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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 . Objectives:.

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Nursing leadership having difficult conversations

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


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.


  • Words 7%

  • Tonality 35%

  • Facial & Body Language 58%

Humans communicate
Humans Communicate:

  • Thoughts

  • Ideas

  • Opinions

  • Feelings

  • Emotions

Poor communication leads to
Poor Communication Leads to:

  • Relationship Breakdown

  • Misunderstandings

  • High levels of emotion

  • Judgement

  • High Drama

  • Incivility

In the workplace
In the workplace:

  • Very little focus

    placed on communication

  • Yet it is essential

    for smoothly

    functioning teams

Communication filters
Communication Filters


  • 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

2 emotional states
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

Emotional states cont
Emotional States (cont)

  • Positive feelings: (tend to be more resourceful, easy going, open to change)

    • Joy

    • Delight

    • Hope

    • Humor/laughter

3 current state of the relationship
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


  • 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

Awareness model
Awareness Model

  • Difficult person

  • Difficult situation

  • Conflict Empowerment:

    • Being bigger than the situation in which you find yourself

    • It’s a Choice

Stimuli for upset or reaction
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 …..

Automatic reactions
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

Patterns or cow trails
Patterns or Cow trails

Raised adrenalin Leads to:

  • Assumptions – we act on them

  • Examples:

    • Fused in my car

      (other drivers)

Nursing leadership having difficult conversations

We can go through life reacting to:

External World


Responding Creatively

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?”

Awareness model continued
Awareness Model (continued)

Communication practice session
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

When correction is needed arc statement
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?


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.

Nursing leadership having difficult conversations

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.

Nursing leadership having difficult conversations

  • 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.

Questions and answers

Karren Kowalski, PhD, RN, NEA-BC, FAAN

Contact via email:

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

Acknowledgements (2004).

  • New England Alliance for Public Health Workforce Development

  • Boston University School of

    Public Health

  • Massachusetts Association of Public Health Nurses (MAPHN)