Nursing is as much about negotiation as it is about patient care. We negotiate with patients, with families, with physicians, with other nurses — all day, every day.
Looking at your work this way might cast a different light. What you once perceived as conflict might actually just be a negotiation in progress.
Key Pointers for Successful Negotiation
- Ultimatums are a No-No: “You better do this or else,” is a surefire way for your counterpart to choose “or else.” No one wants to be backed into a corner feeling like they have no choice. If you find yourself closing in on an ultimatum, you’re losing control of the negotiation. Time to try a different strategy.
- Paraphrase your opponent’s words: This tactic has multiple benefits. It forces you to reflect on and validate what the other person is saying, it allows for clarification of any potential misunderstanding, and it gives you time to think.
- Ask questions: Try to get away from “I’m right and here’s why,” and move toward “Why is X so important to you?” or “What about Y concerns you the most?” A patient may not be using their PCA pump because they’re afraid of overdosing. Or they have a false assumption that using narcotics will turn them into an addict. Once you get to the crux of an issue, you can address the problem, rather than talking in circles.
- Focus on fact statements: You’re caring for a patient with congestive heart failure that appears more edematous and hasn’t had stellar urine output. The family admits they sometimes withhold the patient’s Lasix because it’s difficult to manage the increased urination. Rather than attempting persuasion by saying, “I think Mrs. Smith needs her Lasix for her heart,” try a more solid, factual approach: “Mrs. Smith’s heart will not function well if she is overloaded with fluid.” Even though both statements are similar, the second statement is stronger and takes the onus off of you, placing it instead on the facts. The family is more likely to give the Lasix, not because of what you think but because of how Mrs. Smith will medically benefit.
- Find points of agreement: With the same example as above, Mrs. Smith’s family will greatly benefit from feeling heard and validated. Such statements as “I agree that giving diuretics can interrupt several hours of your day due to bathroom needs. That must be very difficult” will open up the conversation to finding solutions to the actual problem at hand.
- Focus on the patient: A neurologist needs to consult on a patient with dementia, but you have just gotten the patient settled after several hours of agitation. The exam isn’t urgent, but the neurologist is adamant that he completes this consult before he moves on to other demands. Rather than refuse by stating, “I will not allow anyone to disturb this patient,” you can say, “This patient has been agitated for hours. Disturbing him now will cause undue stress and anxiety. He will most benefit from a consult later in the day.” The issue no longer is about what you, the nurse want, but what the patient needs. That’s a lot harder to argue with.
There’s a group of patients that make for the toughest negotiators: children. Here’s a special set of strategies to use with the pediatric patient population.
Tips For Negotiating With Pediatric Patients
- Tell the truth: Your job is not just to instill trust in this single encounter, but to help foster trust in healthcare workers for a lifetime. Lying about a procedure or plan of care will only intensify fears. Also, be careful of saying, “all done,” when you’re not, in fact, completely finished. Kids perceive that to mean they’re off the hook, and if they truly aren’t, they’ll come to mistrust those words.
- Let them come to you: If you have the time, try focusing on the caregivers and giving the child little to no attention in the beginning. Once they realize that you’re not going to force them away, they’ll be more likely to be receptive when you do approach.
- Stay firm: Make statements and avoid questions when possible. “Is it OK if I give you a shot now?” will most likely garner a big “No!” And you’ll have to do it anyway. Try instead, “I need to give you a shot now. It will be a pinch, but it will be fast.”
- Give a choice (or the illusion of a choice): “Should we take your temperature first or see how big you are?” “What Band-Aid would you like?” “Do you want to sit on the exam table or on Mommy’s lap?” Giving a child choices helps create a sense of control in an unpredictable environment.
What’s your most effective tactic for negotiating at work, whether with coworkers, adult patients or pediatric patients?