Learning to Live in the Gray Zone

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

So how do we teach nurses not to be such black-white thinkers? This is an interesting question asked by leaders in several recent leadership development sessions. One manager gave an example:

Last week, one of my young nurses was assigned to six patients. Working with her was our most experienced patient care technician; his only assignment was supporting her. So she then comes to me and says – I am not supposed to have more than five patients. I explained that we were short-staffed, and I gave her our most experienced PCT, who would help her. It did not seem to matter – she said I violated our staffing guidelines. No matter what I said or did, I could not help her think differently. More and more of our nurses can’t live in a gray zone. Assignments are either seen as fair or unsafe. 

Some of his colleagues added their examples:

Feedback is either seen as positive, or it is bullying.

Patients are either respectful, or they are not.

Preceptors are either supportive, or they are bullies.

My schedule either meets my needs or is unfair.

I am either perfect, or I am a failure.

What this manager is describing is black-and-white thinking. Black-and-white thinking, also known as splitting, is the tendency to view the world in extremes. It is the inability to see the gray in situations; A gray zone is a complex place with ambiguity and so many nuances that sometimes it can be difficult to evaluate something as right or wrong. The current healthcare environment has many areas that fall into this gray zone, with staffing being one of the most challenging.

Today’s young nurses often have no expert nurses as role models for working in a gray zone of ambiguity. Learning to live in that gray zone is crucial for professional development. The more you know and grow, the more you realize how nuanced some situations can be. You have to come to peace with that. All professions have gray zones. Black-white thinking is a denial of the complexities of life. It also happens when people are stressed and anxious and feel their lives spinning out of control. Society is full of black-white thinkers who want more certainty than the current environment can guarantee, so it is not surprising to see this in our work settings.

Some suggestions to help staff live more in the gray zone include the following five tactics:

1. Give out a case situation for discussion and ask for a wide range of viewpoints.
2. Point out language that indicates black-white thinking, such as “always,” “never,” or “this is unsafe.”
3. Ask the staff member if there is another way that they could view the situation or other possibilities that should be considered.
4. Ask whether the reaction is reliant on logic or emotions.
5. Diffuse the language by shifting to gray zone words – such as – I feel this assignment might be unsafe or I am having some difficulty with my preceptor and sometimes think she is bullying me. 

Nothing affects your life more than the way you think. Modern psychology has shown that thinking in black and white often leads to psychological stress. This is an important thing to point out to developing professionals. One way to avoid stress and burnout is to learn to live in the gray zone.