Working Relationships

[perksrn]

I consider myself a very reflective person capable of growth. I analyze my own behavior and look for opportunities to improve. This time I'm at an impass.

Many times in my nursing career I've been accused of being a "know it all" or looking down on others. I can honestly say that every nurse, nurses aid, administrative assistant, etc has a lot to contribute. We all come from a different knowledge base and experience pool and can share our expertise to make each other more well rounded. I've soul searched this belief ensuring I'm not fooling myself that I hold this true. I've come to the conclusion that I wholeheartedly believe that.

Here's where the trouble lies. I have learned to research and validate some things that I am told as a nurse. it isn't that I don't trust people but oftentimes in nursing misinformation gets passed along and we end up with some poor practices not even being aware. I look at policies, rationale and best practice to make sure I am protecting my patients and my license. I speak up if someone is instructing me to do do something that doesn't set right.

An example...

I recently changed career fields. In dialysis, techs are allowed to change CVC dressings. I have, in a previous field, taught this and infection control. As the tech was teaching me she corrected me on how to clean with Chloraprep. I explained why we clean in a back and forth motion. She scoffed at me so I tread carefully afterward...but..she then instructed me to clean the Chloraprep off with an alcohol wipe. So, I pointed out that we wouldn't want to wipe it off since it has antiseptic properties (she also "cleans off" Betadine). She was furious. I pulled the policy and ask her to review it with me. She said she didn't care what the policy said and she was going to continue to do it her way.

This is an example but has happened to me more than once in my career. There are certain things that we can compromise on. If it doesn't impact patient care I'm willing to hear different methods. When it does change the game I try to explain where I'm coming from and ask questions. This is almost always received with defensiveness. I don't know everything, however, I know what I know.

Has anyone else ran into this? Any thoughts/advice?

[angeloublue22, BSN, RN]

Yep, I'm also the "know it all." I like things to be done correctly and with evidence to back it. You were absolutely correct with your information. I think what you are experiencing is our innate resistance to change. To help with better communication, I have learned not to ask why questions when it comes to my colleagues ideas because it feels confrontational, especially when their answer has to be "because we've always done it." I try to get their reasoning with an open mind, then adding some of my knowledge but of course not everyone is going to respond well to being corrected, even if it's for patient safety. I also give scenarios that indicate what could go wrong if the protocol is not followed. I also like to get their knowledge base first. For instance, I would have asked how she thinks Cloraprep works to kill bacteria and how long it needs to remain on the surface to do it's job because most disinfectants need to remain on the surface for a certain amount time to thoroughly eliminate bacteria. There's no easy solution to this situation.

[Orca, ADN, ASN, RN]

You will never get burned for following policy.

[psu_213, BSN, RN]

First, don't stop teaching policy/correct technique. Unfortunately, even the most well intentioned educational moments can come across to some as preachy. Some people just don't like to be told they are wrong and will get an attitude when some tries to correct them, no matter how appropriate the teacher is with delivering the message.

Try being matter of fact, but evidence based....for example, "actually the best practice for applying chloraprep is to use a basket-weave technique." If the person wants to know the rationale, try to make sure you have something better than "it just is." Try to be even toned and not sounding "judgey." Regardless, some people are not going to be happy about getting educated and getting their own knowledge questioned, but, hey, pt safety is on the line.

[llg, PhD, RN]

As I was reading your post, I couldn't help but ask myself ... "Why is the OP asking this question?"

Are your really concerned that other people are offended by your "know-it-all attitude?" Is that something you really want advice on? Would you really like to change your approach to correcting others so that they are more receptive to your suggestions? Or are you just bragging that you are exceptionally careful in your practice and want the people here on allnurses to give you pats on the pack for being "Supernurse" -- and to He** to those inferior people who don't appreciate you as much as you would like them to?

If you really want to be a leader and have your ideas fully appreciated by others, you will work on your interpersonal skills so that your research and knowledge is received better. If not, you'll just go on doing what you are doing. You'll be right about most things, but you will not be as effective a leader/teacher than you might be.

To paraphrase an old saying ... If one person thinks you act like an irritating "know-it-all," they might be wrong. If a lot of people think you act like an irritating "know-it-all," they might be right.

[JKL33]

I think there is much we can do to alter our nonverbals (actually our words, too) so that any information we are giving has a better chance of being received in the tone/spirit we would want if someone needed to deliver information to us.

My most natural tendency is to be "straightforward." I had to learn how to finesse communications. Some thoughts:

- Realize how important rapport with coworkers and good working relationships are. You don't have to be BFFs but you do need to be respectful of and friendly with people.

- Pride and ego are involved here - and not just the pride and ego of the one receiving new information. Admit it, a lot of um, straightforward people who like to know the 'right' way to do things (aka "know-it-alls"), kind of enjoy others knowing that they know something. Even if they themselves aren't aware of their pride issue.

- Realize that, when you are sure you know something, it's super easy to be too straightforward about it, because you don't view it on an emotional level but rather as a "fact" - but that's just not how it plays out for the one hearing your information. It's an awkward situation (it could be). Care is in order.

- Constantly correcting is just not good form. It just isn't. So...try to "worry about your own back yard" as my parents would say, unless it's really important.

- There are a ton of times where you can take the time to be more friendly about it (almost always, unless you are right in the moment watching someone about to make a critical error). What's more important - sharing your knowledge (along with your knowledge that you are "right") or using care so that you might actually be successful with something that is in patients' best interest? Definitely the latter. For example, in the OP situation I would say, "You know, I've heard a number of different ways to do this! Some people wipe it, some don't, some go this way first then that way. I may look at the policy later (don't mind me, that's just how my brain works) - I'll let you know what I find out!"

- **Remember that this individual was likely taught to do this the way she is doing it.** That is important. She didn't originate this "wrong" way. For lack of a better word, it's a little like feeling betrayed to find out that someone taught you wrong and you've been doing something wrong ever since. Embarrassing. Heck, in nursing school I was taught a procedure incorrectly (something very basic - fake example: mixing up something like dorsal and ventral). WELL into my career a kind soul carefully "investigated" our difference in understanding with me, using friendly language (and she probably pretended to be confused about it, bless her heart). She put my feelings above her demonstration of knowledge. That is what I have strived to do ever since.

[vintagemother, BSN, CNA, LVN, RN]

I've observed that many (most?) people I work with don't want to be told anything. I, on the other hand, do want to know if I'm doing something wrong. My close friends at work and I have had conversations about this. We have vowed to eachother that we will correct eachother...because we want to do the right thing for our pts and per our employers guidelines.

We all can have an "attitude" when corrected. But I want to be corrected if I'm wrong.

The hard thing is...sometimes a person will correct you even when you're not wrong. Egos are real. Try to teach in a loving, supportive way, that way it may be more likely to be well received. Better yet, don't teach, question and demonstrate, politely.