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I am a nursing supervisor in a nursing home. Most of our patients are white and most of our staff is non-white. Our staff is frequently subjected to vile, racist treatment and remarks by our patients. Naturally, this creates a very difficult working situation. Our staff provides quality care day after day to people who show them flagrant disrespect.

As a facility, we have never sufficiently addressed this. Our nursing administrator, to her credit, wants to bring this issue out into the open and hold discussions with the staff to provide support and improve things if possible. I am sure this will be a crucial conversation where emotions will run high. How do you suggest we proceed?

Thank you,
Seeking Safety

Dear Seeking Safety:

Although you asked specifically about the difficult crucial conversations you are facing, it is important to recognize your team must successfully face both crucial conversations and crucial confrontations to move forward. Let’s look at both.

Crucial Conversations
First, the entire staff will need to hold one or more crucial conversations to discuss how to create a healthy, productive, and supportive environment. As you work through divergent viewpoints and strong emotions to reach alignment, the key elements will be to refuse to make a sucker’s choice and to use mutual purpose to create safety. 

1. Refuse the Sucker’s Choice. Too often, we pull up short in crucial conversations because we make a sucker’s choice: we believe we can either deliver excellent care or we can hold others accountable to a standard of behavior, but we can’t do both. We create win/lose situations in which the residents get away with racist remarks and bad behavior and the staff puts up with it because that is what constitutes good customer service.

This is a classic sucker’s choice, a needless either/or statement. Recognizing that you are making it is the first step to moving forward. Once you have recognized the choice, you can refuse to make it by consciously asking yourself: How can we provide excellent care and avoid alienating or offending our residents when we address their racist remarks?

2. Mutual Purpose. Next, carefully create safety during the dialogue. One of the most powerful tools for doing so is to establish mutual purpose. However, be warned that creating mutual purpose can be used for good or for evil depending on your intent. Allow me to illustrate.

In my work with healthcare professionals, one of the things I enjoy most is the obvious dedication individuals have to patient safety and care. These values are incredibly powerful when creating safety in a crucial conversation through establishing mutual purpose because the mutual purpose to uphold safety already exists. But, the danger comes when this common goal is used to control or direct the conversation. For example, in frustration, an administrator says to a nurse, “No, we have to do it this way because this is a patient safety issue and that is our highest goal.” Suddenly, this administrator is using the mutual purpose of patient safety to control or end the conversation.

In your situation, it may be tempting to say, “We all have the same mutual purpose here, to deliver excellent care to our residents. And, because of that, we must do X, Y, or Z.”  This approach, telling others what their mutual purpose is and then linking a specific course of action to that purpose, destroys safety and dooms the conversation to failure.  Instead, determine what mutual purpose unites the staff and then recognize individuals’ unique strategies to meet that purpose.

Crucial Confrontations
Once the staff agrees about standards of behavior and the importance of holding others accountable to those standards, expect a series of crucial confrontations with the residents as staff members describe the gap between how they expect to be treated and what they observe. These interactions require unique skills. 

1. Describe the Gap. Before you can hold people accountable, you must first clearly describe the gap and explicitly set expectations about appropriate behavior. You can’t assume everyone knows and understands expectations. Say something like:

“Mrs. Smith, when I care for you, I expect we will have respectful and considerate interactions. When you use terms like [blank], I sense you may not respect me because of my race. Can you help me understand what your intent is in using that term?”

2. Avoid a Power Trip. Instead Use Natural Consequences. Be careful not to use your power to motivate change in the residents who are in a dependent, vulnerable position. It is tempting to want to say, “Mrs. Smith, if you use that term to describe me again, I am not going to change your linens today.”

This is power masked as a natural consequence. While it is appropriate to share with the residents how their behavior affects you, it is important you do so in a way that assures them your goal is their excellent care. Instead of motivating the residents to change by explaining the affect their behavior has on the staff, explain the natural consequences of their behavior and how it affects the values and privileges they care about.

You certainly have some difficult conversations and confrontations ahead of you. But, you also have a huge advantage because you are clear on your intent: to provide excellent care in a supportive work environment. Keep that at the forefront and you will be much more likely to succeed.

Best Wishes,
Emily

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A "Hans-some" Gentleman

In my last column, I told the story of Chuck who nearly gave up crucial skills when his attempts at dialogue failed. I shared Chuck’s experience not to demonstrate the complete or even correct process of holding crucial conversations but to illustrate that in our human attempts to master these skills, we will have experiences that teach us what to do and other experiences that teach us what not to do. In my opinion, both are constructive.  

In each column I will share stories, examples and insights that will illustrate that both successful and trying experiences can help us and others master crucial skills.  

And this idea leads me to my next vignette…

I was roaming around the corporate cafeteria trying to decide what to eat for lunch, when I noticed Hans hurtling toward me. Before I knew it, there was hardly any space between me and Hans to serve as any sort of buffer. The only escape route was to weave and bob; or should I bob and then weave?

Standing face-to-face with me, Hans started in with, “You’ve ruined me, you’ve ruined me!” 

Hans had been a participant in a training course I had taught a couple of months previous. But now, he wasn’t sitting in the front row of the class—he was right in front of my face. 

“You’ve ruined me!” He continued his rant. “I keep thinking, ‘Is she telling a story?’ ‘Am I telling a story?’ ‘Was that a story?’—and it’s so wonderful!” 

Hans went on to explain a very interesting journey which began by seeing how others told clever stories and realizing how often others treated these stories as concrete fact. As he progressed, little by little he started to catch himself doing the same thing he had observed in others. This self-awareness was what really helped Hans to catch himself telling his own clever stories. So much so, that much of the time now, he was able to tell the rest of the story right then and there—realizing his thoughts directly determined his ability to be effective in his crucial conversations.

I’ve found Hans’ experience represents a natural learning cycle we all move through. Many people go to training expecting to walk out totally and completely changed. In reality, most people improve incrementally.

First, we start to see how well or how poorly others practice the behaviors we’ve learned. We notice when they do and don’t use the approaches very well (usually we notice the don’t more often than the do). This observation refines our recognition skills.

Next, we start to notice when and how we do and don’t use the approaches. As a general rule, we notice our performance retrospectively.

Finally, we start to catch ourselves closer to the real-time moment and we begin to use our newly discovered skills more masterfully.

In short—mastery takes time. If you remember this one tip, you’ll discover small milestones along the way to help you become more Hans-some.

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