June 1, 2011
Q: "I am a nurse in the O.R. at a local hospital. At times, out of frustration, certain physicians will throw things at us during surgery—soiled sponges, gauze, and sometimes even instruments. Our hospital has a motto of being 'Physician Friendly,' and yet our greatest asset is our people—all of our people—and the respect that we demonstrate to each other. How do I hold a difficult conversation about this behavior 'on the fly?'"
A: There are really two conversations that need to be held in this situation: a conversation about emotions and an expectations conversation.
The Emotional Conversation
When someone demonstrates defensive or reactionary behavior, remember that their behavior and emotion say more about them than about you. Behind a behavior like this is a violated expectation or personal value. When surgeons act out in this way, it might be that they are attempting to achieve or “get” something they want.
The problem is that this “attacking” behavior usually creates defensiveness in people who are on the receiving end. In an emotional state like this, neither party is thinking rationally. The physician, who is angry, thinks that belittling the nurse will motivate a change in the nurse’s behavior. Wrong! The nurse is probably thinking defensively, having thoughts like these: “What did I do wrong this time?!” or “I wonder if I’ll be able to keep my job.” Whatever they are actually thinking, it is clear that neither party is giving full attention to the patient on the table.
Try these tips to restore rationality to the situation.
Don’t become defensive. Ask yourself questions that will help you stay engaged. Try questions like these:
“What did the doctor expect me to do?”
“What does the surgeon want?”
“What is the physician thinking?”
Ask questions. When people are emotional or defensive they are not in a “thinking” place in their head. Asking people questions that require them to think in order to answer helps to restore their rationality. Try asking the offending physician these questions:
“What do you want me to do?”
“What is most important right now?”
Don’t get hooked if you get a nasty response like one of these:
“Well you should know!”
“If I have to tell you, then you shouldn’t be here!”
“I’ve told you before. Don’t you listen?”
Ignore these accusations and criticisms, and ask the questions again until you see rationality return and you get a viable answer.
Ask, Ask, Ask!
The only thing you need to remember “on the fly” is to ask questions that will increase your understanding and thus improve the situation.
The Expectations Conversation
Once the procedure in the O.R. is over and a patient’s well-being is no longer at stake, it’s time to talk about what happened. For this conversation, you want to spend a few moments thinking and preparing before you engage the physician (which you want to do in private, by the way, and not in front of an audience if possible).
Begin with an Attention Check. Remember the purpose of using an Attention Check is to create engagement, not defensiveness. For example,
“I’d like to talk about meeting your expectations. Do you have a minute?”
Share facts first, then your interpretation. The data of what occurred is followed by your interpretation.
“Obviously, when you threw the sponge at me (Data), I was not meeting your expectations. (Interpretation)”
Ask questions to increase understanding. You can ask questions to check your thinking, such as:
“Is that true?”
Or you can ask questions that increase your learning:
“What were your expectations at that time?”
Be sure to keep asking and listening until you have a clear understanding of expectations.
Summarize and share expectations and consequences. Summarize both of your perspectives—yours and the physician’s. Then share your expectations and consequences. It might sounds like this:
“I want to provide excellent care for our patients and extraordinary support for you. And I want to be clear about meeting your expectations. (Expectations)
When you throw things at me, I become defensive to the point that my productivity might fall even shorter of your expectations. (Consequences)
Does that make sense?”
Establish a Plan. Clearly identify what steps need to take place going forward in order to both meet the physician’s expectations and improve your productivity.
It is easy to remember to ask questions when you are confronted with emotion and irrationality. It is a bit more difficult to craft a conversation about expectations. Notice that the example we gave above does not even address respect—that would be a separate conversation entirely.
When you take a moment to think through the various aspects of any difficult conversation, you will help the conversation go more smoothly, and go further toward achieving your desired results. After all, working to improve the way you work as a team in the O.R. is certainly in everyone’s best interest.