It’s 7:10 A.M. Maggie, the night-shift charge nurse, is waiting to give report to Julie, the charge nurse on the next shift. After a long night in the intensive care unit, Maggie’s eager to go home. She is tired and wants to see her young son before he leaves for school.
Julie’s tardiness is nothing new—which riles Maggie even more. As each minute passes, she grows increasingly annoyed. Finally, at 7:18, Julie breezes in, offering several excuses for her lateness. Biting her tongue, Maggie simply gives report and leaves.
As she drives home, she rehashes the situation, and even starts talking to herself. Actually, she’s talking to Julie in absentia—having the conversation she should have had with her, if only she’d had the courage. She has been frustrated with Julie for months; this is the fifth time she has talked to her about being late. She has even suggested ways Julie can build extra time into her schedule to compensate for delays in the parking deck or waiting for an elevator.
At this point, Maggie dreads having Julie pick up her patients. She has started to doubt Julie’s skills and question her commitment to the unit, and is quickly losing respect for her and trust in her promises.
You’ve probably found yourself in a similar situation: Even though you’ve already had a conversation (or two or three) with someone about a particular issue, nothing has changed.
In Crucial Confrontations: Tools for Resolving Broken Promises, Violated Expectations and Bad Behavior, the authors suggest that if you find yourself addressing the same issue with the same person repeatedly, perhaps you’re not having the right kind of conversation. This tends to happen when the issue is complicated or elicits strong emotions.
Using conversational “CPR”
Crucial Confrontations describes three kinds of conversations:
- Content conversations, which address the situation that has triggered the problem at hand
- Pattern conversations, which focus on the repetitive history of the problem
- Relationship conversations, which address how the problem is affecting the relationship between the parties involved.Conversational “CPR” uses a stepped approach. The first time you confront someone about undesirable behavior, have a content conversation. Ask her to agree to rectify her behavior, meet expectations, follow a rule, or come to some other mutually agreeable outcome. For Maggie, a content conversation isn’t the right one to have with Julie at this time; she has already had it several times, discussing Julie’s tardiness and reiterating the team’s expectation that she show up on time for report.If the other person fails to honor the agreement and keeps engaging in the same behavior, it’s time for a pattern conversation. The focus now shifts from specific behavior to the person’s failure to keep the promise. Maggie and Julie have already had pattern conversations, with Maggie pointing out that Julie hasn’t honored her agreement to be on time for report.If the objectionable behavior continues and begins to disrupt your relationship with that person, you need to have a relationship conversation to discuss the impact of the behavior on your relationship. Maggie has reached this point. Her negative feelings have begun to affect her attitude toward Julie and are jeopardizing their working relationship. Instead of biting her tongue this morning, Maggie should have had a relationship conversation. She should have told Julie how her repeated tardiness and failure to honor her agreement to show up on time are affecting their relationship.The challenge of the relationship conversation
The relationship conversation is more challenging than a content or pattern conversation. It requires skill, honesty, and courage. But if you’ve already had content and pattern conversations—to no avail—a relationship conversation is probably the only one that will get the other person’s attention and spur her to change her ways.Of course, Maggie can’t control Julie or her behavior. But she can create the opportunity for her to recognize the significance and consequences of her behavior—and that can be crucial in triggering a behavior change.
Making the right choice
To determine which kind of conversation is right for your situation, pause and reflect. Ask yourself:
- What do I really want to achieve by discussing this issue?
- What would I say to this person if I weren’t afraid to?
- What do I want for both myself and the other person?
- What part of this situation do I “own”? How have I contributed to it?
Taking a moment to consider these questions will help you center your thoughts and figure out whether you need to have a C, P, or R conversation. Too often, we aren’t clear on exactly what change we’re seeking, and can speak only from the emotions we’re feeling. If you focus on the optimal outcome—for you, the other person, your relationship, and others involved (such as your patients)—you’re better able to choose the right conversation. And having the right conversation is more likely to obtain a successful outcome. A word to the wise: no matter what kind of conversation you have, choose your words carefully.
The CPR approach to conversation requires a bit of reflection and practice, plus a concerted effort to try new ways of communicating. So before you even start to speak, reflect on which kind of conversation will achieve the change you seek.
Patterson K, Grenny J, McMillan R, Switzler A. Crucial Confrontations: Tools for Resolving Broken Promises, Violated Expectations and Bad Behavior. New York, NY: McGraw-Hill; 2004.
Patterson K, Grenny J, McMillan R, Switzler A. Crucial Conversations: Tools for Talking when Stakes are High. New York, NY: McGraw-Hill; 2002.
Stone D, Patton B, Heen, S. Difficult Conversations: How to Discuss What Matters Most. New York, NY: Penguin Putnam, Inc; 1999.
Thornby D. Beginning the journey to skilled communication. AACN Advanced Critical Care. 2006;17(3):266-271.
Denise C. Thornby is Director of Education and Professional Development at Medical College of Virginia Hospitals, VCU Health System, in Richmond, Va.