When was the last time you had to be assertive with a coworker?

Davey Do · Apr 8, 2018

Being productively assertive is something which can come with experience. Or not.

One quality seems to be common with bullies is the negative putdowns of another actions. The victim is usually a nonaggressive, passive individual and the bully's aggressiveness usually is fueled by the victim being a defensive new kid on the block.

The aggressive bully is fueled by defensiveness. Metaphorically speaking, the situation is a battle, where the bully attacks and the victim defends. Since the bully is typically more in a position of power, possessing rank and/or seniority and/or experience and/or minions, the outcome of the battle usually goes to the bully.

One technique in dealing with a bully is metaphorically seen as a dance. Allow the bully to lead, giving the illusion of power. Responding with verbal listening by putting the bully's complaint in your own words and giving it back to them is the first step.

The next step is asking questions pertaining to how the bully believes the situation should be handled. This puts the bully in the spotlight, an endeavored goal, which usually elevates their own self-esteem. Giving the bully feedback, verbal listening, will sometimes appease the bully, but not always.

If at any time during the discourse, the bully says or does anything that is inappropriate, they must be called on it. The simple statement, "That was inappropriate" will suffice. If the bully continues to be unchanging in their way, they again need to be called on it. "You need to stop or deal with the ramifications of your behavior" is one of my favorite confrontational lines. It's a vague statement and leaves the bully only to guess the meaning of the intent.

Some bullies may persist. Holding an open palm facing the bully at your side about shoulder level gives the subliminal message of "stop" and saying something like "This conversation has ended" puts the intended victim in control.

Objective documentation and a follow up action need to take place after such situations.

Now, this is merely an overview of some techniques I've utilized that have worked for me and do not fit every situation. For example, when I felt like I was being bullied in a meeting by two supervisors, I did not say, "stop", but instead said, "I can't handle this right now". When one supervisor said "You will handle this right now!", I merely repeated what I said and left the meeting.

It all came out in the wash.

KelRN215, BSN, RN · Apr 8, 2018

I had to be assertive on Thursday and Friday about the same issue but it had nothing to do with bullying. It had to do with administrative people not being able to see the forest for the trees and not understanding what they were being asked to do.

For example, one of my patients didn't receive his full order of supplies this month. I have been trying to fix it for a week but there was a lot of stupid things going on behind the scene with his Medicaid. Finally we confirmed that he was eligible to remain in our program and the DME benefit manager was supposed to just contact the vendor and tell them that he is eligible/they can send out the remainder of his order (they thought his insurance had changed and wouldn't send out everything he needed). It turned into this whole stupid thing where the person was like "I'm having them send me all this information so I can make a new auth for his next order." And I said, "this needs to happen today. He needs these items now. This cannot wait a month until his next order. And we have a continuity of care agreement since we took over this program from another company, these are existing services and that applies. No new auth is needed at this time. Please tell the vendor to send out the supplies."

Wuzzie · Apr 8, 2018

I wish they'd stop telling you guys that there will be all these bullies out there. It's just not as prevalent as they make it seem. You'll have to deal with all sorts of people. Some of them will not be pleasant. It's just like anywhere else. Adapt and look out for yourself. If you don't like how someone is talking to you ask for clarification. Put your big girl panties on and ignore the eye-rolls (not bullying) and chilly reception (also not bullying). It takes awhile for a new person to find their place in an established group but it will come. Ask questions, ask them how they do things and thank them for their time and input. Someone here said it very well. Two ears-one mouth. It gave me pause when I first heard it put that way. Something we all could chew on.

KelRN215, BSN, RN · Apr 8, 2018

I wish they'd stop telling you guys that there will be all these bullies out there. It's just not as prevalent as they make it seem. You'll have to deal with all sorts of people. Some of them will not be pleasant. It's just like anywhere else. Adapt and look out for yourself. If you don't like how someone is talking to you ask for clarification. Put your big girl panties on and ignore the eye-rolls (not bullying) and chilly reception (also not bullying). It takes awhile for a new person to find their place in an established group but it will come. Ask questions, ask them how they do things and thank them for their time and input. Someone here said it very well. Two ears-one mouth. It gave me pause when I first heard it put that way. Something we all could chew on.

I agree. Most of the time you have to be assertive in nursing has nothing to do with bullying. Here's another example of being assertive that had nothing to do with bullying:

2 month old infant with hydrocephalus, EVD not functioning well, recent bleed.

Me: Neurosurgery Resident, this baby's HR is 83.

Neurosurgery resident: She's sleeping, it's ok.

Me: She's 2 months old, it's not ok.

Very shortly thereafter she's seizing and we're pushing her crib directly into the OR completely bypassing pre-op for emergent surgery.

Sour Lemon · Apr 8, 2018

I'm naturally assertive in my day to day interactions, as are my co-workers. When I occasionally have to "over-explain", it's usually to management.

Buckeye.nurse · Apr 8, 2018

I'm assertive pretty much every day I work. Some days the communication is with a doctor (often for a patient who is declining and needs interventions such as the situation KelRN described). Some days I'm assertive with pharmacy, or radiology, or a PCA, or bed placement. This is a skill that is often needed to adequately advocate for patients as a nurse. You will get better with time.

I struggled with being properly assertive in my early 20's, so I elected to take an assertive communication class as an elective when I went back for my BSN. It's made a world of difference with my confidence. I'm sure you know this already, but learn the difference between being assertive and being aggressive. Using "I" statements helps, as does being concise, and (with physicians) using SBAR.

JKL33 · Apr 8, 2018

Being assertive can be as simple as introducing yourself to someone new in your environment and making them feel welcome.

In my opinion it involves things like being respectful, straightforward, kind, and clear in communication while being aware of how your messages are being received.

It is not the same thing as being aggressive, as noted by buckeye. Aggressive is bad. Assertive is a pleasant and professional way of being, not so much a battle tool solely for difficult situations. In fact, if you can figure out how to be pleasantly assertive I believe you will have few truly difficult situations.

I agree 100% with Wuzzie - don't pay any attention to the idea that you need special pre-warning about rampant bullying. You don't. Proper professional communication is required though, as well as generally treating others the way you would want to be treated and avoid looking to take offense.

If you're concerned about bullying, though, it would be good to start thinking about the milieu in which many bedside nurses work. It's a difficult one. Generally speaking it's a high-pressure job with high responsibility and low authority. Recognize that your peers are making their way through this situation day by day just as you will be. Understanding and camaraderie (giving the benefit of the doubt where possible, for example) go a long way. It would be good for instructors to focus more on these things because while there isn't a schoolyard bully around every corner, there are people who stand to benefit from nurses being hypercritical of one another's normal day-to-day interactions. So we shouldn't do it. And we shouldn't support the idea that it is some epidemic that is ravaging the nursing profession.

Good luck and I hope you will consider the information you're receiving about bullying carefully ~

OldDude · Apr 8, 2018

I wish they'd stop telling you guys that there will be all these bullies out there. It's just not as prevalent as they make it seem. You'll have to deal with all sorts of people. Some of them will not be pleasant. It's just like anywhere else. Adapt and look out for yourself. If you don't like how someone is talking to you ask for clarification. Put your big girl panties on and ignore the eye-rolls (not bullying) and chilly reception (also not bullying). It takes awhile for a new person to find their place in an established group but it will come. Ask questions, ask them how they do things and thank them for their time and input. Someone here said it very well. Two ears-one mouth. It gave me pause when I first heard it put that way. Something we all could chew on.

This is soooo true! One thing to add in regard to "bullying." There can't be a bully without a "victim." So, really it's the "victim" that identifies the "bully." It's so easy to become a victim nowadays as an excuse for not agreeing with someone or getting your feelings hurt. Good info Wuzzie.

KJRod · Apr 9, 2018

Wow! All of you provided me with some great advice and input. It helps to hear from nurses that aren't my professors. It sounds like "bullying" can happen, but it really isn't thaaaaat bad. And a lot of it has to do with how a nurse carries himself or herself, such as avoiding a victim mindset and also knowing what actual bullying behavior is. I am also glad that some of y'all touched on non-bullying matters, like what KelRN215 said, because I know that assertive communication goes beyond the topic of bullying. I get the impression that it gets easier as time goes on. However, I do think that I am relatively assertive as it is and I have already started training myself to communicate in a professional manner. Again, thanks for all the great advice!

inthecosmos, BSN, MSN, RN, APRN · Apr 9, 2018

It depends. Sometimes people mistake "assertive" for aggressive and that's when things get sticky. Making sure whatever you do, you give it time and think through your options before being "assertive."

Davey Do · Apr 9, 2018

Using "I" statements helps, as does being concise

Excellent points, Buckeye.nurse!

For example, "I feel..." cannot be argued.

Being concise, as with objective information, is brief and comprehensive.