How To Have Difficult Conversations as a Nurse Manager


Published: 21 September 2016

How do you as the leader set the example? How do you muster up the courage to speak to a team member who has a bad attitude or poor performance?

Fred is habitually late for work and his peers are not happy. Colleagues are always complaining that Sandra takes longer than her allocated breaks. People within the team won’t, or don’t know how to, speak up and tell Fred or Sandra that their behaviour is just not acceptable.

If best practice is not followed when it comes to dealing with performance issues appropriately and sensitively, it can lead to unhealthy and unproductive outcomes that may affect the entire workplace (Australian Government Fair Work Ombudsman n.d.).

When you are afraid or don’t have the skills to tackle under-performance and attitude issues in your team, the culture begins to suffer. Perhaps it’s about not knowing how to make the first step in languaging the conversation. Maybe your skills within this area are a little clunky, and who couldn’t do with a few more strategies to make conversations more effective?

Maybe as a leader you avoid challenging conversations when your ‘fight or flight‘ mechanism in your brain goes into overdrive upon sensing a difficult conversation coming on, because somewhere along the line you have learned that they can be painful (Sochon 2016).

I am sure that you are very aware that procrastinating and burying your head in the sand will not do your culture any favours. The ‘resourceful’ members in your team will pretty soon become fed up, and will begin to feel extremely undervalued when their leader doesn’t step up and address what they see as a requirement of your role.

difficult conversations as a nurse manager

You do know that challenging conversations are not going to go away, and it’s no use pretending that this part of your role doesn’t exist. Your team won’t thank you for not taking action.

What’s more, the Freds & Sandras of this world will continue to disrupt the team, day in day out, week in week out, whilst your accountable team members fast become disillusioned, and are left feeling undervalued when you choose not to address poor performance.

They will identify you as a leader that does not have the backbone to tackle the requirements of your role.

Imagine what it will be like in six months to a year, if you have not found a way to overcome the fear that surrounds these challenging conversations. Consider the work that won’t get done. What will your sick leave be like? How many of your team members will have looked for work elsewhere?

Think about this for a moment. You have conversations with people every day, don’t you? You don’t even give them a second thought. So what is so hard about these so called ‘difficult’ conversations? Why are you are so terrified to take action when you know it is the right thing to do as a leader?

Maybe it goes something a little like this:

  • You make the process about you, you make it personal
    • What if they don’t like me?
    • What if they cry?
    • What if they start yelling at me?
    • What if they threaten me?
  • You don’t know what is going to happen or how they will react
    • You avoid the possible conflict
    • You hope the issue resolves its self
    • You tell yourself that it is not as big as everyone is making out
  • You fear uncertainty, not knowing the outcome
    • You don’t take action
    • You put off the inevitable
    • You stay safe in your comfort zone

Any of this sound familiar? I am sure it does, we have all been there at some stage in our careers.

How To Have Difficult Conversations as a Nurse Manager

Here’s how I turned this fear around and you can too:

  1. What any employee wants in a leader, is an action taker – be courageous and take action now
  2. Put your big person pants on, pull them up, feel the fear and do what needs to be done, this is best practice and a requirement of your role
  3. Take the focus off you and make it about your team member, they need your honesty to improve (and most likely you will be the first person to have honestly addressed their behaviour)
  4. Be empathetic, compassionate & genuinely acknowledge them for being there – remember they will be feeling vulnerable too
  5. Keep your tone even and non-accusing
  6. Remain non-judgemental – there is no judgement or failure, only feedback
  7. Ensure you have all the facts – ask questions, be curious, and seek first to understand. “Don’t go into a difficult conversation with a my-way-or-the-highway attitude” (Knight, 2015).
  8. Address the behaviour not the person (people are never their behaviour)
  9. How can someone improve if they don’t know they have a problem?
  10. Be honest and don’t beat around the bush
  11. Remain confidential and respect the person’s privacy
  12. Seek out a coach or mentor to improve your communication skills even further
  13. The choice to take action is your responsibility – no-one can do this for you.

What are you going to choose to do differently now with the information you have?

Use the tips above to take a different look at how you turn up as a leader, when faced with those challenging conversations. Your team will thank you for it!

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Portrait of Marie McAneney
Marie McAneney

Marie McAneney has a Diploma in Nursing and over 25 years’ experience as a registered nurse. In the past five years, she has held senior leadership roles, leading and managing both small and large teams. In 2011 she completed “The Australian Applied Management Colloquium”, and is currently studying Coaching through the Coaching Institute in Melbourne at the Professional Master Level. She is a qualified Hypnotherapist and Meta Dynamics™ Profiler and Practitioner, which focuses on an individual’s thinking style. She is extremely skilled in human resource and leadership management, with a focus on developing teams and individuals within teams Marie is passionate about influencing positive change within the workplace and its culture, and does this by inspiring and empowering nurse leaders, to lead their teams from where they stand, to rediscover their courage from within, and to effectively language and interact with the people in their world. See Educator Profile

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