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BONUS
CONTENT FROM NURSING MADE INCREDIBLY EASY!
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.
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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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