Professional Development

Building Your Communication Skills

In her Harvard University Division of Continuing Education Professional Development website blog, Marjorie Lee North, a consultant for political candidates, physicians, and lawyers, offers advice on:

·      Learning to listen

·      Knowing your audience

·      Paying attention to your nonverbal skills.

You can read the full blog here.

Tips for long-term exercise success

Walking, swimming, cycling, jogging, skiing, aerobic dancing, or any of dozens of other activities can help your heart. They all cause you to feel warm, perspire and breathe heavily without being out of breath and without feeling any burning sensation in your muscles.

Whether it is a structured exercise program or just part of your daily routine, all exercise adds up to a healthier heart. Take the first step by walking. It’s free, easy to do and when you have a walking companion, you’re more likely to stay motivated. Get started with these tips.

Volunteering resources

More than 1.3 billion people across the world lack access to basic healthcare services – mostly because the number of healthcare workers is not rising fast enough to accommodate the demand of a growing global population. The World Health Report says “the right workers with the right skills in the right place doing the right things” can address the need for better global healthcare. Softening the blow of insufficient medical care in developing countries are nurses who volunteer their time, skills and expertise to the cause. Learn more about what you can do here.

Stress-Reducing Creativity

While art therapy is its own field, you can use the benefits of art to express your creative side and drawing skills to reduce stress and get in touch with your feelings. I think most of us knew this instinctively as kids: virtually all of us know the joys of sculpting something (with play-dough), painting something (with fingers), or drawing (with crayons and other materials).


mindful breathing exercises

Mindful Breathing

Tip 1 of 6 Mindfulness Exercises You Can Try Today

This exercise can be done standing up or sitting down, and pretty much anywhere at any time. If you can sit down in the meditation (lotus) position, that’s great, if not, no worries.

Either way, all you have to do is be still and focus on your breath for just one minute. Continue reading »

How to Nail Your Next Nursing Job Interview

Let’s face it. There’s no such thing as “job security” these days. With healthcare constantly shifting and organizations being bought, sold or taken over — you just don’t know if your job is going to be there tomorrow.

So even if you’re reading this post and thinking to yourself, “I don’t need this information. I’m not going on an interview anytime soon,” you never can be sure.

Couple this uncertain climate with the fact that there are thousands, even millions of nursing students graduating every year. Guess what that means? That’s right — a competitive market filled with well-educated professionals looking for their next role.

You’re going to want a way to put yourself ahead of the crowd. To differentiate yourself among all of the well-qualified nurses and nursing students vying for the hiring team’s attention.

Here are 5 tips to help you nail your next nursing job interview

1. Be prepared. This means more than doing your homework on the company you’re interviewing with. Get a good night’s sleep. Research all you can about the organization. Understand the goals, strategic priorities and vision of the employer. Find out who you are interviewing with if you can and look them up on LinkedIn and learn a bit about their professional background. Practice responding to some of the more traditional interview questions ahead of time. Finally, leave your house early so that you show up on time.

2. Ask as much as you tell. Of course, there will be a lot of questions coming at you in an interview. And as you proceed through the interview, you want to answer the questions as a professional. It is also a good idea to come prepared with questions for them. At the end of the interview, it is likely that they will say to you, “Now, do you have any questions for us?” You want to avoid asking questions about the schedule or anything that may have you coming across as anything less than a team player. If you did your research about the organization ahead of time and listened to what they asked you in the interview, you should be able to present 2–3 professional questions back to them. Ask things of them to show that you are interested in the position and the place of employment.

Read more at Health E-careers

night shift nurses tips

How to Recover from Night Shifts

Nurses are no strangers to the ill-effects of working night shifts. Aside from being physically draining, a graveyard schedule can also put them at risk for several health issues like high blood pressure, obesity, and abnormal cholesterol levels.

Despite these negative effects, working night shifts are still inevitable for most nurses especially those who are working in short-staffed hospitals. To help you stay healthy and fit, here are some of the best tips on how nurses can recover from night shifts. Continue reading »

Gaining confidence in public speaking

EVA, a professional practice coordinator, and her team of clinical educators are thrilled to learn that their abstract on an iLead in Nursing initiative (Innovation in LEadership and ADministration in Nursing and Health Care Systems) has been accepted for a concurrent session presentation at the ANCC Pathway to Excellence Conference®. Eva will co-present for 1 hour along with one of her team members. Continue reading »

How to succeed at floating

If you’ve ever floated,  you know the experience can be challenging at times. Wherever you work, you may sometimes feel you don’t have enough hours in the day to complete all your tasks, especially when working in clinical situations less familiar to you. Continue reading »

home care

Ten tips for transitioning from home care nurse to nurse manager

Sarah made the transition from inpatient hospital nurse to home care (HC) nurse 6 years ago. She enjoys her practice and likes helping the patients and families whose cases she manages. Her performance evaluations have been very good.

When her HC organization posts a job opening for nurse manager, Sarah considers applying for it—but wonders to what extent her nursing skills and knowledge would transfer to the manager position. Continue reading »

Dress code

Dress codes matter!

October’s article “What works: Implementing an evidence-based nursing dress code to enhance professional image” ( got me thinking about dress codes and how important this topic is to professionalism, public perception, and patient outcomes (such as satisfaction).

If you Google the term “staff nurse image,” the first pictures that pop up show a nurse wearing a white uniform or a white lab coat and blue scrubs. So despite the fact that white uniforms have been long gone from a nurse’s day-to-day wardrobe, why does the perception of a white uniform still persist?

A unified, professional style for nursing with a unique identity was the norm for decades. From the early 1900s until the 1970s, attire for the female centric profession was a white dress, cap, and hose. For many years, this uniform was linked to nursing, and strictly enforced dress codes ensured the standard didn’t change. However, when the style finally did change and pantsuits as well as colored scrubs became acceptable, public perception didn’t necessarily change with it. Today, nurses’ uniform color and designs reflect the dress code standards of the department or organization.

Public perception and professionalism: Is there a correlation?

Yes—not only does a correlation exist, but research over many years shows that behavior and dress strongly color our perceptions of an individual’s personality, competency, and commitment. Nurses’ professional image, including how we dress, can shape public perceptions of us, which can contribute to our success and potential future achievement.

So, if the evidence is clear that appearance is inseparable from our professional image, why are nursing dress codes so hard to develop and sustain? And why aren’t all nursing uniforms the same? With the shift to value-based healthcare and strong consumer preferences determining where patients go for care, the greater significance of this question is more important now than ever before.

Who’s the caregiver?

In today’s healthcare environment, it can be hard to identify a particular caregiver by role. Nurses, technicians, housekeeping staff—everyone dresses in scrubs. Studies have shed light on the difficulty that patients and families can have singling out registered nurses from other hospital staff. This confusion is a real problem when patients want to talk to a nurse about their care.

Many hospitals, home health agencies, and clinics have taken the dress code issue to heart and implemented uniform programs that help patients quickly identify an employee’s role by the color he or she is wearing. For example, in a given organization, all nurses might wear navy blue; nursing assistants, burgundy; and respiratory therapists, khaki. Some facilities even place a brochure in patients’ admissions packets and hang posters in patient rooms showing different staff functions and the colors they represent. Called “color by discipline,” this system it’s easy to understand. It helps patients determine who’s in charge of their care and who does what, so they’re more likely to ask questions and discuss what’s on their mind.

What’s next?

Research shows patients who are actively involved in their own care and communicate with their healthcare team have a safer, more satisfactory care experience—a goal we all want. I believe uniform dress codes help the patient and family with staff identification and instill confidence they’re being treated by an organized, professional team.

But an organization’s dress code goes only so far. How we personally use that dress code at work to represent ourselves is up to each one of us. How we dress reflects our personal approach to professionalism. (By the way, expect more emphasis on stricter dress codes as more research comes to light about infection rates and the consequences of home-laundered scrubs.)

Yes, dress codes matter. Read the research, understand the evidence, and embrace being the professional you are.


collaborative culture

Conversations to inspire and promote a more civil workplace

“I believe we can change the world if we start listening to one another again. Simple, honest, human conversation…a chance to speak, feel heard, and [where] we each listen well…may ultimately save the world.”
Margaret J. Wheatley, EdD

Given the stressful healthcare workplace, it’s no wonder nurses and other healthcare professionals sometimes fall short of communicating in respectful, considerate ways. Nonetheless, safe patient care hinges on our ability to cope with stress effectively, manage our emotions, and communicate respectfully. Interactions among employees can affect their ability to do their jobs, their loyalty to the organization, and most important, the delivery of safe, high-quality patient care.

The American Nurses Association (ANA) Code of Ethics for Nurses with Interpretive Statements clearly articulates the nurse’s obligation to foster safe, ethical, civil workplaces. It requires nurses “to create an ethical environment and culture of civility and kindness, treating colleagues, coworkers, employees, students, and others with dignity and respect” and states that “any form of bullying, harassment, intimidation, manipulation, threats, or violence will not be tolerated.” However, while nurses need to learn and practice skills to address uncivil encounters, organization leaders and managers must create an environment where nurses feel free and empowered to speak up, especially regarding patient safety issues.

All of us must strive to create and sustain civil, healthy work environments where we communicate clearly and effectively and manage conflict in a respectful, responsible way. The alternative—incivility—can have serious and lasting repercussions. An organization’s culture is linked closely with employee recruitment, retention, and job satisfaction. Engaging in clear, courteous communication fosters a civil work environment, improves teamwork, and ultimately enhances patient care.

In many cases, addressing incivility by speaking up when it happens can be the most effective way to stop it. Of course, meaningful dialogue and effective communication require practice. Like bowel sound auscultation and nasogastric tube insertion, communication skills can’t be mastered overnight. Gaining competence in civil communication takes time, training, experience, practice, and feedback.

What makes for a healthy workplace?

The American Association of Critical-Care Nurses has identified six standards for establishing and sustaining healthy work environments—skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership.

In my own research, I’ve found that healthy work environments also require:

  • a shared organizational vision, values, and team norms
  • creation and sustenance of a high level of individual, team, and organizational civility
  • emphasis on leadership, both formal and informal
  • civility conversations at all organizational levels.

I have developed a workplace inventory that individuals and groups within organizations can use as an evidence-based tool to raise awareness, assess the perceived health of an organization, and determine strengths and areas for improvement. The inventory may be completed either individually or by all team members, who can then compare notes to determine areas for improvement and celebrate and reinforce areas of strength. (See Clark Healthy Workplace Inventory.)

How to engage in challenging conversations

One could argue that to attain a high score on nearly every inventory item, healthy communication must exist in the organization. So leaders need to encourage open discussion and ongoing dialogue about the elements of a healthy workplace. Sharing similarities as well as differences and spending time in conversation to identify strategies to enhance the workplace environment can prove valuable.

But in many cases, having such conversations is easier said than done. For some people, engaging directly in difficult conversations causes stress. Many nurses report they lack the essential skills for having candid conversations where emotions run high and conflict-negotiation skills are limited. Many refrain from speaking with uncivil individuals even when a candid conversation clearly is needed, because they don’t know how to or because it feels emotionally unsafe. Some nurses lack the experience and preparation to directly address incivility from someone in a higher position because of the clear power differential or a belief that it won’t change anything. The guidelines below can help you prepare for and engage in challenging conversations.

Reflecting, probing, and committing

Reflecting on the workplace culture and our relationships and interactions with others is an important step toward improving individual, team, and organizational success. When faced with the prospect of having a challenging conversation, we need to ask ourselves key questions, such as:

  • What will happen if I engage in this conversation, and what will happen if I don’t?
  • What will happen to the patient if I stay silent?

In the 2005 report “Silence Kills: The Seven Crucial Conversations for Healthcare,” the authors identified failing to speak up in disrespectful situations as a serious communication breakdown among healthcare professionals, and they asserted that such a failure can have serious patient-care consequences. In a subsequent report, “The Silent Treatment: Why Safety Tools and Checklists Aren’t Enough to Save Lives,” the authors suggested a multifaceted organizational approach to creating a culture where people speak up effectively when they have concerns. This approach includes several recommendations and sources of influence, including improving each person’s ability to be sure all healthcare team members have the skills to be “200% accountable for safe practices.” Ways to acquire safe practice skills include education and training, script development, role-playing, and practicing effective communication skills for high-stakes situations.

Creating a safe zone

If you’ve decided to engage in a challenging conversation with a coworker who has been uncivil, choose the time and place carefully. Planning wisely can help you create a safe zone. For example, avoid having this conversation in the presence of patients, family, and other observers. Choose a setting where both parties will have as much emotional and physical safety as possible.

Both should agree on a mutually beneficial time and place to meet. Ideally, the place should be quiet, private, away from others (especially patients), and conducive to conversation and problem-solving. Select a time when both parties will be free of interruptions, off shift, and well-rested. If a real or perceived power differential exists between you and the other person, try to have a third party present.

You may need to initiate the conversation by asking the other person for a meeting. Suppose you and your colleague Sam disagree over the best way to perform a patient care procedure. You might say something like, “Sam, I realize we have different approaches to patient care. Since we both agree patient safety is our top concern, I’m confident that if we sit down and discuss possible solutions, we can work this out. When would you like to get together to discuss this?”

Before the meeting, think about how you might have contributed to the situation or conflict; this can help you understand the other person’s perspective. The clearer you are about your possible role in the situation, the better equipped you’ll be to act in a positive way. Rehearsing what you intend to say also can help.

Preparing for the conversation

Critical conversations can be stressful. While taking a direct approach to resolving a conflict usually is the best strategy, it takes fortitude, know-how—and practice, practice, practice. Prepare as much as possible. Before the meeting, make sure you’re adequately hydrated and perform deep-breathing exercises or yoga stretches.

On the scene

When the meeting starts, the two of you should set ground rules, such as:

  • speaking one at a time
  • using a calm, respectful tone
  • avoiding personal attacks
  • sticking to objective information.

Each person should take turns describing his or her perspective in objective language, speaking directly and respectfully. Listen actively and show genuine interest in the other person. To listen actively, focus on his or her message instead of thinking about how you’ll respond. If you have difficulty listening and concentrating, silently repeat the other person’s words to yourself to help you stay focused.

Stay centered, poised, and focused on patient safety. Avoid being defensive. You may not agree with the other person’s message, but seek to understand it. Don’t interrupt or act as though you can’t wait to respond so you can state your own position or impression.

Be aware of your nonverbal messages. Maintain eye contact and an open posture. Avoid arm crossing, turning away, and eye rolling.

The overall goal is to find an interest-based solution to the situation. The intention to seek common ground and pursue a com­promise is more likely to yield a win-win solution and ultimately improve your working relationship. Once you and the other person reach a resolution, make a plan for a follow-up meeting to evaluate your progress on efforts at resolving the issue.

Framework for engaging in challenging conversations

Cognitive rehearsal is an evidence-based framework you can use to address incivility during a challenging conversation. This three-step process includes:

  • didactic and interactive learning and instruction
  • rehearsing specific phrases to use during uncivil encounters
  • practice sessions to reinforce instruction and rehearsal.

Using cognitive rehearsal can lead to improved communication, a more conflict-capable workforce, greater nurse satisfaction, and improved patient care.

DESC model

Various models can be used to structure a civility conversation. One of my favorites is the DESC model, which is part of TeamSTEPPS—an evidence-based teamwork system to improve communication and teamwork skills and, in turn, improve safety and quality care. Using the DESC model in conjunction with cognitive rehearsal is an effective way to address specific incivility incidents. (See DESC in action: Three scenarios.)

Other acceptable models exist for teaching and learning effective communication skills and becoming conflict-capable. In each model, the required skills are learned, practiced, and reinforced until responses become second nature. Another key feature is to have the learner make it his or her own; although a script can be provided, it should be used only to guide development of the learner’s personal response.

Nurturing a civil and collaborative culture

Addressing uncivil behavior can be difficult, but staying silent can increase stress, impair your job performance and, ultimately, jeopardize patient care. Of course, it’s easier to be civil when we’re relaxed, well-nourished, well-hydrated, and not overworked. But over the course of a busy workday, stress can cause anyone to behave disrespectfully.

When an uncivil encounter occurs, we may need to address it by having a critical conversation with the uncivil colleague. We need to be well-prepared for this conversation, speak with confidence, and use respectful expressions. In this way, we can end the silence that surrounds incivility. These encounters will be more effective when we’re well-equipped with such tools as the DESC model—and when we’ve practiced the required skills over and over until we’ve perfected them.

Effective communication, conflict negotiation, and problem-solving are more important than ever. For the sake of patient safety, healthcare professionals need to focus on our higher purpose—providing safe, effective patient care—and communicate respectfully with each other. Differences in socialization and educational experiences, as well as a perceived power differential, can put physicians and nurses at odds with one another. When we nurture a culture of collaboration, we can synthesize the unique strengths that healthcare workers of all disciplines bring to the workplace. In this way, we can make the workplace a civil place.

Cynthia M. Clark is a nurse consultant with ATI Nursing Education and professor emeritus at Boise State University in Boise, Idaho. Names in scenarios are fictitious.

Selected references
American Association of Critical-Care Nurses. AACN standards for establishing and sustaining healthy work environments: A journey to excellence. Aliso Viejo, California: Author; 2005.

American Nurses Association. Bullying in the Workplace: Reversing a Culture. Silver Spring, MD: American Nurses Association; 2012.

American Nurses Association. Code of Ethics for Nurses with Interpretive Statements. Silver Spring, MD: Author; 2015.

American Nurses Association. Incivility, Bullying, and Workplace Violence. 2015.

Clark CM. Creating and Sustaining Civility in Nursing Education. Indianapolis, IN: Sigma Theta Tau International Publishing; 2013.

Clark CM. Hardwired for the ‘soft skill’ of civility. September 2, 2014. musingofthegreat

Clark CM. National study on faculty-to-faculty incivility: strategies to promote collegiality and civility. Nurse Educ. 2013;38(3):98-102.

Clark CM. Seeking civility: strategies to create and sustain healthy workplaces. Am Nurse Today. 2014;9(7):18-21.

Clark CM, Springer PJ. Academic nurse leaders’ role in fostering a culture of civility in nursing education. J Nurs Educ. 2010;49(6):319-25.

Clark CM, Springer PJ. Nurse residents’ first-hand accounts on transition to practice. Nurs Outlook. 2012;60(4):e2-8.

Griffin M, Clark CM. Revisiting cognitive rehearsal as an intervention against incivility and lateral violence in nursing: 10 years later. J Contin Educ Nurs. 2014;45(12):535-42.

Laschinger HK, Wong CA, Cummings GG, Grau AL. Resonant leadership and workplace empowerment: the value of positive organizational cultures in reducing workplace incivility. Nurs Econ. 2014;32(1):5-15.

Maxfield D, Grenny J, Lavandero R, Groah L. The Silent Treatment: Why Safety Tools and Checklists Aren’t Enough to Save Lives. Patient Safety & Quality Healthcare; September 26, 2011.

Maxfield D, Grenny J, McMillan R, Patterson K, Switzler A. Silence Kills: The Seven Crucial Conversations for Healthcare. VitalSmarts Industry Watch; 2005.

TeamSTEPPS®: National Implementation. Agency for Healthcare Research and Quality.


Afraid at work

Sometimes certain people have personality problems — and anger problems. If that person happens to be in a position of authority, the result can be violence. This was, indeed, the situation at X University Medical Center, and personnel in the OR Department, as well as nurses in the surgical department, were wary. In fact, they were afraid. One of the surgeons went far beyond being impolite: he was both verbally, and as the following case study illustrates, physically abusive.

In this case, a young nurse was doing the best she could. But it wasn’t good enough or fast enough to satisfy the surgeon who was making a postsurgical hospital visit to a patient. He was trying to remove the patient’s dressing, and the hemostat simply wouldn’t close correctly. As the surgeon became more and more agitated, the young nurse asked if she could help by finding him a new sterile hemostat. Instead of answering, he yelled and threw the hemostat at the nurse, hitting her in her right eye and tearing the skin, causing blood to run down her face. The patient was outraged and yelled at the physician who yelled more at the nurse, who stood there bleeding — too shocked to say anything.

All the noise attracted the attention of the nurse manager, who quickly took charge of the situation (the patient made clear what had happened). The manager had the nurse escorted to the emergency department for stitches and cornered the physician to tell him in no uncertain terms that he was never to assault one of the nurses (or anyone else for that matter). She reported the entire situation to administration and to the chief of surgery.

The nursing staff rallied around the injured nurse, offering help and support. The CNO was furious at what had happened, and the CEO was appalled. They insisted the nurse see a plastic surgeon and also saw to it that the surgeon who initiated the attack paid for it. The chief of surgery insisted the surgeon write a letter of apology to the nurse, which he refused to do. As a result, the surgeon lost his privileges at this hospital.


Much has been written about violence in the workplace, and there is no doubt that violence is never acceptable. However, this is an ethics column and almost everyone agrees that violence in the workplace is wrong. What often is not addressed in the importance of collegial relationships in preventing and diffusing violence — and supporting one another in every way possible. “Understanding nurse-to-nurse relationships and their impact on work environments,” a 2013 study published in Med-Surg Nursing by Moore, Leahy, Sublett, and Lanig, found that many of the nurse participants had considered leaving the profession, had considered leaving a particular hospital, or had left a nursing unit because of poor nurse relationships. The crucial role nurse managers play in establishing good nurse relations was highlighted. Eighty-two staff registered nurses responded to a researcher-developed online questionnaire. The researchers performed a qualitative content analysis, categorizing data according to questions and then analyzing the information for key thoughts. They concluded that a healthy work environment requires sustained positive nurse-to-nurse relationships.

This certainly is one aspect of collegial relationships, but there are many more. What they all have in common is that each aspect ultimately benefits patient care. Nurses, as they assume their professional identities, are pledged to:

  • the work of understanding, interpreting, and expanding the body of the profession’s knowledge.
  • the equally disciplined work of criticism and self-regulation
  • the work of developing and cultivating in themselves and their colleagues those character traits upon which personal and professional excellence depend.

The ethical principles that underlie the formulation of intraprofessional relationships derive from three sources: human rights, shared obligation to promote the public’s welfare, and the development and nurturing of a professional bond. Intraprofessional collegial relationships do not tell one how to act but rather to teach one how to be. To be a nurse is to share in creative, constructive intraprofessional relationships that encourage partnership in the development of a profession whose primary goal is to serve the health needs of others.

If nursing is to continue to evolve (this includes a legally recognized scope of practice, self-regulation, and more), then collegiality must be integrated into each nurse’s development at all levels of professional practice. Thus, faculty, management, and peers must nurture a sense of commitment to the profession and to all its members. Members at all levels of the profession need to own their mutual obligations to one another and to the profession, and nurses of all ranks and levels must seek to improve the systems, institutions, and structures that shape their school and work environments. This action will help our schools and colleges promote the development of critical intelligence and our workplaces promote excellence in practice so that our socialization process in both will support the development of the professional bond.

In this instance, nurses at all levels, ranks, and specialties sought to mitigate the damage and support the young nurse. The hospital and medical staff responded appropriately by removing the surgeon from their staff. However, one is left to wonder if this young nurse was encouraged by anyone to file criminal charges against the surgeon. For, while I am not a lawyer this was no accident. It was deliberate and I would call it assault and battery.

Leah Curtin is Executive Editor, Professional Outreach for American Nurse Today.