The Magic of Limit-Setting

8 Surprises from One Nurse’s “No”!

by Beth Boynton, RN, MS

For many of us, saying “No” isn’t an easy task.

We may feel guilty that we are not doing enough,

worry that we will disappoint someone, or be

afraid that we won’t be liked or that we’ll receive

a poor performance evaluation. Maybe even all of

the above.

As nurses, we are all part of a “helping” profession,

and sometimes it seems that taking care of ourselves is last on the list. Yet saying “No”, or setting any kind of limit can show respect for ourselves and others and often is a beginning for collaborative problem-solving. Here is a story to show you what I mean. The 8 surprises are summarized at the end.

“No, I can’t,”; said Nancy.

“Please;”; begged her supervisor, “Betty called in sick and there are two post-ops waiting in recovery. We need you!”

Nancy, took a deep breath and sighed. She was trying to become more assertive and was working hard to identify her own needs. She wanted to express them in a healthy way. She had a growing awareness of her tendency to put others first. “Really”, she said quietly, “I can’t”.

“I need you to be a team-player, Nancy,”; her supervisor’s tone had an edge.

Inside, Nancy could feel her heart racing. There were so many things to consider. Why won’t she listen when I say “No”? I am physically and emotionally exhausted. I want to have dinner

with my family. What about my co-workers? The floor is already crazy. I’ve already worked 15 extra hours this week. They won’t like the overtime. I need rest. I want time with my family. I need to be liked and accepted.

The supervisor added, “I’ll give you double time! It’s a crisis! Can’t you stay for 2-3 hours?”

“I’m very tired and have plans with my family. It is hard for me to say “No” and I feel like you are not listening to me.”

“I’m sorry. You’re right. I’m so caught up in finding coverage that I’ve lost sight of much else. I realize that you have already had a hard day of work.”

“Thank you. I see that our unit is in a bind. I want to help and I also want take care of myself. I don’t want to compromise safety. I need to know that long-term solutions are underway. I’ll stay for two hours if we can find safe work.”

“Nancy, I’m glad you spoke up. I appreciate your help and your concerns around it. For tonight, how about handling the discharges you know? They both need a lot of teaching, but no

treatments. Both families are helpful. Does that seem feasible?”

“Yes, I’ll call home. “

“I realize this is a short term fix. I can see that you are considering your own needs and those of the unit. You have also helped me to realize that I could be a more effective listener. These are the kinds of collaboration skills we discuss in our leadership training. The new CNO has encouraged me to come up with a teambuilding project using upper management support and staff input. I think this could be an opportunity and that you would be a great resource. I’ll talk with the CNO, get her thoughts and bring it to next week’s staff meeting. Thank you.

Nancy felt good about her decision and approach. It was a new way of being and her supervisor’s feedback was affirming. She called home and explained the situation. Her spouse, although frustrated, understood, and they agreed to talk more about work and family later. Nancy went back to work, confident that her ability to set limits was growing and that abetter work-life balance was evolving.

What were the 8 Surprises?

1. Nancy said “No!” It was hard, but she did it. As risky as it felt, she decided to honor her own needs and trust that she and the unit would be OK.

2. She used an “I-Statement” to address the increasing pressure she felt from her supervisor’s persistence. These are not easy!

3. Her supervisor apologized and listened. Too often we are in a rush and don’t seem to have time to listen to each other respectfully.

4. Her supervisor was open to learning something about her leadership style and willing to work on her own growth. This is a sign of authentic leadership!

5. Her supervisor used an “I-message” to show where she was coming from and then validated Nancy by acknowledging that she had been working hard all day. The whole tone of the conversation shifted from a frustrating duel to a collaborative approach.

6. Together they came up with a SAFE solution that addressed the current urgency and included a commitment and time-frame for addressing the chronic problem.

7. Nancy has been clear that she is working on limit-setting and is doing a great job of setting the stage for a healthier work-life balance.

8. This hospital has an opportunity to focus on their staffing issue BEFORE this nurse looks for another job, gives up, makes a catastrophic error, or quits out of frustration.

What kind of list of outcomes can you think of if Nancy had said “Yes”?

Thanks for reading,

Beth

P.S. Let me know if you have any thoughts to share re: this article. bbbboynton@verizon.net

Summer 2008

Beth Boynton, RN, MS, is an organizational development consultant and author of Confident Voices: The Nurses’ Guide to Improving Communication & Creating Positive Workplaces. (Special book offer: SAVE 20% NOW at Beth's EStore Use coupon code: D359FSBP)

She is an adjunct faculty member with New England College and publishes the free e-newsletter: Confident Voices for Nurses. She has published numerous articles, offers a variety of workshops, and can be reached at bbbboynton@earthlink.net or 207-752-0826. Or visit www.bethboynton.com