Having a Crucial Conversation

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Some conversations are much more difficult than others, especially in the current environment where emotions are high and staff often feel unappreciated. When I ask leaders today about the tough conversations they are having with staff, the list often includes the following:

• An unwillingness to accept professional accountability for one’s actions.
• Inability to accept constructive feedback.
• Incivility and bullying of other members of the team.
• Negativity toward hospital leadership.
• Disrespectful behavior toward frontline managers.
• Lack of empathy toward patients and families.
• Lack of consideration and backup to other team members.
• Persistent gossip and drama creation.

Crucial Conversations is a book I always recommend to beginning leaders. I have noticed it on the bookshelves of many leader offices I have visited. Whether they are about professional practice issues, time and leave problems, patient safety concerns, or disrespectful behavior, these conversations are never easy.  According to authors Patterson, Grenny, McMillian & Switzler, a crucial conversation involves strong emotions, opposing opinions, and high stakes.  Too often, leaders avoid these discussions until the situation becomes very serious. Learning to manage these tough conversations effectively 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 judgment that you must discuss with a staff member who always reacts defensively?  Be clear about your goals before you hold the conversation to 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 discussion.

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 vigilant monitor of how you are behaving in a conversation and the impact you are having.

3.  Make it Safe

Make it safe for 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 a crucial conversation involves something that has made you very angry, it is important to get in touch with your feelings about the situation. Why do you feel the way 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 a 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, so 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 conducting conversations where they expect considerable pushback from the staff members 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 to improve their relationships with others and help them grow as leaders.

Read to Lead

Patterson, K., Grenny, J., McMillan, R. &  Switzler, A. (2021 Third Edition). Crucial Conversations: Tools for Talking when the Stakes are High.  New York: McGraw-Hill.

© emergingrnleader.com 2023

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