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.
Getting
empowered to kick fear
In my workshops, I've found that an empowerment activity,
such as breaking a board with a bare hand, is a valuable
tool to help nurses realize fear is created by thoughts
and beliefs that tell them they can't do something.
When they overpower those thoughts and prove the belief
wrong, they find they can overcome many of their fears.
Activities and exercises
that challenge participants' fears are those that
seem impossible, that elicit comments such as "it
can't be done" or "I can't do that."
The fear of breaking a board may not be a fear they
face in the workplace, but the board can represent
every situation in their lives where they give less
than 100% or shrink back because of intimidation.
The success of this type
of learning is profound. Although you shouldn't try
this on your own, nurses I coach discover they can
break 1-inch boards with their bare hands with very
little preparation. Alternatively, I have nurses line
up and move across the stage, one by one, doing some
kind of unique or original movement to face their
fears. No matter what the activity, with supportive
coaching, encouragement, and the process I've outlined,
people can be transformed as they succeed at seemingly
impossible activities. |
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.
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