Crucial Conversations - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, FAAN

Last week, I had a meeting with a nurse leader who is a preceptor to one of my graduate students in nursing leadership. She is a seasoned critical care nurse leader with significant leadership responsibilities. I was impressed with the time that she had taken to share her leadership lessons learned with our graduate student. She has warm, easy going manner and a great sense of humor. On her desk, I noticed a copy of the book Crucial Conversations. She referred to the book as her leadership bible. I just seem to be having many more of these conversations with staff in today’s environment, she observed. Whether they are about professional practice issues, time and leave problems, patient safety concerns or disrespectful behavior, these conversations are never easy. A crucial conversation, according to authors Patterson, Grenny, McMillian & Switzler, is one in which there are strong emotions, opposing opinions and high stakes. Too often, leaders just avoid these discussions until the situation becomes very serious. Learning to effectively manage these tough conversations is an important nursing leadership skill. Some key ideas presented in this important book include the following:

1. Start with the Heart

Before you begin a crucial conversation, ask yourself what you really want to see as an outcome and what is at stake. Begin with the right motives. Do you want to help a staff member improve their performance or behavior? Has the situation moved beyond this, and do you need to help the staff member recognize the need to resign or seek a transfer to another area? Is there an error in judgement that you need to discuss with a staff member who always reacts defensively. Be clear as to what your goals are before you hold the conversation so you can keep it on track, but recognize what is at stake here for you, the other individual and your relationship. This will help you to avoid looking for ways to win, punish or keep the peace during the dicussion.

2. Learn to Look

The goal of a crucial conversation should be to maintain a dialogue. You want to avoid the conversation moving into a mode where both parties become defensive and dialogue breaks down. When conversations feel safe, the dialogue will be free flowing. When it feels unsafe, the dialogue can easily break down. Be a viligant monitor of how you are behaving in a conversation and the impact you are having.

3. Make it Safe

Make it safe for both you and the other party to have a tough conversation. Sometimes these conversations become contentious not because others dislike the content of the conversation, but because they believe you have malicious intent. Mutual purpose becomes important in creating a zone of safety. Identify a shared goal. Look for points of agreement.

4. Master your Story

When the crucial conversation involves something that has made you personally very angry, it is important to get in touch with your feelings about the situation. Why do you feel the way that you do and if you have strong emotions, what is the appropriate way to respond. Separate fact from story by focusing on behavior.

5. State your Path and Explore the Path of Others

In an unemotional way, it is important to share your facts and perspectives during a crucial conversation. At the same time, find out what the other person is thinking. Look for areas of agreement and be sincere in your desire to listen to what is being said. Ask questions to increase understanding.

6. Move to Action

To successfully conclude a crucial conversation, it is important to come to consensus about what will happen next. Document who will do what, by when and settle on a way to follow-up.

Crucial conversations are rarely easy to conduct which is why they are frequently avoided until situations spiral out of control. When possible, don’t allow yourself to get drawn into one of these conversations on the spur of the moment. The key to success in these conversations involves careful planning of how the discussion will be conducted, what you intend to say and what you hope as an outcome. Writing down some key points can be helpful to keep you on track. Some seasoned nurse leaders use their colleagues as sounding boards to practice how they will conduct conversations where they expect considerable pushback from the staff member involved. For beginning nurse leaders, these crucial conversations about tough issues can be especially difficult and sometimes personally painful. Over time, leaders begin to realize that these conversations are necessary, improve their relationships with others and help them grow as leaders.

Read to Lead

Patterson, K., Grenny, J., McMillan, R. & Switzler, A. (2012). Crucial Conversations: Tools for Talking when the Stakes are High. New York: McGraw-Hill.

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