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Nurse Assertiveness is Essential to Safe Care and Cultures

Why Teaching Nurses to Be Assertive for Patients AND Themselves is Essential for Safe Care and Cultures

In an earlier post I highly recommended a TED Talk by Leilani Schweitzer, whose little boy, Gabriel’s heart stopped while hospitalized. All of the alarms that he was hooked up to had been turned off by a nurse.




Leilani is articulate and despite unimaginable emotional pain has found it in her heart to forgive this nurse.  She has a compelling message about the importance of three components of medicine:
  • Transparency
  • Compassion
  • Truth
In this case, all three were utilized in one of the two hospitals involved in the child’s death and contributed to changes in the alarm design and some healing for this Mom.  If you can, please find 15 minutes to listen to her TED Talk

I agree with everything she says and find her to be remarkably astute in her understanding of individual and systems’ failures.  I also see a fourth and somewhat illusive component. Assertiveness for nurses.  Not only so that nurses will speak-up as patient advocates, but for themselves too!  In this case, how does a highly trained professional get to the point that she would do something that appears so egregious?  Part of the answer lies in having the self-awareness and self-respect to say:
  • I’m having a hard time thinking with all of these alarms and interruptions.
  • I’m too tired to work overtime.
  • I need help.  (and ultimately: We need help.)
All of these arise out of a sense of ‘self’ that is critical for patient safety and for sustaining long-term rewarding careers.  The very nature of assertiveness calls upon us to respect our needs and those of others. Nurses must be able to set healthy limits even though it is tricky because patient advocacy is one of our primary duties.  There is a very important difference between being an effective patient advocate as a nurse and being a martyr.

It would be easy to be aghast at the nurse’s action. Who could justify turning off an alarm, not just at the bedside, but the nurses’ station too?    She shouldn’t have. That’s obvious. But seeking to understand has individual and organizational implications that a comprehensive Root Cause Analysis (RCA) will illuminate. Did she have alarm fatigue?  Was there a history of false alarms with this and other patients?  That shift?  That day?  That unit?  Was understaffing contributing to excessive interruptions and distractions?  Was this nurse on chronic ‘overload‘?

Over the last decade there has been an increased focus on training nurses in assertiveness.  Yet available models such as TEAMSTEPPS and SBAR or ISBAR focus on speaking up to physicians and others for patients.  This is only part of building true assertiveness and I advocate for a deeper process that involves emotional intelligence, respectful listening, and collaborative cultures.  I don’t think we can optimize safe care and safe cultures without it. What do you think?

Guest post by Beth Boynton RN, MS

Beth Boynton, RN, MS, is a nurse consultant, author, and teacher specializing in communication and collaboration among healthcare professionals and within organizations. She offers interactive workshops, leadership coaching, a ‘whole systems’ approach for culture change efforts, and a new method for building ‘people skills’ called ‘Medical Improv’. She has recently completed her second book, a core text called: Successful Nurse Communication: Safe Care, Healthy Workplaces, and Rewarding Careers which is scheduled to be published by F.A. Davis Publishing Co. Spring 2015. She writes about related issues at, “Confident Voices in Healthcare” blog. Her video, “Interruption Awareness: A Nursing Minute for Patient Safety,” and blog have drawn audiences from all over the world. She is trained in the Professor Watson Curriculum for Medical Improv through Northwestern University Feinberg School of Medicine. She has one grown son who is works in India, loves improv, Zumba dancing, walking, and swimming, and lives in Portsmouth, NH.

You may view Beth's online contiuing education course - 4 Essential Stratefies that Promote Patient Safety. This is a 2 contact hour course that features Beth in 10 short video's designed to engage and teach the student.  This instructional continuing education course is designed for nurses who are in direct care or middle management positions in hospitals; long-term care facilities, and other frontline in- and out-patient practice settings.  Despite 15 years of national focus on improving patient safety outcomes, we continue to have staggering statistics involving preventable deaths, illnesses, and injuries that are due to medical errors. And because communication breakdowns and associated problems with inter-professional relationships have long been major contributors to these alarming problems it is imperative for nurses to develop skills and promote positive interpersonal dynamics. Respectful interactions and effective communication seem simple on paper, yet successful efforts to practice them in the field remain elusive.  In this course, students will examine patient safety statistics and root cause analysis data in order to understand the scope of the problem and how persistent issues with communication and human dynamics are interfering with providing safe care.  This foundation will provide the incentive to commit to exploring and practicing communication strategies that will help to solve them. A basic knowledge of assertiveness, listening, and emotional intelligence is required as students take a ‘deeper dive’ with Beth Boynton, RN, MS to develop their abilities to:  set limits, delegate tasks, and give and receive constructive feedback.
Posted: 3/17/2015 6:51:54 AM
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