Section 1 – Describe a Crucial Conversation
It was again Patient X, brought in for the second time this month into the emergency department due to a new diabetes complication. The patient was a woman in her fifties, who previously had her leg amputated due to the advancement of diabetes. The physician who attended her ordered lab work to determine the level of glucose, which came back as 1200. The physician immediately asked intravenous insulin medication for the patient, yet Nurse A, who was in charge of the patient’s medication, was not administering her insulin as the physician instructed.
Nurse B, who had a long history with Patient X before being moved to another unit, came to visit her former patient and to encourage her with her treatment, when she heard the physician ordering intravenous insulin to be administered to the patient. She was surprised to see that Nurse A was not in a hurry to respect the physician’s indications, so she approached him. She explained him that he confronted with a high stake situation as the patient had previously had severe problems due to diabetes complications and unless treated promptly the case can aggravate again. When confronting Nurse A, Nurse B showed visible strong emotions towards the diabetes patient’s case, and for this reason her tone was accusing. Nurse A felt he was attacked and immediately riposted by shouting at the other nurse, asking her to leave his unit as she was not working there. He explained her that he knew how to do his job, defending himself that he had done nothing wrong. Although her anger grew when Nurse A showed that he was more interested in protecting his unit from outsiders who had the patients’ wellbeing at their hearts rather than administering the prescribed medication, Nurse B understood that she faced a crucial conversation situation. She knew that she had to change her approach for convincing Nurse A to properly care for Patient X. Nurse B showed signs of active listening, confining Nurse A that he does a great job taking care of all his patients in the unit, changing her opposing views about Nurse’s A irresponsible behavior. However, using a polite, calm and assertive communication, Nurse B informed Nurse A about the consequences that Patient X might face if she was not correctly and promptly administered her medication. To her surprise, Nurse A shut down his reluctance towards Nurse B, put aside his negative emotions and correctly administered the prescribed medication to Patient X.
This crucial conversation evolved quickly and it was handled well and effectively because Nurse B exerted excellent communication skills to convince Nurse B of the gravity of Patient X’s case. The wellbeing and the life of Patient X were in stake, because without prompt administration of intravenous insulin the patient could turn out severe complications and Nurse A could have been accused of malpractice. In the end, the intervention of Nurse B was decisive as the case was resolved and the potential consequences were avoided when Nurse A administered the prescribed medication.
Section 2 – Discuss Strategies
Maxfield, Grenny, Lavandaro and Groah (n.d.) state that in nursing communication breakdowns can be deadly, which was the case of the crucial conversation described above. The authors also indicate that effective communication in nursing implies speaking up, explaining the positive intent regarding the patients and caregivers’ wellbeing, deflecting the interlocutors’ negative emotions or avoiding making accusations (Maxfield et al., n.d.). While Nurse B exerted most of the above-recommended communication skills, she adopted an accusing tone when she initially approached Nurse A. Instead of accusing Nurse B of not handling Patient X according to the physician’s orders, Nurse B should have approached Nurse A in a calm, yet assertive manner, presenting him relevant data and facts about the patient’s history in order to sustain her claim that providing immediate care to Patient X is mandatory. Nurse’s B delay in administering the medication for Patient X can be classified as a honest mistake, as the nurse might have been distracted or had competing tasks (Maxfield et al., n.d.). For dealing with honest mistakes cases in nursing, there is recommended to adopt “handoff protocols, checklists, computerized order entry systems, automated medication, dispensing systems” (Maxfield et al., n.d., p. 2). This type of procedural focused system would contribute to better addressing crucial conversation in the future.
Section 3 – Apply Leadership
One important leadership asset is developing and maintaining trusting relationship, which are funded based on effective communication skills for understanding why people act as they do and for guiding them towards a desired path (England & Morgan, 2012). For advanced practice nurses, greater leadership skills are required for solving problems, for addressing situations wherein they need to step in and guide or develop a patient care process, or for collaborating or following others who are leading a healthcare situation (“The Future of Nursing”, 2010).
In the nursing context described above, there are required leadership strategies to address the crucial conversation problem. More experienced nurses need to act as mentors for their newcomer colleagues, teaching them how to provide adequate healthcare services (“The Future of Nursing”, 2010). Nurse B applied this leadership strategy, using effective communication techniques. Changing other caregivers’ mindset (Felman & Greenberg, 2005) is another leadership strategy in nursing profession, effectively incorporated in the crucial conversation described.
Section 4 – Conclusion
There is a very low tolerance to hesitations or honest mistakes in nursing, as they can lead to losing lives. Likewise, the lack of communication or ineffective communication can negatively impact patients’ and caregivers’ wellbeing. For these reasons and many others, communication and leadership skills are mandatory in the nursing profession. Knowing when to step in and to collaborate or to guide a health care situation in an assertive, yet diplomatic manner is a key leadership skill in nursing profession. Communication is crucial to effective leadership and to solving complex healthcare situations. Accusing tones can only worse situations, while active listening and calm communication, based on objective data can solve complex communication breakdown cases, leading the way to improving patient care. Communication is essential in leadership for describing the gravity of healthcare situations and for providing suggestions or guidance on how to resolve the situations professionally.
References
England, C. & Morgan, R. (2012) Communication skills for midwives: challenges in everyday practice. New York: McGraw Hill Education.
Feldman, H.R. & Greenberg, M.J. (2005) Educating nurses for leadership. New York: Springer Publishing Company, Inc.
Maxfield, D., Grenny, J., Lavandero, R. & Groah, L. (n.d.) The silent treatment. Why safety tools and checklists aren’t enough to save lives. VitalSmarts, AORN & AACN.
The future of nursing: leading change, advanced health. (2010) National Academy of Sciences.
