Why Teaching Nurses to Be Assertive for Patients AND Themselves is Essential for Safe Care and Cultures

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Assertiveness, not only so that nurses will speak-up as patient advocates, but for themselves too! Click To Tweet

In an earlier post I highly recommended a TED Talk by Leilani Schweitzer, whose little boy, Gabriel’s heart stopped while hospitalized. All of the alarms that he was hooked up to off had been turned off by a nurse.

leilani schweitzerLeilani is articulate and despite unimaginable emotional pain has found it in her heart to forgive this nurse.  She has a compelling message about the importance of three components of medicine:

  • Transparency
  • Compassion
  • Truth

In this case, all three were utilized in one of the two hospitals involved in the child’s death and contributed to changes in the alarm design and some healing for this Mom.  If you can, please find 15 minutes to listen to her TED Talk

I agree with everything she says and find her to be remarkably astute in her understanding of individual and systems’ failures.  I also see a fourth and somewhat illusive component. Assertiveness for nurses.  Not only so that nurses will speak-up as patient advocates, but for themselves too!  In this case, how does a highly trained professional get to the point that she would do something that appears so egregious?  Part of the answer lies in having the self-awareness and self-respect to say:

  • I’m having a hard time thinking with all of these alarms and interruptions.
  • I’m too tired to work overtime.
  • I need help.  (and ultimately: We need help.)

All of these arise out of a sense of ‘self’ that is critical for patient safety and for sustaining long-term rewarding careers.  The very nature of assertiveness calls upon us to respect our needs and those of others. Nurses must be able to set healthy limits even though it is tricky because patient advocacy is one of our primary duties.  There is a very important difference between being an effective patient advocate as a nurse and being a martyr.

It would be easy to be aghast at the nurse’s action. Who could justify turning off an alarm, not just at the bedside, but the nurses’ station too?    She shouldn’t have. That’s obvious. But seeking to understand has individual and organizational implications that a comprehensive Root Cause Analysis (RCA) will illuminate. Did she have alarm fatigue?  Was there a history of false alarms with this and other patients.  That shift?  That day?  That unit?  Was understaffing contributing to excessive  interruptions and distractions?  Was this nurse on chronic ‘overload‘?

Over the last decade there has been an increased focus on training nurses in assertiveness.  Yet available models such as TEAMSTEPPS and SBAR or ISBAR focus on speaking up to physicians and others for patients.  This is only part of building true assertiveness and I advocate for a deeper process that involves emotional intelligence, respectful listening, and collaborative cultures.  I don’t think we can optimize safe care and safe cultures without it. What do you think?


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What are your thoughts?