’. Timmins

and McCabe (2005)

report that a lack of

assertiveness may be

associated with a per-

ception that to be

assertive demonstrates

uncaring behaviour. But, as we show in this article,

assertiveness is being able to say what you feel, while

respecting the other person’s point of view. We suggest

that assertiveness is caring behaviour.

For example, you may find that your colleagues contact

you about a patient on a day off or when you are on hol-

iday. Because you do not want to be thought of as uncar-

ing, you do not voice your frustration or feelings of

anger. Instead, you agree to discuss the patient.However,by saying nothing, are you inviting future intrusions into

your well-earned time off?

Saying no in an assertive way –the broken record techniqueHow can we say no in a way that allows us to remain

respectful of the other person?

It is often when we want to say ‘no’ that we find it most

difficult to be assertive.The first technique to try is the

use of repetition which is also known as the ‘broken

record’ technique (Smith, 1975). It is particularly useful

when dealing with people who are unable to take no for

an answer.A new district nurse may be vulnerable to such

approaches. When using this technique, you quietly

repeat a phrase back to the person, as shown in Box 1.

With each repetition, the goal is to stay very calm,keep

your tone of voice the same and avoid g iving in to the

pressure. The broken record technique is an effective

assertiveness skill because you maintain your stance while

still showing respect for the other person.

FoggingAnother aspect of assertiveness is coping with criticism

from colleagues.

Smith (1975) suggests the use of fogging.This involves

listening closely to what the person is saying and

acknowledging that there may be some truth in it.

An example of fogging:

Lisa: You were really late for the meeting with

the new manager, that’s really unacceptable.

Susan: You are right, Lisa, it was unacceptable

that I was late.

When you are using the fogging technique, you are

agreeing with the possibility that the person may be

right.

Negative assertionThe third technique is negative assertion (Smith, 1975).

This is when you accept that you may have made a mis-

take and agree with the criticism. Here is an example of

negative assertion.Norma is a newly qualified district nurse and has found

the assessment of a new patient very difficult.She is being

challenged by a colleague and feels rather defensive about

her lack of confidence.

Kate: Your assessment and care plan is reallyvague and useless, Norma.

Norma: (defensive) Well, I think it is alright.

OR

(negative assertion) You are probably right, Kate,I have found this really challenging and don’t

think I have done my best work.

Negative inquiry You may follow this with a fourth technique of negative

inquiry (Smith, 1975). This is when you follow up the

perceived criticism with a specific prompt to find out

more about the criticism.

For example:

What is it about the assessment that you thinkis particularly vague, Kate?

If the criticism has been just, the individual will be able

to give examples of the problem which may be of help to

you. However, if the criticism is unjust, it is unlikely that

they will be able to generate any specific examples.

282 British Journal of Community Nursing Vol 10, No 6

‘It is often when we want to say ‘no’ that we find it most difficult to be assertive. The

first technique to try is the use of repetition, which is also known as the ‘broken record’

technique. It is particularly useful when dealing with

people who are unable to take no for an answer. A new

district nurse may be vulnerable to such

approaches. When using this technique, you quietly repeat a phrase back to the person.’

Box 1. Example of the broken record technique

Sally: Fiona, will you take the student for me next week?

Fiona: No, I already have a student to take out with me.

Sally: But, another student will not really make much ofa difference…

Fiona: I already have a student to take out with me.

Sally: But you are so good with students, it would reallyhelp me out.

Fiona: I already have a student to take out with me.

Sally: Ok, then, I will ask Katy.




Putting assertiveness skillsinto practiceMaking requestsConsider yourself in the following encounter between a

district nurse and the duty GP in Box 2. Could the use of

assertiveness skills help in this situation? This examplehighlights the use of two techniques described above.

This type of situation can be particularly difficult if you

perceive that the individual carries more influence than

you. Not only is it essential to prepare for this meeting by

having all the relevant details about the patient, but also,

be ready to assert yourself when challenged.

Giving feedbackWhen giving feedback in an assertive manner, one useful

technique is the 3-step ‘I’ message. Look again at the

example about being late for a meeting. If Susan is fre-

quently late for meetings, Lisa might feel that she needs

to discuss the issue. However, the example illustratesa rather aggressive approach when Lisa says ‘Susan,

you are late’.

The three step ‘I’message is a way of giving Susan feed-

back in a more useful and assertive way.

Lisa might rephrase the feedback as follows:

‘Susan, I feel angry when you are late for themeetings with the manager because it means wecannot use her limited time to discuss all thestaffing issues.’

Here, your own feelings are expressed about the issue

and its effect in a particular situation.This is very differ-

ent to the aggressive ‘you make me so angry when you

are late’.

ConclusionConsider the types of encounters when you feel least

assertive. For example, you may feel that the person has

more influence than yourself.As a result you consider that

you have no right to disagree. This could be a situation

similar to that of Jenny and Dr Calder in Box 2. In thistype of scenario, it will help to plan ahead by working

through possible responses beforehand.

The rehearsal of assertiveness skills will also help in

spontaneous encounters when there is no time for plan-

ning.Whether the situation is pre-planned or spontaneous,

you can always learn to assert yourself. BJCN

Bishop S (2000) Develop Your Asser tiveness.. 2nd edn. Kogan Page, London

Deering C (1996) Learning to say no. Am J Nurs 96(4): 62–4

Paterson R (2000) The Assertiveness Workbook: How to express your ideas and

stand up for yourself at work and in relationships. New Harbinger, Oakland

Smith M (1975) When I Say No, I Feel Guilty. Bantam, New York

Timmins F, McCabe C (2005) How Assertive are nurses in the workplace?

A preliminary pilot study. J Nur s Mana ge 13(1): 61–7

British Journal of Community Nursing Vol 10, No 6 283


Box 2. Use of two assertiveness techniques

You have been to visit Mr Roberts who has lung cancer. You feel that his mood is very low and you are concernedabout him. You would like a GP to assess his mental state. However, you have always found today’s duty doctor to bedismissive of your opinions and you anticipate that today will be no different. You have also been taken off-guard or

had insufficient information or time to respond with confidence. The usual outcome of previous encounters is that youeither give in or do not pursue your requests.

Jenny: Dr Calder, I have been to see Mr. Roberts today and I am concerned about his mood. I wonder if he may be depressed.

Dr Calder: He was fine last time I saw him – have you become an expert in mental health now?

Jenny:You are right, I am not an expert in mental health (negative assertion) but I am very concerned about Mr. Robert’s mood (broken record).

Dr Calder: He was fine when I saw him last week.

Jenny: I saw him this morning and I think things might have changed. I am concerned that his mood is very low (broken record).Also, he says that he is not sleeping well, has lost his appetite and has lost

interest in everything. He even said that he feels his life is rather pointless.Dr Calder:You know, Jenny, that does sound different to when I saw him last week. Maybe I should

pay him a visit.

Jenny:Thanks, I would appreciate that.

KEY POINTSAssertiveness is a way of communicating with

another person while respecting both your and their

point of view, without having to resort to aggressive

or passive behaviour.

Thinking about situations when you feel least

assertive is the first step to becoming more assertive.

Practising techniques such as fogging, negative

assertion and negative inquiry will help to develop

your skills.


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