By Beth Boynton

“I-Statements” can be time-consuming and emotionally challenging. We have to check in with ourselves about how we feel and why. We also have to be willing to have ownership about our part in a conflict and possible solutions.

Are they too wishy washy for us in healthcare? Do they take too much time? Don’t we need to focus on the next urgent issue and not tip toe around people’s feelings. 

The answer is sometimes yes and sometimes no!

Communication-related or ‘soft’ skills are essential for best outcomes in healthcare and sometimes require more time than we have or think we have. Here is an example and checklist you can use to determine when an “I-Statement” makes the most sense.

The Situation
Three nurses are at the nurses’ station. Two are talking about the new policy on discharge planning. The third nurse, Donna, is documenting a new order she just received on one of her patients.  Donna is finding it difficult to concentrate and the order involves setting up a Patient Controlled Anesthesia pump w/ complex medication orders.  Here are two possible approaches Donna could take:

A)  “Shhhhh, stop talking so loudly!”
B) “I’m frustrated with your loud conversation.  It is hard for me to concentrate on writing these orders correctly.  I’d appreciate it if you would lower your voices or find another place to have your conversation.”

Which do you think she should take?

The Answer:  It depends on what the relationships are and what Donna would like them to be! 

For instance, if Donna has a positive history of working with these two colleagues, and they have established a pattern of mutual respect and collaboration, then they are likely to take a quick “Shhhhh”, apologize, lower their voices, and move on. They may also discuss other options such as a quiet place for Donna to go.

If, on the other hand, Donna doesn’t know these two nurses, or there is tension in their relationship and Donna would like to help all involved get to a more collaborative place, then Donna would be wise to use an “I” Statement.

“I-Statements” can be very effective in many conflicts because they show ownership and respect for other perspectives.  Problem solving involves all stakeholders and commitment to outcomes is inherently increased with a collaborative process.

Since communication and collaboration issues are persistently showing up as root cause factors in safety statistics,  doesn’t it make sense to incorporate communication strategies that will build positive relationships at times?

Try using this “I- Statement” checklist with your next conflict to determine whether you should take the time and energy involved to use an one. The more more checks, the more valuable an “I-Statement will be.

“I” Statement Checklist   

• I am trying to repair, build, or maintain a relationship.
• I want to find a solution that works for the other person AND me.
• I value and respect my own opinion.
• I value and respect the opinion of others.
• I am willing to disclose an appropriate amount of personal information.
• I am open to ideas from another.
• I am willing to compromise or collaborate.

Respectful communication and conflict management are challenging and complex, especially with so much going on in our clinical environments.  Nurses’ time IS precious and sometimes making time for tough conversations that help us to build positive workplace relationships should be a priority.

Looking for your next healthcare speaker? Get in touch with us at the Capitol City Speakers Bureau today to make your healthcare event a success!

By Beth Boynton

In applied or medical improv activities, we are always practicing communication skills and building positive relationships in a trusting environment.

With proper facilitation participants practice taking a little more risk, in a safe way to share ideas and build on the ideas of others. Intellectually, these growing edges seem simple. They are not.

​Both sides of the communication coin, listening and speaking up involve sharing power and that can be very challenging. Being more assertive means showing ownership , being accountable, and maybe even wrong. Listening more respectfully requires a letting go of control to make room for other people’s ideas and concerns. 

If our communication is limited then so too are our relationships. Our collaborative problem-solving will be stunted, we may hold resentments about not feeling heard, we’ll have trouble managing conflict, and ultimately will not be bringing our best selves into our team and leadership roles. Another way to explore how the roots of our communication can impact the system and is to look at three of the principles of complex adaptive i.e. human systems; adaptability, the butterfly effect, and flexibility. 

Adaptability
Adaptability refers to the ability of the participants to adapt and learn from changes in their environment. In a high-stakes, high-stress health care environment, we could not be adaptible without consistent, effective and respectful communication.

For example, inviting input on an issue and listening to it is key for engaging staff. Leaders sometimes avoid such engagement, because they assume that staff will expect them to follow all recommendations, which could lead to conflict if they don’t. Instead of validating, considering input and setting limits, they simply avoid asking. Staff who don’t feel heard may become disengaged or use resistance to solutions (consciously or subconsciously) as a passive-aggressive way of being heard. Whereas, many people will accept reasonable limits if they feel heard.

Leaders can also embrace this idea to increase staff accountability for stubborn problems like, for instance, hospital-acquired infections. By asking staff, “What do you need to comply with hand-washing protocols?” and then listening carefully to the responses, they create the conditions for learning new information that might help, and they relay the message that input is valued.

The butterfly effect
The butterfly effect refers to a small event happening in one place, like a butterfly flapping its wings contributing to a large event happening someplace far away, such as a hurricane on the opposite side of the world. The butterfly effect of disrespectful versus respectful communication can be seen in these two health care-related examples:

• A doctor yells at a nurse on Tuesday. On Saturday, she hesitates to call him to report a subtle change in a patient’s condition. Instead, she reports her concern to the oncoming nurse, who makes it a priority to check this patient, but the telemetry alarm beats him to it. The patient dies.
• Nurse A overhears Nurse B talking about her in a negative way and interrupts the conversation. “I’d appreciate it if you have concerns about my work that you discuss them with me directly.” Nurse B apologizes and later helps Nurse A get pain medication to her post-op patient quickly. The patient and his wife feel cared for. The patient experience scores improve.

Emergent behavior
Emergent behavior refers to how we behave in the moment and in relationship to others. To gossip or not, to offer or take in constructive feedback versus avoiding conflict, or to speak up or remain silent about a concern are soft skills that are intrinsic in each of these behaviors:

• The nurse assistant who went in and held a patient’s hand in the middle of the night when she sensed the patient was anxious.
• The surgeon who tells the OR team she expects each of them to watch for and report problems.
• The social worker who reminds the unit coordinator that computer system is going to be down during the evening shift.
• The nurse leader who negotiates budget allocations for delegation skill training for nursing staff and a part-time nurse assistant during the busiest times.
• The housekeeper who shares her insight with the clinical team that a post-op patient’s fear of falling was the reason she was afraid to walk with the physical therapist.

Conclusion
These communication-related skills and how they relate to outcomes in healthcare may be hard to see, but now that you know how to look for them, you’ll spot them more easily. As you do, you may see or suspect their impact in the workplace.

Did the nurse who hurt her back ask for help? Was the surgeon receptive to challenges during the wrong-site surgery? Would the resident have fallen if the nurse assistant sat with her for a few minutes and listened to her concerns?

Without getting at the roots of assertiveness and listening we will not have, cannot have the healthiest system we owe our patients and providers. 

Looking for your next healthcare speaker? Get in touch with us at the Capitol City Speakers Bureau today to make your healthcare event a success!

By Beth Boynton 

Integrating improv activities into your day to day work can be part of an organizational development effort to boost to morale, improve communication skills, build positive relationships and cultures.

Today we're exploring an incredibly simple activity called “I am”.

If you are willing to take 10 minutes out of a staff meeting, clinical inservice, orientation process or other, you will build positive relationships and promote assertiveness and listening skills! Don’t be fooled by the simplicity of this activity as the results can be profound!

Discovering “I am”
This exercise is simple and promotes trust, self-awareness, empathy, and communication skills. By making time for “I am” in your meeting, you will help staff practice assertiveness and listening while inviting people to get to know each other a little better. 

How to Teach “I am”
On a piece of paper, have staff complete the sentence, “I am _____________” three times.

Tell them they will be sharing with 2-3 others in the group. Give them examples:
“I am excited about this meeting.”
“I am stressed about our new EMR.”
“I am hungry.” 

Give the group 5 minutes or so to complete and then instruct them to share with 2-3 others over the next few minutes. 

Facilitation Tips

• Encourage participants to spent equal time sharing their “I ams” and listening to those of others. 
• Be patient with the initial quietness of this activity. People tend to be tentative at first, yet within a minute or two all sorts of conversations emerge.
• If your group is large use a bell or other signal to wrap up their conversations.
• If time allows or your priorities warrant debrief with questions:

1. What do you think about this improv exercise?
2. Can you describe any learning related to emotional intelligence or communication skills?
3. Is, and if so how, is this activity helpful to the team?​

What do you notice about this activity?  Was it easy to teach?  Did people seem to have fun? Even some who might groan a little?  

There is a lot more to applied improv than meets the eye!

Looking for your next healthcare speaker? Get in touch with us at the Capitol City Speakers Bureau today to make your healthcare event a success!

By Beth Boynton

When I teach Medical Improv, what I’m really teaching are ‘soft’ skills!  The improv is basically an effective strategy for teaching them.

Sometimes I get asked, “What are they?" It is a great question!

Emotional intelligence, interactive, people, relationship, and social skills all come under the umbrella of ‘soft skills’.

Some of these factors involve skills, like listening and assertiveness, yet many involve human awareness, feelings and behaviors. And when we start getting into these areas, things get a little more tricky, right?  They are inter-related, vary among us, and are influenced by almost infinite variables i.e. the weather, being tired, other people’s behavior, and the cultures we work in.

Anything that impacts how we feel and behave, individually and organizationally is likely to influence our ‘soft’ skills. This is why they are challenging to teach.

It is also why Medical Improv is such an exciting teaching tool. Different people learn different things at the same time playing the same activity! In the activity Same Time Story, for example, one person is practicing speaking up while the other is practicing listening.  And it is no small thing that they are having fun and building their relationship too.

What are some examples of ‘Soft’ Skills?

Here is a list that I’ve developed over the years and am often updating with input from participants:

• Trust
• Courage
• Confidence
• Presence
• Divine play
• Public speaking
• Self-awareness
• Self-reflection
• Self-control
• Respect for self and others
• Listening
• Curiosity
• Assertiveness
• Empathy
• Nonverbal communication
• Respect for others’ perspectives
• Collaboration/teamwork
• Ability to lead
• Ability to follow
• Ability to shift between leading and following 
• Flexibility
• Adaptability
• Able to identify emotions in others
• Other _________

What would you add to this list now that you get the general idea? Are there any ‘soft’ skills you are working on?

​Do you have any thoughts on how these skills are related to patient safety, patient experience, or workforce health?

Looking for your next healthcare speaker? Get in touch with us at the Capitol City Speakers Bureau today to make your healthcare event a success!

By Beth Boynton

Daniel Goleman, the psychologist well-known for bringing the term emotional intelligence into mainstream culture with his ground-breaking book, Emotional Intelligence:  Why It Can Matter More than IQ, describes empathy as an important component of social competence. In a more recent article, he describes empathy as a component of effective leadership stating the importance of understanding others’ feelings and points of view.  

Empathy and relationships
Ultimately, empathy is important for building healthy relationships of all kinds, including professional ones with colleagues and therapeutic ones with patients.  It is closely tied to attentive listening where the focus is on the other person.   

Remember only 10-20% of our communication is attributed to the actual words we exchange!  

An empathic person is taking in all sorts of the other 80-90% of information in any given relationship. A nurse with a high degree of empathy has an invisible radar that interprets facial expressions, body language, and tone of voice.  She may be the one on the unit who notes the early signs of a patient’s escalating anger or a colleague’s signs of irritability.  This nurse can be a real asset to the team because he may help prevent a workplace violence incident or get help for a peer who is developing burnout. 

Nurses vary with their ability to start an IV in an elderly dehydrated patient or accurately assess subtle lung sounds before a fluid overload crisis, right? We also vary in our ability to show and feel empathy.   That’s Okay because just like practicing clinical skills, empathy can be developed too!

Many exercises come from the emerging field of Medical Improv where theater activities are used to build emotional intelligence and communication skills. For instance, one activity involves synchronized storytelling aka same-time-story, where two people try to tell the same story at the same time.

How to play synchronized storytelling
This activity requires working in pairs, where one person tells a story while the other acts as a mirror and tries to tell it at the same time. So if I say, ‘Once upon a time,’ the idea is that my partner is going to say that at the same time that I am.

It’s a little slow at first, and what happens is the person following the storyteller becomes intently focused on that person. Because the activity requires almost 100% attention on another person in a safe and fun way, there is a natural opportunity to develop empathy.  

If you decide to try it with a colleague, make sure you both have a chance to play both roles and notice:

• Whether you are thinking of anything besides the person telling the story.
• What hints you get from the storyteller that don’t involve words. 
• How the activity impacts your relationship with your partner.
• What is easy and comfortable for you versus what is unfamiliar.

While this activity and these concepts may seem outside the scope of clinical communication, they open the door to developing awareness and skills associated with empathy.  They also create opportunities to discuss the value of the skillset and when and where it can help in your work as a nurse.

Looking for your next healthcare speaker? Get in touch with us at the Capitol City Speakers Bureau today to make your healthcare event a success!

By Beth Boynton

​Let’s face it, nurses — we’re all different! Millennials grew up with rapid advances and total comfort with technology, more progressive values about women in society and the workplace, and a heightened sense of boundaries and limit-setting. There is so much that Baby Boomer nurses can learn from their Millennial nurse peers. Boomer nurses, on the other hand, have years of valuable experience despite the challenges of providing care amidst inadequate staffing, bullying, and toxic workplace cultures.
​
I have no doubt that if we can build relationships and respect our differences, the things we can learn from each other will have a positive impact on patient care, career paths, and the nursing profession. 
Here are seven tips to help Millennial and Boomer nurses create bridges to thriving interprofessional relationships and all sorts of positive outcomes:

1. Recognize the inherent value in diversity. 
Sometimes our differences are overshadowed by fears or power struggles that are hurtful and keep us separated. Yet diversity is an element of complex adaptive systems that allows for a variety of creative ideas. When the clinically seasoned Boomer nurse joins forces with the tech-savvy Millennial, the possibilities for problem-solving in any given situation are much more than the sum of two parts.

2. Be curious!  
I’ve heard Boomer nurses make unkind and generalized remarks about Millennials and visa versa. Is this necessary? Curiosity is a fundamental listening skill that requires focusing on what we don’t know about another person and a willingness to suspend judgment. Rather than making assumptions about experiences, behaviors, or intentions, consider being curious.  

3. Invite dialogue.  
If you’re a Baby Boomer, use your curiosity to find out what it’s like to be a new nurse in today’s healthcare system. What are the challenges and rewards that your Millennial colleagues are hoping for?  If you’re a Millennial, do you ever wonder what it’s been like to practice nursing with chronic problems like toxic cultures and bullying? Taking the initiative to learn more about each other will automatically build relationships. I bet you’ll have some really interesting conversations, too!

4. When values conflict, show ownership for yours.  
If you don’t like the way someone else is behaving, reflect about what’s going on for you. A Boomer who thinks a Millennial is lazy might really be feeling resentful because their young colleague seems to have a healthier work-life balance and personal boundaries. If that Boomer can identify and deal with such feelings, they’ll have the potential to improve their own self-care. 

5. Validate differences with respect.  
Millennial nurses may find themselves surrounded by Boomer nurses who have much valuable knowledge and skills coupled with very bad habits in terms of bullying and incivility. If younger nurses can express respect for seasoned nurses’ experience while clearly stating that inappropriate behavior is not OK, a whole world of relationships and learning opens up.
 
6. Ask for what you need from each other.  
Do you need help with a decision to call a physician? How about help with the new EMR? In a healthy team of Millennials and Boomers, there’s a dynamic exchange of expertise — and if there isn’t, this is one way to get that ball rolling.

7. Show gratitude for what your colleagues bring to the table! 
Millennial to Boomer:  “Thank you so much for your support when Mr. Jones passed away. He was my first patient death.”  
Boomer to Millennial: “Thank you so much for helping me figure out how to program that new IV pump. I couldn’t get it to work right.”

Conclusion
Yes, Millennials and Boomers are different, and sometimes differences create tensions that interfere with learning, communication, patient care, and mutual appreciation. Can you envision trying out any of these tips on younger or older colleagues? If you can, let us know how it turns out!

Looking for your next healthcare speaker? Get in touch with us today to make your healthcare event a success!