You need to call the doctor for pain medication for a patient but for whatever reason the doctor on duty makes you nervous. Your patient needs you but you’re nervous and aren’t so sure of yourself. What do you do?
How to Be Assertive
You need to employ a little technique called assertiveness. Remember though, there’s a distinct difference between being assertive and being aggressive. What’s the difference and how can you become more assertive when you feel anything-but?
Not only is being assertive a useful skill in life, nurses are also trusted to advocate for their patients. Here are a few helpful tips to get you started on the road to respect and effective, assertive communication.
1. Be Confident, Not Pushy
When you approach people, you need to have confidence in yourself. Whether it is a difficult doctor or a hurting patient, you need to display confidence in yourself and your ability to speak your mind. You can’t shrink from confrontation and fall into a passive communication style because so much of nursing is about talking to people.
Being assertive is about getting your opinion across and letting the other person know what you want. You have to have enough confidence to know that what you are asking for is a legitimate need for your patient.
The problem with this side of assertiveness is when people become a know-it-all bully. When you are constantly pushing your thoughts and opinions on other people, you are more of a steam-roller than a team player.
It is a difficult balance to achieve when you need to speak your mind as a nurse. Furthermore, if you have a strong personality, toning back your speech to listen to others is even more difficult. Assertiveness does not mean you dominate. It means you speak your mind and work with other people.
2. Listen, Don’t Pretend to Hear
When you are under pressure or emotions get in the way, it’s easy to ignore what the other person is saying. You need your opinion to be heard and this might mean that you don’t listen to the opinions or thoughts of others as much as you should. The problem with this is that you might be wrong.
Being assertive is not simply about getting what you want but about making sure you achieve a fair outcome, where all opinions are taken into consideration. You have to listen to your patient or the doctor to collaboratively make a decision.
Striving to understand the point of view the other person has and examining your own thoughts to reach a win-win result, you need to listen to be assertive and be an active participant in the conversation – or at the very least, to make good return arguments. Listening is the only way you are going to get the best care for your patient.
Open collaboration is an important part of being assertive. Others will remember when you listened to their point of view, and will treat you with the same respect in future engagements.
3. Be Clear, Not Confused
In addition to confidence and listening, you need to be able to make yourself understood when being assertive. Before calling a doctor, gather your information and have it clear in your head. If you get on the phone with the doctor before you have fully formed in your mind what you are going to say, you won’t be able to push them for what you need. You may end up wasting their time and yours, and you won’t help the patient by not really knowing what you need. You need the confidence to clearly state the patient’s troubles, as well as your needs from the doctor.
With patients, clarity is even more important. They can often be scared and confused, in a strange place and medical jargon is thrown at them left, right and centre. Nurses act like a ‘medical translator’. We have to dissect what the doctor said and repackage it in understandable terms for the patient. Again, it is important to have a clear idea of what you want to say about the patient’s condition. Take a moment to gather your thoughts so that you can clearly explain open heart surgery, for instance. Most people won’t understand, but it is through clear, assertive communication that you can help allay your patient’s fears.
Assertive Handover with other Health Professionals – ISBAR
Your patient’s condition is deteriorating and you need to tell the doctor. You have your vitals, your chart, and a full head of information that you want to blurt out as soon as their voice crackles across the line. Chances are, this strategy of communicating with doctors is not going to get you far.
The shotgun method of nurse-doctor communication – double-barrelled, give ’em everything you’ve got – is only going to make them confused, and you frustrated. What’s worse, you may not make your point effectively, and the patient could suffer because of it. You have a very busy, often impatient person listening to you. You have to make the most of your time, and the best way to do that is with organisation and assertive communication.
The ISBAR Method
ISBAR stands for identify, situation, background, assessment, and recommendation. Merely having this structure in your head when picking up that phone to the doctor can make the call flow a bit more smoothly. The doctor on the other end will get a clear picture, you will get all of your information out concisely, and the patient will get the treatment they need.
First, identify who you are, your role and who you are talking about (your patient or client).
The situation part of ISBAR seems self-explanatory, but it can often throw you off when dealing with a patient you are not sure about or just have a bad feeling about.
If the patient fell or has a low blood pressure, it’s easy to state the situation, but what if the patient is diaphoretic, complaining of ‘just not feeling right’, and their vitals are fine? It gets a little more difficult to state the situation when the patient is not presenting something black and white, so you should take some time to think about what is prompting your call to the doctor. What exactly is it that is bothering you? What do you think the doctor can do for you?
(In this section of the report, state concisely whom you are calling about and what prompted the call.)
The background section of this approach has the most variability built into it. If the doctor you are speaking to is an on-call doctor and doesn’t have the slightest idea of who the patient is, you are going to have to give them the basics of the patient’s history.
However, if the patient has been going to this doctor for 30 years, you probably wont need to give as much background.
The timeline leading up to the situation is important. What was the patient doing earlier in the day that may have an impact on the current situation? Did they have some incident or event that has some bearing on how they are acting now?
This type of information is critical in giving the doctor a complete clinical picture of the patient’s condition.
All doctors will ask for them, regardless of the reason you are calling. Pathology, recent test data and any other collected information from the history can also be given at this time. Included in this section is other data that may not fit anywhere else. You can insert how the patient looks to you personally.
Do not be afraid to let the doctor know where your concerns lie. If you do not express that your patient is worrying you, then the doctor will not know enough to be worried themselves. They are basing all of their decisions on what you are telling them. If you leave off your gut feelings that prompted you to call, they are not going to understand the severity of the situation.
Trust yourself and your assessment skills, and tell the doctor what you see.
Recommending a solution to a problem might feel a bit awkward to a nurse, especially newer ones, but doctors are often open to collaboration and do not mind working in tandem with a nurse. However, remember you want to be assertive, not demanding. Often phrasing your thoughts as a question can be a great way of asking for something you think might help your patient.
For instance, you could say that since the patient is so short of breath, would it be possible to get them a stat portable chest x-ray? This allows the doctor to understand your line of thinking and opens the lines of communication between the two of you. If they agree, you got what you wanted. If they disagree, they will likely explain why. By recommending a course of action, you put the ball in the doctor’s court and give them a clear line of action that is going to help your patient.
After all, you know your patient best because you are with them the most (see Communicating with Patients). The doctor knows the medicine. Assertive collaboration with ISBAR, you can come up with a plan to get the patient healthy.
Top Ten Tips For Being Assertive in a Multidisciplinary Team
Here are ten tips for being assertive in multidisciplinary teams. Many of these techniques take practice but will result in you becoming a stronger person, and more professional:
- Be organised
Educate yourself on topics to be discussed; have the necessary facts and resources to support any comments or proposals. This reduces the possibility of being passive, which may allow others to infringe on you.
- Be motivated
A team is only as strong as the motivation and belief of each member in the cause in question. If you are unable to find the motivation, then it would be more professional of you to allow another to take your place on that team.
- Know your role as a team member
The key word to remember is ‘team‘. To make things work and flow efficiently, every member will have a specific role. Each should know their responsibilities as well as understand those of the other members.
- Be willing to learn, be open minded
This is not easy for some individuals but learning new ideas or new methods will always result in growth, both for the team and the individual.
- Always remain calm and professional
If you are feeling angry, do not answer or offer an opinion for a few moments. Gather your thoughts and respond only when you are in control. Aggression in meetings accomplishes little but the creation of bad feelings.
- Learn to truly listen – not just hear
Be willing to let another speak and finish what they want to say before interrupting with your own thoughts or comments. Sometimes people have difficulty expressing what they mean clearly and concisely. If you listen long enough, you may realise what they were trying to say is exactly what you were thinking, or perhaps you will see a new point of view.
- Don’t ridicule others’ opinions, reasons or suggestions
Express your opinions – stand up for your point of view – but respect those of others.
- Keep the best interest of the group in mind
Keep to topic. What is this meeting about? Remain focused on the best outcome. Support the reason for the team and ultimately those whom it helps.
- Use ‘I‘ and avoid ‘you‘ statements when speaking
For example, say, ‘I disagree‘, not ‘You’re wrong‘. ‘You‘ messages often create defensiveness.
- Learn to say no
It is perfectly acceptable to stand your ground on ideas or circumstances in which you truly believe. Simply agreeing to everything because you are afraid to ‘rock the boat’ will ultimately only hurt the strength of the team. It will also defeat the purpose of the meeting, which is not to let one person dominate, but to achieve the best possible outcome.
If you’re not already doing so, try putting some of these tips into practice over the next few weeks.
Being assertive takes practice. It is neither helpful nor respectful to your professional contribution to be passive or aggressive. Assertive communication makes you a stronger team player and can help the team better meet its goals and improve patient outcomes in a more timely and effective manner.
[show_more more=”Show References” less=”Hide References” align=”center” color=”#808080″]
- Ayres, A 2014, ‘How to Be More Assertive For Better Communication’, Life Hacker AU, 11 June, https://www.lifehacker.com.au/2014/06/how-to-be-more-assertive-for-better-communication/
- Blanche, A 2017, ‘Navigating Your team’s diverse communication styles’, Atlassian Blog, 31 May, https://www.atlassian.com/blog/inside-atlassian/how-to-navigate-diverse-communication-styles-at-work
- Jarboe, E 1999, ‘Speaking Up: How to Be More Assertive’, Pioneer Thinking, viewed 24 November 2016, http://pioneerthinking.com/home/speaking-up-how-to-be-more-assertive/
- Mayo Clinic Staff 2017, ‘Being assertive: Reduce stress, communicate better’, Mayo Clinic, http://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/assertive/art-20044644
- Tartakovsky, M 2016, ‘5 Tips to Increase Your Assertiveness’, Psych Central, https://psychcentral.com/lib/5-tips-to-increase-your-assertiveness/
- Wake, D 2013, ‘Collaboration and Communication’, Ausmed Education, North Melbourne, VIC, https://www.ausmed.com.au/learning-centre/collaboration-and-communication-description
Lynda is a registered nurse with three years experience on a busy surgical floor in a city hospital. She graduated with an Associates degree in Nursing from Mercyhurst College Northeast in 2007 and lives in Erie, Pennsylvania in the United States. In her work, she took care of patients post operatively from open heart surgery, immediately post-operatively from gastric bypass, gastric banding surgery and post abdominal surgery. She also dealt with patient populations that experienced active chest pain, congestive heart failure, end stage renal disease, uncontrolled diabetes and a variety of other chronic, mental and surgical conditions. Her Website.