Nursing Leadership: Having Difficult Conversations.

1. Nursing Leadership:  Having Difficult Conversations. Karren Kowalski, PhD, RN, NEA-BC, FAAN Grant, Project Director Colorado Center for Nursing Excellence Public Health Nursing Webinar July 29,2010

2. Objectives: Describe communication and why poor communication can be problematic in the workplace. Explain three types of communication filters. Define human reactions seen during a conflict or difficult situation. List communication tools used in working with peers and staff to provide constructive feedback.

3. Communication • Words 7% • Tonality 35% • Facial & Body Language 58%

4. Humans Communicate: • Thoughts • Ideas • Opinions • Feelings • Emotions

5. Poor Communication Leads to: • Relationship Breakdown • Misunderstandings • High levels of emotion • Judgement • High Drama • Incivility

6. In the workplace: • Very little focus placed on communication • Yet it is essential for smoothly functioning teams

7. Goleman’s Framework for Emotional Competencies

8. Communication Filters 1. MENTAL STATE • Frame of Mind • Optimism vs. Pessimism • Affects information processing • Affects ability to focus on “present moment” • Assumptions • Intentions and Hidden Agenda • Judgments of Self & Others • Belief systems

9. 2. Emotional States • Negative feelings about job, co-workers etc. • Insecurity • Threats • Stress • FEAR • Ego Needs (for approval, perfection, need to be right) • Unhealed Wounds

10. Emotional States (cont) • Positive feelings: (tend to be more resourceful, easy going, open to change) • Joy • Delight • Hope • Humor/laughter

11. 3. Current State of the Relationship • Positive relationships are the foundation of Human Enterprise • Quality of relationships effects productiveness of the team • Unresolved conflicts destroy teams

12. Definitions: • Relationship - the state of being related or connected or bonded together • Conflict - competitive or opposing action of incompatibles: antagonistic state or action, opposing needs, drives, wishes or demands • Confront - to face especially in challenge; meet or bring face to face

13. Awareness Model • Difficult person • Difficult situation • Conflict Empowerment: • Being bigger than the situation in which you find yourself • It’s a Choice

14. Stimuli for upset or reaction: OUTSIDE Trigger: an action by another person or by yourself The responding Feeling is Inside “You Make me Feel so …..

15. Automatic Reactions Stress or Fear (buttons are pushed) Unconscious – fight or flight Create list of responses/reactions • Panic, Defensive, Frustrated, Resentment, • Defensive, Victimized, Sabotaged, Threatened • Anger, Negative, Self-righteous, Attack, Annoyed • Blamed, Sarcastic, Freeze, Clam up, Withdraw, • Counterattack, Walk, Denial

16. Patterns or Cow trails Raised adrenalin Leads to: • Assumptions – we act on them • Examples: • Fused in my car (other drivers)

17. We can go through life reacting to: External World vs. Responding Creatively

18. IN REACTION • FEEL BLAME “You make me Feel ……. “ • THINK JUDGMENT “I think You’re a Jerk” • WANT DEMAND “Why don’t you get a life?”

20. Awareness Model

21. Awareness Model (continued)

22. Communication Practice Session identify feelings or sensations I’m feeling refer to your perspective of the situation, check assumptions I think identify what you want from the relationship or situation I want How I’d like to work together is

23. When correction is needed: ARC STATEMENT A = Action the person has taken R = Reaction from the administrator/leader C = Consequences or impact on other team members Can you see how this negatively impacts the team?

24. ARC STATEMENT

25. references American Association of Critical-Care Nurses (AACN) & VitalSmarts. (2005). Silence kills: The seven crucial conversations for healthcare. San Francisco: The American Association of Critical-Care Nurses. Druskat, V., & Wolff, S. (2001). Building the emotional intelligence of groups. Harvard Business Review,79(3), 81-91. Jason, H. (2000). Communication skills are vital in all we do as educators and clinicians. Education for Health,13(2), 157-161.

26. Morreale, S., Spitzberg, B., & Barge, K. (2001). Human communication: Motivation, knowledge, & skills. Belmont, CA: Wadsworth. Nemeth, C.P. (2008). Improving Healthcare Team Communication: Building on Lessons from Aviation and Aerospace. Aldershot, UK. Ashgate Publishing.  Ltd. Patterson, K., Grenny, J., McMillian, R.; & Switzler, A. (2002). Crucial Conversations: Tools for Talking When Stakes are High. New York, NY; McGraw-Hill.

27. Patterson, K., Grenny, J., McMillian, R.; & Switzler, A. (2004). Crucial Confrontations: Tools for talking about broken promises, violated expectations and bad behavior. New York, NY: McGraw-Hill. • Porter-O’Grady, T. (2004a). Constructing a conflict resolution program for health care. Health Care Management Review,29(4), 278-283. • Porter-O’Grady, T. (2004b). Embracing conflict: Building a healthy community. Health Care Management Review, 29(3), 181-187.

28. QUESTIONS and ANSWERS Karren Kowalski, PhD, RN, NEA-BC, FAAN Contact via email: karren.kowalski@att.net Nursing Continuing Education credits are available for 30 days following the live presentation. In order to receive your evaluation form and nursing contact hour certificate please email your: name, state, email address to: Patti White, MAPHN at pattiwhite105@gmail.com

29. Acknowledgements • New England Alliance for Public Health Workforce Development • Boston University School of Public Health • Massachusetts Association of Public Health Nurses (MAPHN)