The Value of Cognitive Rehearsals in Nursing Leadership

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

Cognitive rehearsals are frequently cited in the nursing literature as a way to help young nurses confront incivility and bullying. The rehearsal of what to say if you are bullied has proven to be extremely valuable and is part of many nurse residency programs. But cognitive rehearsals can also prove quite valuable in leadership. By ‘rehearsing’ ways of dealing with a particular situation, you are then better equipped for when such situations should arise. It can help you to avoid self-defeating behaviors and lower your anxiety level. It also strengthens the possibility of a more positive outcome. The following are some examples that I have used in leadership workshops:

Scenario One

Chris is a new manager in critical care. One of her staff nurses, Gloria, has a pattern of extreme rudeness when talking with staff in other departments. Yesterday, a nurse in the ED attempted to give Gloria a report on a patient ready for transfer. Gloria refused to take the call from the ED stating that she was too busy. Chris took the report herself and was in the room when the patient arrived. Both nurses were upset and exchanged words. You attempted to mediate the conflict. Neither one seemed interested in any further conversation.

Chris has scheduled a coaching session with Gloria. She anticipates that it will be a very difficult conversation because Gloria becomes defensive with feedback. A complicating factor is that Chris is new, and has not built a foundation of trust with Gloria. Chris is anxious and wants to be sure to handle it well. Her director suggests that they do a cognitive rehearsal to simulate what could happen and how Chris should respond. They talk through the event, the behavior and the impact of Gloria’s actions. Initially, Chris was focused on Gloria’s attitude. Her director pointed out that this would not be helpful in the conversation and simulated a variety of responses that Gloria might have if Chris started down this trail of conversation. She asked Chris to simulate how she would stay focused, listen and not react to what was said to her. She advised that Chris write down 3 key points that she needed to make and urged her to be solutions and future-focused. The conversation ended up being much more constructive than Chris anticipated because she walked through this cognitive rehearsal.

Scenario Two

Matt is a Chief Nursing Officer in a community hospital that was recently purchased by a much larger health system. Matt has taken his small community hospital twice through Magnet designation and is proud of the staff. The culture of the new organization is quite different. Less than 5% of their facilities are Magnet and they are very focused on cost-cutting. Matt has been through two rounds of budget cuts already and feels that he can’t cut staffing any further without compromising quality. He is anticipating that this will happen and is in a moral quandary about how to manage it.

Matt decides that he needs executive coaching to help him think through this situation. One of the first exercises that he does is a philosophy of leadership and values identification. His coach points out to him that his philosophy and values should serve as a north star in helping to guide him in future decision making. They also serve as a moral line that he may decide not to cross. Through cognitive rehearsal with his coach, Matt develops a strategy for how he will approach further discussions about cutting staffing. He also decides what line he won’t cross. While this cognitive rehearsal has been painful, Matt does feel more empowered. He may not be confronted with a situation where he decides to walk away from his role because of a values misalignment but if he is – he is ready and at peace.

Cognitive rehearsals in leadership can help you to decrease anxiety, heighten confidence, and improve impulse control by practicing effective ways to address potentially stressful situations. It is a strategy worth employing.

Read Rose Sherman’s new book – The Nurse Leader Coach: Become the Boss No One Wants to Leave