BONUS CONTENT FROM LPN2009

Break through your fears
By Barb Langlois, RN, MSN

Fear: We all live with it. Some people try to push through it while others are slowed down or even paralyzed by fear. If you aren't fully aware of your fears, you may never leave your own comfort zone. By avoiding uncomfortable situations, you hamper your ability to develop personally and professionally. Letting nursing workplace fears get the better of you can fracture not only your work life and professional potential, but also diminish the quality of your patient care.

As a workshop leader, I've discovered that finding inner courage using empowerment activities is a remarkable approach for overcoming individual fears and transporting that feeling of strength and personal power back to the workplace.

In this article, I'll tell you how to follow a practical four-step process to overcome your fears once you've found your courage. But first, let's examine how and why your fears influence your behavior and choices.

How fear impacts patient care
Each person's fear manifests itself differently in the workplace. For example, fear of conflict may play a part in your decision to avoid contacting a certain physician about a patient-care issue. Perhaps you have good reason for that fear. You may know that this physician becomes angry when he's called at night, or you may have seen him rage at another nurse who questioned his orders. If your fear prevents you from communicating with the healthcare provider appropriately, you may jeopardize patient care.

Fear has an immense ability to keep us in a place of comfort. It stops us from reporting errors, professional incompetence, bullying, and disrespectful behavior. It impacts our relationships and the care we give to our patients. Let me give you an example.

I was recently working with an ED nursing team when I learned that most of the nurses were afraid of the clinical leader, whom I'll call Joyce. Several of them said that Joyce often yelled at other nurses and if they didn't do things her way, she'd make life miserable for them. For instance, she'd give them the heaviest patient assignment and not provide assistance when needed.

I asked why they didn't talk to Joyce about her behavior. They said they were afraid: afraid of her reaction, afraid she'd get defensive, and afraid a confrontation would make things worse.

This common situation frequently leads to increased sick days as nurses attempt to manipulate their shifts to avoid working with the offender, increased turnover rates, and fractured nursing teams. These broken teams have unresolved conflict, communicate poorly among themselves, and don't work well together.

Fear in a nursing unit tends to be all-consuming. Nurses focus their time and energy on how to avoid the fear, strategies to move away from fear, and conversations that justify fear. For instance, I often hear nurses speaking with one another about negative experiences with someone they fear, justifying their fear by keeping it alive.

Making a break from your fears
Overcoming fear isn't about finding creative ways to avoid a confrontation or trying to change the other person. You need to find the courage to admit to fears; take time to consider how fear is affecting your professional life, your choices, and your patients; and use your personal power to break through your fears.

Breaking through fear can be frightening yet exhilarating. It can obliterate guilt pent-up from not facing the fear earlier. Follow this simple four-step process, which I developed, to help you break through fear:

• First, acknowledge your fear. For example, acknowledge that you're afraid to speak to your clinical leader. Don't deny it and don't try to lessen the fear by complaining about this nurse to colleagues.
  
• Feel your fear. For example, pay attention to what fear does to you when you think about speaking to your clinical leader about her behavior. Do you have tachycardia? Do you feel nauseated? Do you have a dry mouth? Does your self-doubt surge? Zero in on your physical and mental responses to fear because this discomfort is what usually prevents people from moving forward. Many people become so uncomfortable with these feelings that they'll do anything to avoid experiencing them. The result is resentment toward the offending person.
  
• To conquer your fear and develop your potential as a nurse, picture yourself conquering your fear. See yourself having a successful conversation with the clinical leader. Don't picture yourself arguing with her; instead, picture a positive resolution. Notice and enjoy how it feels to have this great resolution.
  
• Take the fourth step that lets you move through your fear: Believe that you can conquer your fear and do something to make it happen. Trust that your mind and body will give you the strength and energy you need.
  

As simple as this four-step process seems, you must begin the process by finding your courage. See Getting empowered to kick fear. If you undertake empowerment activities to conquer other fears, you'll be better able to squash down the false voice in your head that says you can't do something.

After completing these emotionally charged activities, you'll be reenergized to deal with your workplace fears. Contacting the physician is no longer the burdensome fear it previously was. Approaching the clinical leader about her behavior may still stimulate feelings of fear, but you can more easily move through the fear now. During the actual confrontation, notice how the emotion of fear feels to you—is your heart racing, your mouth dry, and your stomach upset? Remind yourself that these are only feelings, and proceed with your conversation. Fear, like any emotion, has only the power each person gives it.

A case example
Now let's see what would happen if you confront Joyce. To minimize a defensive response, use "I" statements rather than "you" statements. In other words, focus on what you're experiencing rather than trying to describe her behavior or motives. Finish speaking and give her a chance to respond. Be open to the fact that she may have a very different perception of the event than you do.

After your courageous conversation, three outcomes are possible:

• Joyce may accept your feedback and change her behavior.
• Joyce may be angry or defensive in the moment but then spend some time privately thinking about what you said. She may come to realize her behavior is inappropriate and try to make the changes needed.
  
• Or, Joyce may react defensively to your conversation.

Even if Joyce remains defensive, you've broken through your fears and used your power to create your life. You can't make Joyce change, but you can take charge of your own life. You can begin to set boundaries for unacceptable behavior, you can be a role model for others in your unit, and most importantly, you can stand up for yourself. The next confrontation will be easier and when others see you taking action, you'll gain their respect.

Like most bullies, Joyce didn't see herself as one. She thought she communicated very openly and directly, without sugarcoating anything. She believed that her staff appreciated her style of communication. Like most people, Joyce had good intentions.

When confronted, Joyce immediately justified her actions because her intentions were good. She didn't think she raised her voice; she just wanted to be sure others could hear her in the busy ED. She denied withholding assistance and seemed to be hurt by the accusation because she prides herself on providing excellent patient care. She said it might seem that way because she has other responsibilities as a clinical leader.

The conversation gave her good insight into how she was perceived by others. Joyce didn't radically alter her style. The big change, though, was how the nurses responded to her. Instead of being fearful, now most nurses respond with something like, "Hey, Joyce, can you change your tone a bit?" And Joyce laughs. You can't force others to change but you can take action that may influence their behavior for the better.

Steps to courage
Breaking through fear using empowerment activities and the four-step process of dealing with fears will give you new courage in the workplace. You can focus your time and energy on achieving professional potential and excellence in patient care.

Resources
Felblinger DM. Incivility and bullying in the workplace and nurses' shame responses. J Obstet Gynecol Neonatal Nurs. 2008;37(2):234–242.
Manojlovic M, DeCicco B. Healthy work environments, nurse-physician communication, and patients' outcomes. Am J Crit Care. 2007;16(6):536–543.
What's needed to address bad behavior? OR Manager. 2008;24(11):7–8.

Source: Nursing2009. September 2009.