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Create better communications

You’ve been assigned a full load of complicated patients. One of them is dying. His family is at the bedside and looks to you for support. After leaving his room, you enter the nurses’ station, and a co­worker immediately asks, “Could you please cover my assignment so I can go to lunch?”

How do you think you’d react?

A. Say “OK,” but immediately regret it and feel angry that she didn’t notice how busy you were.
B. Fly off the handle, exclaiming, “Can’t you see how busy I am?!”
C. Calmly state, “I’m sorry, but I can’t help you right now because I’m extremely busy.”

The assertive edge
We spend approximately 75% of our waking day communicating with others verbally and nonverbally. (Nonverbal communication takes place through such behavior as eye contact, gestures, facial expressions, posture, and positioning.) Obviously, good communication skills are a must. How would you rate yours?

If you chose answer C above, your communication skills are good. This answer describes an assertive, self-confident response that gets your point across in a way that promotes better understanding. It lets your coworker know—in a nonconfrontational way—how you feel and why you can’t cover her assignment. It’s clear and concise, casts no blame, and reflects concern for both your patients’ welfare and your own. It has opened the door for dialogue.

On the other hand…
A response like the one in answer A means you’re avoiding the issue of how stressed you are, opting instead to appease your coworker. This deflates your self-esteem and may leave you feeling angry and victimized. Answer B shows verbal aggression, which may cause others to resent you. You’ve blamed your coworker for not noticing your stressful situation. What’s worse, you expect her to know what your situation is even though you didn’t tell her.


Examining your communication style
Each person has a unique communication style, influenced by such factors as geography, culture, gender, generation, and upbringing. Stress, as from a challenging patient load, also can affect communication style.

To help you evaluate your communication style, use the “look, think, and act” model—a research process described in Action Research in Health, written by Stringer and Genat.

Look at your environment
Examine your work environment closely. Over the course of a work day, with whom do you com-­municate? Are some of these people easier to communicate with than others? Is there someone you try to avoid communicating with? Do your communications leave you feeling frustrated at the end of the day?

Think about your communication skills
All of us can remember times when our communications didn’t go smoothly or somehow went badly despite our best intentions. What could you have done differently in that situation?
If you could see yourself from another’s eyes as you communicate, what would stand out? To make an honest appraisal of your communication skills, answer the following questions:

  • What’s your style of engaging with others? How do you start conversations?
  • Is it easy or difficult for you to communicate assertively?
  • Do you express your thoughts clearly and concisely? Or are you long-winded?
  • Do you expect others to read your mind?
  • Do you withdraw from conflict or remain silent?
  • Do you fly off the handle easily?
  • Do you speak to others as you like to be spoken to?
  • Do you say what’s on your mind at the appropriate time, when the other person is most receptive to your message?
  • Are you as good at listening to others as you are at expressing yourself?
  • What types of nonverbal cues do you communicate? Are you good at picking up on others’ nonverbal cues?
  • Do you find it easy or hard to say “no” to others’ requests?
  • Do you use “I am” messages or “You should” messages a lot?

Act to enhance your communication
Make a list (for your eyes only) of people with whom you communicate easily, and another list of people with whom you’ve had difficult communications. Review your “challenging” list, and try to think of ways you could improve your communications with these people. Here are some suggestions:

  • When starting a conversation, give the other person a chance to speak and state his or her views.
  • When it’s your turn, express your thoughts and feelings clearly and concisely, staying on point. If you’re long-winded, you may lose your listener from the get-go. For instance, when asking your supervisor for time off, be concise. Don’t launch into a long story about when you last had time off and why you need time off now.
  • Don’t over-explain or over-apologize. Avoid statements such as “This may be a stupid question, but…” and “I’m sorry, but…”. These phrases counteract assertive communication.
  • Think before you speak. Don’t rush into an answer you may regret later. If you aren’t sure how to respond, state, “Let me get back to you on that.” If a coworker asks you to work an extra shift for her, don’t reply until you’ve had time to look at your calendar and think about it. Saying “yes” when you mean “no” isn’t assertive and can cause problems down the road.

Practice communicating
Communicating is an art and a skill we can learn—and improve—on a daily basis. Communicating assertively takes practice, but it’s worth it. If your communication skills aren’t up to par, practice expressing yourself in front of a mirror or with a trusted friend.
Another way to improve your communications is to find a role model—someone whose communication skills you admire. Study this person’s communication style and emulate it.

Visualize the best-case scenario
Visualize yourself communicating with others exactly as you’d like to. Visualization is a powerful tool used by public speakers and others rehearsing difficult communication situations; it’s useful in many other areas of life, too. Right now, think of a communication situation that isn’t easy for you, and visualize in every detail how you’d like the situation to unfold. Focus on this image often and associate it with an affirmation, such as, “I am communicating with ease in every situation.”

If a conversation goes awry, don’t be hard on yourself. Instead, reflect on how you might do things differently next time around. Then simply let it go.

Throughout your day, repeat the following affirmations to yourself to help improve your communications and peace of mind:

  • I have no control over others’ responses, only my own.
  • No one is perfect.
  • I will do the best I can in any situation that arises.

Selected references
Clark C. Holistic Assertiveness Skills for Nurses. New York, N.Y.: Springer Publishing Co.; 2003.

Gawain S. Creative Visualization: Use the Power of your Imagination to Create What You Want in Your Life. Novato, Calif.: Nataraj Publishing; 2002.

Seaward B. Managing Stress: Principles and Strategies for Health and Well-Being. Sudbury, Mass.: Jones and Bartlett Publishing; 2004.

Stringer E, Genat W. Action Research in Health. Columbus, Ohio: Pearson Merrill Prentice Hall; 2003.

Cynthia J. Brown, DNS, RN, is a Postdoctoral Research Fellow at the Center for the Study of Complementary and Alternative Therapies at the University of Virginia in Charlottesville.

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