Wellbeing Ideas: Assertiveness for Self-Care

BY MELINDA JESUDASON AND JANET BAILLIE, QNMU WELLBEING TEAM

We don't enter the nursing and midwifery professions without a desire to care for others, to improve the quality of life and physical and mental health and wellbeing of our patients and their families.

However, this can come at a cost.

Dr Jean Watson, nurse theorist, nursing professor and author of more than 30 books on caring theory observes that this need to care for others is both a nurse’s greatest strength and fatal flaw.

When caring for others comes at the expense of caring for ourselves, combined with an increasingly demanding, COVID-19-impacted, overstressed workplace, the results can be devastating.

A recent global survey by McKinsey and Company (2021) looking into the impacts of COVID-19 on frontline staff, found that one-fifth of Australia’s registered nurses say they intend to leave their current role in the next 12 months.

Forty-one percent of these nurses say they are planning to leave directcare roles entirely or leave Australia.

You are Powerful

Clearly there needs to be changes in the system to support those carrying the load in patient care.

A multifaceted approach is necessary to address complex issues when there are numerous barriers present.

While the task may seem too large and it may feel like, as nurses and midwives, we do not have any control, this is exactly when we can recognise we are powerful in our own lives.

Now is the time to exert your power for the care of yourselves.

Furthermore, your patients, their families, and your colleagues will all reap the benefits.

Healthy Boundaries

In both our personal and our professional life, we all have the power to set healthy boundaries regardless of what others around us do.

The concept of boundaries has been likened to a house and property surrounded by a fence.

This indicates where the property ends and where the neighbour’s property starts.

Your personal boundaries are like this and indicate what is yours and what you are responsible for and what belongs to others.

Healthy emotional and physical boundaries protect you from abusive relationships by showing what you will and will not tolerate.

You cannot change other people, including difficult colleagues, but you can teach people to respect you (EvanMurray 2012 & Whittington, 2005).

Assertive Communication

So in a busy, under-resourced, stressful work environment, how do we do that?

Communicating assertively is the key. Assertive communication, and positive communication, simply means to effectively express your needs, rights and opinions in an honest and open manner that is respectful of others and doesn’t violate their rights.

This includes speaking to those in authority.

It empowers us to be heard and to be able to have influence on our workplace. It can assist in stopping bullying and helps to equip us to control stress and anger and improve coping skills (Omura, et al., 2017).

Furthermore, as a nurse or midwife, it is vitally important to be able to respectfully express concerns about issues that could potentially impact patient safety.

It is recognised that communication errors and a hesitancy to speak up can lead to adverse patient outcomes.

Assertive communication has been shown to improve patient safety outcomes and the overall performance in healthcare teams (Omura, et al., 2017 & Kolbe, et al., 2012).

Saying No

A key ingredient in assertive communication is the ability to say no. This is not easy in a work environment where there are often unfinished tasks and staff shortages. However, the alternative may be feeling overwhelmed, stressed and burnt-out.

If your employer is not supporting you to finish your shift on time, take your breaks, and prevent unmanageable workloads, then saying no is you protecting your ‘house and property’ and looking after what you are responsible for –yourself.

If your natural communication style is more passive, it may be a challenge to say no and use assertive language.

The good news is we can all practice assertiveness and develop this skill.

It can be helpful to practice saying statements aloud alone and rehearse what you want to say in preparation for a request you know you will have difficulty saying no to.

If you’re asked to do overtime or an extra shift that doesn’t suit you, practice your response: “No, I’m not available to do that.”

You do not have to give a reason or say sorry if you prefer not to.

If you’re asked why you can’t do it, a good strategy is to simply repeat firmly and politely, “I’m not available”.

Body Language and Tone

Another important part of assertive communication is how you use your body language and tone.

If your natural communication style is more aggressive, you may tend to speak loudly and harshly and potentially come across as a bully who ignores the opinions of others.

Aggression can lead to a lack of trust, or people avoiding or opposing you because of the way you communicate.

Speaking slowly and calmly and holding a nonthreatening, relaxed posture with appropriate eye contact is often enough to bring trust and connection to even difficult conversations.

It is well established that tone and body language make up the greatest part of a person’s communication, with words alone accounting for less than 10% of personal communication.

C P D

1. Think of a recent work interaction with a difficult colleague where you responded in a verbally aggressively manner? How could you have responded differently?

2. What strategies and advice would you suggest to a colleague who has trouble saying no to management requests?

3. What steps can you take to develop healthy boundaries in your personal and professional life?

Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

Sources

Berlin G, Lapointe M, Murphy M, Viscardi M. (2021). Nursing in 2021: Retaining the healthcare workforce when we need it most. McKinsey & Company. www. mckinsey.com/industries/healthcaresystems-and-services/our-insights/ nursing-in-2021-retaining-thehealthcare-workforce-when-we-needit-most

Evans-Murray, Anne. (2012). Uncomplicating life, simply: recognising and avoiding destructive patterns in your life. Health Ed Professionals.

Kolbe, M., Burtscher, M. J., Wacker, J., Grande, B., Nohynkova, R., Manser, T., ... & Grote, G. (2012). Speaking up is related to better team performance in simulated anesthesia inductions: an observational study. Anesthesia & Analgesia 115(5), 1099-1108. https://doi:10.1213/ ANE.0b013e318269cd32

Nuance Communication. (2021). From Overload to Burnout. What Clinicians Think. https://www.nuance.com/asset/ en_uk/collateral/healthcare/whitepaper/wp-from-overload-to-burnoutwhat-clinicians-think.pdf

Omura, M., Maguire, J., Levett-Jones, T., & Stone, T. E. (2017). The effectiveness of assertiveness communication training programs for healthcare professionals and students: A systematic review. International journal of nursing studies 76, 120-128. https://doi. org/10.1016/j.ijnurstu.2017.09.001

Watson, Dr J. (2023). Watson Caring Science Institute [website]. www. watsoncaringscience.org

Whittington, M. (2005). How to Play the Game. Penfold Buscombe.

To be a nurse or midwife is to care.

The challenge is to celebrate and honour the gift and strength of caring, while not allowing this characteristic to become a fatal flaw.

Practicing positive communication and assertiveness is one way to help maintain the balance and show self-care and self-compassion.