Imagine being a nursing student working in another part of the country for a 4 week clinical placement, and imagine that in the first few days of clinical, you observe unethical practice by the nurse you are buddied with.

What would you do?

Kate was that nurse and what follows is a recount of her experience, her no clear plan solution, and how coaching her through this situation resulted in outcomes she would have never thought possible.

Kate's Experience

After a morning of patient assessment and care, Kate's buddy nurse (Tom*) was going over the charting and paperwork that needed to be completed. It was during this time she observed Tom document clear lung fields on a patient she did not believe was assessed for lung sounds.
In the moment, she was shocked, offended, and disgusted by his practice. She said nothing to Tom, excused herself and reported her experience to me.

Her No Clear Plan Solution

"I can't believe that this is the standard of practice here" she said "You need to reassign me to the other team, I can't work with him, I am not failing my clinical because of him". She added "I am worried about the safety of his patients".

Whether you are new to leading a team or an experienced leader, this situation has the potential to raise the hairs on the back of your neck. It may feel tempting to take her up on the offer, reassign her and avoid any uncomfortable conflict with Tom or Kate and avoid any time consuming investigations.

But there is a real danger is not getting to the heart of the matter.

Kate's No Clear Plan solution does not address the real concern or desired outcome. It is a phantom plan that removes the immediate threat (being associated with unethical practice and risk failing clinical) but it fails to consider the scope of the issue and her responsibilities to be a part of the solution.

In her words, patient safety and standards of practice were the values driving her reaction. Being reassigned did nothing to ensure either.
Her solution falls short because nursing practice (and success in the course) is based on the nursing competencies; even the ones about advocating for patient safety and resolving conflict among team members.

What is Coaching?

Sir John Whitmore defines skilled coaching as “unlocking people’s potential to maximize their own performance.”

So many leaders (myself included) have fallen into this trap, taking responsibility to solve the problem. That is not your role. Your role is to mentor, guide, and coach your team through difficult conversations to build their capacity and potential.

It would have been easy for me to talk to Tom. I am very confident and comfortable brining forward difficult topics. But I was not the one with the concern ... Kate was, and this was her conversation to have.

She did not know it then, but she was about to embark on the most significant experience in her nursing career and I was delighted to be her guide.

Coaching Kate to Gracefully Resolve Conflict: 5 Critical Steps

Over many years in this field, I have observed five steps that are present in every difficult conversation. These are my five 'must have' steps for effective coaching successful resolution.

1. Goal: Start with the end in mind. Ask open ended questions to help your employee uncover what really matters and why (aka intention).

In Kate's situation, once we got past the initial emotions, her real goal surfaced: safe patient care and standards of practice. From this viewpoint, she recognized that being reassigned to another team only contributed to the problem. This was her place of buy in. She was no on board to have a difficult conversation with Tom, even though she was scared and nervous.

2. PuRposeful Planning: Ask your employee to consider their options and what they will need to be successful. As a leader, you can share your observations around their commitment, courage, dedication and offer up new ideas to them without any expectation that they utilize any of your contributions. Offer it without expectation.

Kate was nervous and anxious, she preferred to not talk to Tom

She also realized she could not work safely if she avoided it because she would always be looking over his shoulder, checking to see that his patients were safe.

We sat together and crafted up several conversation starters, ways in which she could share her concerns. They started out fairly blunt and accusatory. This is normal and a great starting point.

Finding their words will help you coach them through refinements so that the message is conveyed in respectful ways.

Leadership Tools: Use the 50 Powerful Scripts to help you coach them.

Role play the conversations to improve confidence.

Kate needed to hear the words come out of her mouth so she could feel their presence and impact. I role played and provided honest, in the moment responses to help her see how her words may be received. She refined it to the point she was comfortable to move ahead with the timeframe I provided (end of day).

3. Align: When the opportunity to speak with someone shows up, many people shy away from it. Avoid it. Let is just disappear into the night. As a leader, you can encourage and champion your employees, but this is mostly an inside job.

Prepare them ahead of time, let them know there is often a moment where our nerves will be so strong that we may not go through with it.
Kate shared how if she was in her home hospital she would not even hesitate to talk to her colleagues about this, and we drew on that conviction and confidence to help her take the steps she needed to do.

4. Conversation time! Create a container (i.e. timeframe) in which the talk must happen to encourage them to commit to taking action. Role play conversations here to help them hear how things will sound (I use the Safe Conversational Scripting Process)

Kate did engage Tom and reported to me immediately afterwards.

"I can't believe it! That was better than I could have imagined!"

She shared that when she shared her observations with Tom he agreed with her, offering that he charted findings he made the day before, assuming no changes had taken place. He then said "this is not best practice, let's go listen to the lungs together and make sure the documentation is accurate".

5. Evaluate! Celebrate the employee for having the courage to be imperfect and still stay in difficult conversations (seriously, imposter syndrome holds many people back - and they tried). Next, help your employee to learn from the experience by looking at what felt good, went well, and needs refinement. Take this learning forward into your next opportunity.

Kate's joy was infectious and her confidence in her values and her ability to stand up for them increased 100x that day. I let her swim in that water without interruption and watched her and Tom build a deeper trust and comfort to work together for weeks afterwards. She used that experience to reflect on her nursing competencies and her influence.
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I could have talked to Tom, but then we would have missed out on all this delicious growth and personal development for Kate.

If you would like training or coaching in this tool or other strategies, I am a Leadership Coach and Communication Skills trainer and I am available to help you unlock your potential so you can create a ripple effect in your team.

I recently started a new video series called Courageous Conversations. Each short video explores a common workplace scenario, demonstrates how to use one of the 50 Powerful Scripts to End Offensive Behaviors, and its benefits.

Check out the latest video here: