Crucial Conversations with Providers

Crucial Conversations with Providers

Crucial conversations are often conversations that need to take place when the stakes are high, opinions vary, and emotions run strong (Ulrich, 2009).  In a research study conducted by VitalSmarts entitled Silence Kills, seven crucial conversations were identified that health care workers continue to fail to have, which include: broken rules, mistakes, lack of support, incompetence, poor teamwork, disrespect, and micromanagement.  As nurses, our role is to be the patient’s advocate.  We need to have the courage to engage in crucial conversations with providers, especially if there is a suspected error that could result in harm to the patient.  It is critical to know that you are not alone and where to seek help.  Our leadership team is always here to be used as a resource and/or support system to our staff. 

A Tool to use in crucial conversations with providers is State My Path. Using this technique will help you to organize the elements of the conversation to enhance the communication.

• S-hare your facts: Describe the elements of the event or situation, starting with the least controversial
• T-ell your story: State the conclusions that you are formulating
• A-sk for other’s paths: Encourage others to share opinions
• T-alk tentatively: Do not disguise your conclusions as the facts
• E-ncourage testing

Resources:

If after the crucial conversation with the provider you still do not feel comfortable with the outcome, trust your gut.  When you believe there is a problem, investigate before it is too late. There are steps as a nurse you can take, please first inform “our team” the charge nurse, nurse leaders, CNS or nurse manager of the situation.  If “our team” is not available the CRN is available and can be paged 24 hours a day.  If the provider is a first year resident, then you can always page their upper resident or the Nurse Practitioner for that department.  If the situation is involving medication, you can contact pharmacy, ask to speak with the pharmacist or use lexi-comp to look up the medication.  No matter what the situation is, you are not alone.  It is important that as nurses, we are our patient’s advocates.  Speaking up saves lives!

References:

Maxfield, D., Grenny, J., McMillan, R., Patternson, K., & Switzler, A.  (2005). Silence kills.  VitalSmarts L.C., Retrieved from http://www.aacn.org/WD/practice/docs/publicpolicy/silencekills.pdf.

Patterson, K., Grenny, J., McMillan, R., & Switzler, A.  (2012). Crucial conversations: Tools for taking when stakes are high.  McGraw Hill (2^nd ED): retrieved from http://home.ikseek.com/DropBox/Crucial%20Conversations.pdf

Ulrich, B. (2009).  Engaging in crucial conversations.  Nephrology Nursing Journal, 36(6), 583.