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February 22, 2017

Q&A With Nurse B: Overheard A Mean Conversation!

Welcome to Q&A with Nurse Beth Boynton, RN, MS. 

In this 10-part weekly series, we'll be navigating common conflicts in nursing and healthcare with an eye towards shared accountability and co-creative solutions.

Submit your conflict to keith@nursemail.org.


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Dear Beth,

I recently overheard a conversation among several home health nurses that I was uncomfortable with, and I’d like to hear your thoughts. Basically, one nurse was describing another nurse’s behavior with a patient, and the group was laughing; the nurse being talked about was not present. The conversation went something like this:

I heard that Peggy told one of her patients, Mrs. Jones, that she needed to stop humming while she was prefilling her insulin syringes.

To this, some of the other nurses responded with laughter and brief comments such as:

Nurse 1:  Oh, brother; I like Mrs. Jones’ humming.

Nurse 2:  Peggy can be very bossy; that’s why she gets a lot of complaints.

Nurse 3:  Why did she need the patient to stop? She couldn’t do the prefill with humming?

I’m the newest nurse on the team and have only been with this organization for a few months. I don’t really know how well these nurses get along; I did sense a sarcastic tone and it made me cringe. Is this harmless chatter or something more serious? Should I have said something, and, if so, what?

Signed,

LEFT ME WONDERING

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Dear LEFT ME WONDERING,

Thanks for sharing a very important scenario for us to discuss. It is possible that this interaction was innocent and good-natured, but it doesn’t sound like it to me. I see three red flags that should be considered, especially given the importance of creating healthy workplaces, promoting respectful communication, and developing effective teamwork, all of which contribute to quality, safe care, and morale. I’ll share my concerns and then offer thoughts about your response.

Red flag #1: The nurse being talked about was not there.

Right away this can create an unhealthy dynamic, because they are talking about the nurse behind her back; this excludes the nurse and could be considered ganging up on her. Peggy is not available to hear their comments and may have been offended or humiliated if she had. I would not rule out a mean-spirited or power-based intention from the nurse who initiated the conversation; maybe this represents an unconscious or subconscious habit that is seen as acceptable within the organizational culture.

In other words, the nurse making the statement about Peggy may not be aware of how such a comment might be hurtful or that she may be building unhealthy alliances that result in Peggy’s exclusion. If this nurse were to receive feedback about her behavior and continue to behave in such a way, I would be more inclined to label her behavior as bullying or passive-aggressive.

Red flag #2: Your sense that the tone was sarcastic and the fact that you cringed.

There are many variables that influence our responses, including personal history, mood, and relationships with the people involved. Nevertheless, responses are signals about what could be going on, and honoring them is a good idea. It is also important to stay open to alternative explanations; you are actually doing this by expressing your curiosity in this letter!

In my opinion – and I know I could be wrong – these comments about Peggy’s supposed statement to Mrs. Jones seem invalidating and therefore disrespectful.  “Oh brother” sounds dismissive, and “I like Mrs. Jones’ humming” attempts to delegitimize Peggy’s experience.  Calling Peggy “bossy” is name-calling, and bringing up other “complaints” sounds presumptuous. Raising the question that Peggy “couldn’t do the prefill with humming” sounds like a put down more than genuine curiosity.  If I am right, then these are passive-aggressive behaviors.

Passive-aggressive behaviors are notoriously difficult to identify and discuss, in part because the same behavior under different circumstances or with innocent intentions could be no more than friendly chiding.  If the team has a strong history of mutual support and respect and/or Peggy was present for the discussion, the comments may have been more innocent. This uncertainty makes some people question how they feel; but rather than question one’s feelings, it is vastly better to acknowledge them and be curious about other explanations.

Red flag #3: Telling someone else what they need.

Assuming that Peggy did tell Mrs. Jones that she needed to stop humming, I see an additional communication issue. Peggy is telling Mrs. Jones that she needs to stop humming, when I suspect that it is Peggy who needs quiet so she can concentrate. There is absolutely nothing wrong with Peggy needing quiet, but her approach with this patient, if it truly occurred, is more likely to end up in a power struggle, with feelings of resentment or anger on the part of the patient.

Put yourself in the patient’s shoes and consider how you might feel with these two different approaches:

“Mrs. Jones, you need to stop humming right now.”

“Mrs. Jones, I’m having a hard time concentrating on your insulin syringes; it is important that I get the right dose. Would you mind not humming while I finish up?”

(Other options include going into another room, wearing ear plugs, or helping Peggy and Mrs. Jones come up with another creative solution.)

Which of these shows ownership? How is one a request and the other an order? How might the answers here impact how Mrs. Jones feels about her role? Can you see how one approach empowers the patient to be a collaborative partner in her care, while the other may nurture a dependent role?

Your Response

There are several strategies for you to consider based on your comfort level. First of all, not joining in the laughter is a statement in and of itself. You might try a diplomatic comment, such as, “I know I need a quiet environment when I’m doing similar tasks.” This will tell them you are not going to jump on the bandwagon in laughing at Peggy, and also introduces this idea that having quiet isn’t a bad thing for a nurse to want.

Another assertive approach could be: “I’m not comfortable with this conversation happening behind Peggy’s back; I’m not sure that you mean to be gossiping, but that’s what it feels like.”  This way, you own your discomfort and offer feedback about what their conversation sounds like without actually accusing the group of gossiping. Although there is no guarantee, some of these nurses might reflect on their own behavior and have less to be defensive about!

If you were in a supervisory role, this could be a great opportunity to talk with the nurses about, and possibly offer training in, giving and receiving feedback. You may also want to find a time to talk with Peggy about what you heard and offer some coaching.

Summary

Communication is much more difficult than it appears, especially when there is real or perceived conflict. Showing ownership and validating others are mainstays of speaking up and listening; this can also help conflicts to be more productive and respectful.

If your organization is looking to build healthy dynamics, this short scenario is rich with learning opportunities. Print it out and bring it to a staff meeting to discuss with your colleagues; if you don’t feel safe doing that, slip it under your supervisor’s door. This could be an safe, effective way to raise awareness about similar patterns in your organization.

Thanks for sharing this very important workplace dynamic with us. I hope this was helpful, and we’d love to hear from you when you’re willing to follow up.

Beth

Next Up: Articulating The Value Of What You Do

Beth Boynton, RN, MS specializes in communication, collaboration, and workplace culture.  She is a Medical Improv Practitioner and author of Confident Voices (CreateSpace 2009) and Successful Nurse Communication (F.A. Davis 2015).  Her third book,  Medical Improv: A New Way to Improve Communication is scheduled for release in 2017.

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