Career Sphere

STOP: A strategy for dealing with difficult conversations

Monica is late for work again. June has body odor. Brian doesn’t comply with the hospital’s cell-phone policy.

As a nurse manager, you know you need to do something. Are you avoiding the tough conversations required to deal with these issues? What’s holding you back from communicating openly with your staff? This article can help you open up your communication style and stop avoiding tough conversations. (See Topics that can make for tough conversations.)

Preparing for difficult conversations

As with anything, preparation is important. Before confronting someone about a prickly topic, ask yourself:

  • What’s the problem?
  • How do I feel about it?
  • What do I want to be different?

Suppose you need to confront a staff nurse who has been bullying new nurse graduates. Here are the key questions to ask yourself beforehand, along with possible answers:

  1. What’s the problem? Answer: A staff nurse is bullying new graduates, who aren’t getting the support they need as they transition to the work environment.
  2. How do I feel about it? Answer: I am angry and frustrated. If this keeps up, I will lose staff. There’s also the issue of patient safety if new nurses can’t seek help.
  3. What do I want to be different? Answer: I want the bullying to stop. I want a positive work environment with collaboration and cooperation.

Putting STOP to work

The STOP strategy helps guide you through difficult conversations. Here are the key components:

  • State the situation or problem.
  • Tell the person what you want.
  • Offer an opportunity to respond.
  • Provide closure (review, summary, or thanks).

State the situation or problem

Sharing facts increases your confidence: for example, “This is the third time this week….” But be sure to separate the behavior from the person doing it. Rather than labeling the person lazy or sexist, describe the behavior. For example, “I’ve noticed that….”


Share your feelings: “I feel…” or “When you do A, I feel B.” Avoid saying, “You make me feel….”
Sometimes it’s hard to start a difficult conversation. Here are some tentative beginnings:

“Perhaps you’re not aware…”

“I’m beginning to wonder…”

“I need your help with something.”

Tell the person what you want

Don’t expect people to know what you want unless you tell them. Suppose your college-age son is home for a weekend and running the washing machine and dryer outside your bedroom at midnight. If you tell him his laundry chores are interrupting your sleep, he may think he should stop at, say, 10 p.m. So be specific: “I’d like you to be done with your laundry by 8 p.m.”

Offer an opportunity to respond

Make this a two-way conversation. Otherwise, you’re just delivering criticism. Invite the other person to respond: “Do you agree?” or “Can we work something out?” or “What do you think about this?” The person’s response provides an opportunity to evaluate how the conversation is going.

Provide closure

To prevent rambling and repetition, review or summarize the conversation. For instance, thank the person for meeting with you: “Thanks for getting together to discuss this important issue. I hope you can improve. We’d hate to lose you. You’re an excellent clinician.”

Using STOP for common workplace problems
Sometimes the best way to learn something is to see examples in common workplace situations. Review the six examples below.

Problem: Tardiness

S: Monday and Tuesday, you arrived 20 minutes late for work.
T: I want you to be here at 6:45 A.M. (Don’t say “You have to be punctual.”)
O: Can we agree to this?
P: Thanks. This will help us work better together.

Problem: Body odor

S: I need to talk to you about a personal issue, and there’s no way to make it easy for either one of us. I’ve noticed you often have body odor that you may not be aware of. It could be your personal hygiene, diet, or a physical problem.
T: I hope you’ll check this out and do something about it. I’m sure you can improve this situation.
O: Am I making sense?
P: Thanks for meeting with me.

Problem: Sexual harassment

S: Perhaps you’re unaware that when you talk to me, your eyes move up and down my body.
Sometimes, you put your hand on my shoulder or around my waist. These behaviors make me uncomfortable.
T: I want them to stop.
O: Can we agree to this?
P: Thanks. That will help us work together better.

Problem: Incivility

S: The way you told me the staff thinks I’m an idiot has me worried. You smiled when you said it. I wonder if you take pleasure in giving me negative feedback.
T: I’d like to have a better working relationship with you. Let’s talk about a different way to speak to one another.
O: So that we can resolve this issue, what’s your take on the situation?
P: Thanks for meeting with me. I want us to work together better.

Problem: Lack of teamwork

S: Working on this project takes a lot of teamwork. You’ve been late with your last two deadlines. I’m frustrated being held up and having to catch up.
T: I want you to have your work done on time.
O: Can we agree to this?
P: Thanks. This is a very important project.

Problem: Dress-code violation

S: I see you have a new eyebrow piercing. It’s a violation of our dress code.
T: Please remove it during work hours.
O: Do you have any other questions about the dress code?
P: Thanks. See you later at the staff meeting.

Getting started

Fear can hold us back from difficult conversations. Fear is based on the importance of the subject and of the relationship. Dealing with a store clerk about a damaged product is easier than dealing with a coworker about body odor. Build your confidence as you practice the STOP strategy in situations with a lower fear factor.

Knowing how to handle tough discussions yields many benefits. (See Reaping the benefits.) The STOP strategy is simple and easy to use. It can improve your communication as you gain confidence and stop avoiding difficult conversations.

Kathleen D. Pagana is a keynote speaker and professor emeritus at Lycoming
College in Williamsport, Pennsylvania. She is the author of The Nurse’s Communication Advantage and The Nurse’s Etiquette Advantage. She is also the coauthor
of Mosby’s Diagnostic and Laboratory Test Reference, 11th ed. To contact her, visit www.KathleenPagana.com.

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