Not there to make friends, but don't make enemies either.

[dudette10, MSN, RN]

I work all over the hospital floors, so I encounter different unit cultures and know nearly every floor nurse in the hospital (minus L&D) and most ancillary staff that comes to the bedside (phlebotomy, RTs, transporters, dietary, even a few rad techs and primarily outpatient HCW like EEG). I have been corrected on policy/procedure, had actions suggested to me, been told what's within the nursing role and not. And I've done the same to others. I *think* I'm well-liked--although I could be wrong--based on people's demeanors when interacting with me and based on the fact that I've been told a few times by a various people (unsolicited) that if they were in the hospital, they would want me caring for them. It's the biggest compliment I've ever received from co-workers. In a recommendation for grad school, one nurse manager wrote that I make working "fun" with my "positive attitude and sense of humor."

That said by way of preamble, there is one and only one nurse that makes me bristle. I reported off to her recently, and I began trying to figure out *why* she makes me bristle. Is it me? Am I being too sensitive? Or is she really bristle-worthy?

She's a newer nurse of less than one year, and, based on what limited interaction I have with her because she works the opposite shift and we only do hand-offs, I think she is a conscientious, thorough nurse with good communication with her patients.

The problem comes in with communication to her co-workers, regardless of role. She is a good advocate, but in advocating, she makes people defensive rather than collaborative. When providing "suggestions" or making requests, there is a tone, a body language, that makes me feel defensive. I don't like feeling defensive. I heard her on the phone with a colleague from another role and it was obvious that she also made him feel defensive. When she talks to the unit secretary, the secretary's face hardens with the briefest of acknowledgements regarding the request. When she says hello to the CNAs, they don't even break a smile and look away almost immediately.

No matter. The whole interaction last evening rolled off my back, but it got me to thinking about communication among colleagues in a more general way. I'd like to get your thoughts on it.

There are a lot of threads around here about communication between colleagues. Some responders seem to advocate ignoring brusqueness and tone at all times and tell the OP to grow a thicker skin. Some responders seem to suggest that if one is otherwise a good nurse, that a difficult communication style be forgiven. Then, there are some that will defend against any type of communication style that's less than Pollyanna with NETY and bullying.

As in many things, I'd like to posit that the answer is somewhere in between. Healthcare is one of the most team-oriented environments of any profession. Effective communication is vital to keep the gears moving and to facilitate on-going collegial relationships. Given the importance of communication in our work, it often doesn't make sense to me when someone here will defend, without question, the actions of unpleasant people that an OP works with. Granted, we only hear one side of the story...

I've seen quite a few good communicators in nursing that each time I've thought, "She's the best I've ever seen." Recently, I met someone who is absolutely perfect for her role that upped the ante. Another nurse and I were talking about her simply extraordinary communication skills, and the other nurse remarked, "That woman could fire me, and somehow I would feel good about it. She's that good."

Not everyone is an extraordinary communicator, but when it comes down to it, and even moderately pleasant communication style CAN get the job done AND be somewhat "easy" for the one on the receiving end of correction/feedback. It's not an either/or proposition. I also feel that communication which makes one defensive is ineffective and puts too much onus on the receiver to sort out their gut reactions in order to react appropriately...so much so that the very important message can get lost, learning is impeded, and a collaborative relationship is not achieved.

What's your perspective on this novella I just wrote? Looking forward to your ideas and thoughts. Specific examples to illustrate your point would be helpful.

[Ruby Vee, BSN]

It's a good topic.

Obviously you're not coming to us crying because this nurse made you feel bad or hurt your feelings and is a big fat bully who needs to be fired. (Whew! Getting sick of those posts!)

The nurse you're describing has issues communicating with others, and unless someone points out to her what you've noticed, she's going to poison her working environment to the point where SHE will be coming to us crying about others bullying HER. At the same times, others will complain that she is bullying them. And as the float nurse, you are not in a position to hold her accountable. That's a tough situation. If she has any friends on the unit, it would be a great kindness for one of them to sit her down and talk to her -- but that's a very difficult thing to do and it takes a true friend indeed to summon the courage for a conversation like that.

A number of years ago, I was going through a difficult divorce. I was angry at my husband, angry at the world and not getting any support from anyone. We had moved to a new city the previous year, 1000 miles from my family and friends, and here's my husband making female friends (intimate female friends) right and left. I was so focused on my problems at home I had no energy to try to make friends, an activity which has never come easily to me. I positively radiated anger and much as I would have liked to, I couldn't shake it off while I was at work. I was probably behaving in exactly the way you describe that nurse behaving. Relationships at work were less than collaborative and I couldn't understand why everyone hated me. My orientee, in what was a truly courageous act, sat me down and told me that I was coming across as angry all the time, and people were responding to that. Things didn't immediately improve. Once I was aware of my level of anger, I still had to work through it. I still had to pay attention to how I was coming across to others -- but at least I had a starting point. Things gradually improved. That orientee has been a lifelong friend, a TRUE friend.

[jadelpn, LPN, EMT-B]

Do not ever let yourself get into a position where you are feeling and internalizing comments to the point of feeling defensive. With that being said, if people are bristling at the sight of this nurse, it could be she is feeling defensive to begin with.

The bottom line is that teamwork and communication become the most critical when there's an emergent situation, a code, something that means that at that point in time, someone's life or lack thereof is in the hands of nurses who HAVE to communicate well.

So I think that the next time you get hand off, and a comment is made that feels like an accusation, you could start by acknowleging "that sounds odd to me, I will look into it today" (in the case of someone doing or not doing something)or "I am not sure what the goal is, but I will talk with the MD about it" You can make some generalized comment about the content of her issues.

Some newer nurses are still in a hyper focused mode, that can come off as witchy. And that they will be losing license at the drop of a hat if things are, in their eyes, 100000% correct. Sometimes they can't see forrest through trees, and that can come off as "attitude". And with seasoned nurses, we have seen the entire forrest and surrounding areas, and the "attitude" is that we all just wanna get home and take a hot shower.

Regardless, just be sure that personlizing doesn't happen. And personlizing to being defensive will not serve you well especially in an emergent situation.

[dudette10, MSN, RN]

Thanks to both of you. Hope more will jump in.

Although this wasn't intended to focus on my interaction with the nurse, jade, I meant that feeling defensive was an auto reaction. I didn't have to think about her comments, then feel defensive; in, fact, it was the opposite: instantly feel defensive, THEN think about what she was saying so her message wasn't lost. That discomfort and what was necessary to overcome it within seconds to effectively continue the task at hand was the basis for my more general thoughts about nurse communication. How tone, body language can impede our critical work.

[caliotter3]

Well, after reading all that, I got curious about just what it is that makes everybody react the way you describe. Wonder if I met this person would I have the same reaction by the end of the interaction.

[LadyFree28, BSN, LPN, RN]

I have witnessed the opposite side; there have been instances where the "soft" communication occurs and then the message is lost.

I try to remain objective and reason with the WHY and other rationales.

I use the "I have a concern" model as a means to communication...there will be people who do choose to still remain lost though, and it's until something happens do they either change or remain the same, and that's unfortunate.

There are a few newbies that are struggling with this; my fellow co-workers that have are more seasoned are attempting to help hone those skills, and their communication is excellent; it's still 50% effective at times; it can be exasperating at times for my colleagues.

[dudette10, MSN, RN]

Well, after reading all that, I got curious about just what it is that makes everybody react the way you describe. Wonder if I met this person would I have the same reaction by the end of the interaction.

Good question. It's one of those things that is very hard to describe. Nothing inappropriate is said, but the tone. Any response seems to be lost in the ether, as if she is so focused on her ideas that others are not considered.

Here's another example, and I hope it leads to a broader discussion, rather than a focus on this nurse. (My fault, maybe I shouldn't have used my interaction with her as my first example.) As orders were coming in for a patient, they were written in a way I wasn't used to for a common timed order. It confused me. I called the senior resident who wrote them to get clarification and to let him know that the way the orders were written would probably cause confusion among subsequent nurses, especially because timing was important, and all tasks for the order series would not be completed during my shift. I called him, and he responds with, "Ok. Next." and "Ok. What else?" I got the distinct feeling he wasn't hearing me, but I let it slide. When the "corrected" orders came in, they were STILL wrong and confusing. I was right, he was not listening to me.

I have worked with this resident for two years, so I knew that part of his problem was that he was stressed. I decided to go talk to him to get these orders corrected. I waltz into the abandoned patient unit set aside as a resident lounge with sleeping rooms, he sees me, and he sighs. I said, "Doc, I know you are stressed out, but that doesn't excuse you from listening to nurses when they call you with questions about orders. If the orders stand the way you've written them, they will not be done properly or on time. Let's fix this in the next five minutes, and I will be out of your perfectly-coiffed hair!"

I ended up behind the keyboard showing him the way to time them properly. At the end, he said, "I'm sorry. Bad day. Still friends?" "Yep," I said with a faux wag of my finger at him, "as long as you listen to me!"

Although we all encourage each other to do what needs to be done, regardless of a doc's reaction, it can be difficult to do. What would have happened if a new employee or new nurse encountered that doc's brusqueness?

[dudette10, MSN, RN]

I have witnessed the opposite side; there have been instances where the "soft" communication occurs and then the message is lost.

Very good point. Although I don't think I have encountered that, maybe the communication was *so* soft that I didn't even recognize that there was a message!

Another example: I have witnessed communication between nurses that have made me want to leave the room before fisticuffs broke out. Both good nurses, both confident in their practice. The one who started questioning the other on her adherence to a brand new protocol *was* right, in my opinion. But anger oozed out of her pores as she was questioning the other. The message was lost because they ended up just not speaking to each other. I had to give the receiver a pass because this new protocol has been causing some problems, and the kinks are being worked out. If approached differently, learning would have taken place, but a Cold War ensued instead.

[jadelpn, LPN, EMT-B]

If you have the familiarity with residents, the "hey I know you have a LOT on your plate, but the orders you sent will not work, so, is it ok if we change the timing to protocol? Or I'll get yelled at, the rest of the nurses will boycott,and I KNOW you don't want THAT to happen!! Can I do a telephone order for the same medication eceterra,but the timing is 0900, 1400, and 2100?"

"Ok ladies, the protocol language stinks, we need to think about it being clearer, but for right now, lets give the benefit of the doubt.I do NOT want to make this area into a WWE ring, so what you are questioning? Hmmm ya, I see your point on this. Ok, here's the plan_______________________. Sound good to everyone? Awesome. Carry on then....."

Sometimes, we can communicate in a less stressful tone, and see each side, therefore getting done what needs to be without the emotions attached.

[dudette10, MSN, RN]

Jade, you couldn't have paid me to get into the conversation between those two nurses! They are both wonderful, but, inthat exact moment, they might have literally bit *my* head off!

[ceebeejay]

She's a good nurse, no so good at communication, sounds like she needs an intervention. Some of that effective communication toward her to see if she can take constructive criticism.

[morte, LPN, LVN]

she does need help, more persons are fired for lack of "getting along", then for doing a less than stellar job.