Nurses Need Good
Negotiation Skills
Every health care provider has 'the toughest job'. Physicians must make it through a grueling marathon of learning and training. Administrators struggle with conflicting demands and not enough dollars. Nurses, however, deserve a special place in the high stress pantheon.
Nursing professionals must cope with the conflicting demands of a growing number of stakeholders. Doctors may breeze on and off the ward, most administrators don't interact with patients, but nurses are blamed for bad food, noisy neighbors, and slow responses to patient needs.
Nurses find themselves having to act as the interface between competing interests. A nurse needs to mediate between conflicting sides of patients' families, advocate for various care protocols, and agitate for a little respect for him/herself. Negotiating skills can help one deal with these demands and many others.
When we train people in negotiation, our usual advice is to separate the people from the problem. Even if you could make someone disappear, that is not likely to resolve the substantive issue. Often for a nurse that advice could be turned on its head; you have to recognize that you are not the problem. Stepping away from demands, divorcing yourself from the demeaning, recognizing that being responsible is a job description and not a measure of your ego can reduce stress big time. Being able to do those things makes you a more powerful negotiator. When you can negotiate well, you can do a better job of mediating.
People who deal with nurses, on the other hand, need to ask themselves whether a particular nurse is the problem, or whether she/he represents a partner who can help get the problem solved.
Medical ethics may present the most serious issues where nurses act as mediators. Understanding the consequences of the variety of choices available in terms of proper treatment, economic necessity, and moral choices requires serious analysis - and then clear communication.
To be an effective advocate, a nurse (or any other professional) needs to listen actively to what the patient is really saying. Is it a question of comfort? Is a patient's dignity being assessed? When an insurance company or HMO uses statistics to decide on treatment, how can a patient advocate be effective? Unless a person feels they are being taken seriously, they feel as if they are being treated unfairly.
A nurse needs to understand the interests of his/her patients. They need comfort, they need to feel as if they are getting attention, they have a rather significant interest in receiving quality care.
Because nurses are on the front line of the delivery of health care, and because there are major changes in the organization of health care delivery, nurses need to use negotiation skills to know when to go along, when to object, and how to have an impact in either case.
There are many tools available for effective negotiation. Most involve common sense. Listening actively to what others are saying. If you aren't listening, how can you expect others to listen to you? Do your homework in terms of power balance and the substance of what you're doing. Make assumptions, but know that each assumption must be re-examined constantly. If you keep your mind open, your wits about you, and your analytical faculties working full time, skillful negotiation can yield results that are in everyone's best interests.
Published in Healthcare Review, May, 1996
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