1. Lockhart, Lisa MHA, MSN, RN, NE-BC

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Q: What does the phrase "crucial conversations" mean?

A: Many of you have read or heard of the popular book Crucial Conversations: Tools for Talking When Stakes are High.1 This book has been extremely influential since its publication, and the authors and presentations on the book's content have been featured at the American Association of Critical-Care Nurses National Teaching Institute and other professional conferences because of its relevance to everyday life in healthcare.

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A conversation is crucial when it has high impact, meaning that the outcome is of critical importance and options or opinions have a large variation. These conversations can either be planned as an organized meeting or occur spontaneously as a sensitive issue arises. To handle these interactions well, you must ask yourself, "What do I really want for myself, for others, and for the organization." This will assist you in staying focused on what's truly important and having an open, trusting dialogue.


The goal isn't to win, but for the group to do so. This involves compromise and self-control. In fact, self-control and personal monitoring are vital to success when engaged in a crucial conversation. We all respond differently to confrontation, so it's important that you understand your own reactions before engaging with others.


Take a look at your intent, purpose, and how you're perceived. Hopefully, you know what you want to say and why you believe it, but how do others view your delivery? What's your body language and volume of voice? Do you place emphasis on certain words? This is, perhaps, the hardest part to grasp when managing a crucial conversation, but it's vital to invest time and effort into recognizing how you really communicate and manage yourself.


The next step is learning to look at the facts without emotion. Remember this is a win-win goal situation. It simply isn't feasible that you're always right and your facts are flawless. Be willing to truly listen. When listening, remember that there's a distinct difference between listening to respond and doing so to understand. Always strive for the latter and maintain focus on a mutually agreeable resolution.


The authors caution that we should remember to separate what we're asking for (strategy) from what we want (purpose). They suggest using CRIB for the best dialogue: commit to a mutual purpose, recognize the purpose behind the strategy, invent a mutual purpose if you're unable to agree on one, and brainstorm new strategies. This is sound advice to assist you in remaining focused on mutual satisfaction, not victory for self.


Let's put this into practice. As a clinical nurse, it appears to you that the daily assignments are disproportionate. Your charge nurse divides the floor into sections without regard for acuity. You're increasingly frustrated and overwhelmed by your assignment, so you want to seek resolution to the problem. Set a time to meet with your charge nurse that will be free of interruptions. State your case using facts, not emotions. Explain where you think the disparity is (the acuity) and have a solution to recommend (making assignments based on acuity). Listen politely and without interruption when your charge nurse responds; there may be valid reasons for the method being used. By really listening to each other, you should be able to reach a mutually agreed upon, reasonable solution.


If you haven't already, I recommend reviewing the personal and group strategies presented in the book. I'm certain that you'll find the ideas helpful for your professional life.




Patterson K, Grenny J, McMillan R, Switzler A. Crucial Conversations: Tools for Talking When Stakes are High. 2nd ed. New York, NY: McGraw-Hill; 2011.