Being a Facility Administration in healthcare, assertive communication is essential for upholding healthcare standards, ensuring compliance by my staff along with patient safety. This is a situation that I experienced as the Facility Administrator at DaVita where I was required to address a serious performance issue with my RN. At first, I struggled to be assertive due to my own fears of conflict, but I think adjustments in my verbal and nonverbal communication eventually led to a good outcome.

One of my nurses had a pattern of completing the initial patient assessments several hours after treatment had begun. The assessment is to be completed within 1 hour of treatment start time. I had observed many patient delays in charting within our electronic health record system. Despite gentle reminders and informal conversations, the issue continued.

The final straw occurred when the Medical Director visited the clinic to review a patient’s record and noted that the pre-treatment assessment was logged nearly two hours after dialysis had already started. The MD was concerned and I knew I needed to address this issue immediately.  

I scheduled a meeting with the nurse to discuss the issue. However, because the nurse had been with DaVita for many years and often expressed feeling overwhelmed at work, I approached this meeting with caution. I opened the conversation with, “I know the schedule has been tough,” and “You’ve been working hard and going great.”  I think that I set the tone immediately downplaying the situation and issue. My tone was overly sympathetic and uncertain. I avoided stating the problem specifically. I think that my nonverbal communication also lacked confidence.  I avoided direct eye contact during the conversation. My nurse was immediately defensive and talked about how busy it is on the floor and how hard the job is.

This meeting ended without a plan or RN accountability for the situation and the problem continued for another week. After reviewing the documentation concerns with the MD, I knew I had to discuss this with the nurse again. This time I need to approach it with assertiveness and clarity. In our second meeting, I was prepared with notes on talking points.

I began by directly addressing the situation at hand and I was sure to maintain eye contact. I remained calm but was serious.

This time, the RN acknowledged the seriousness of the issue. We openly discussed workflow adjustments and what support she might need from me. Since then, the documentation has been consistently on time.

As an FA, I am learning every day that my communication style is very important in these types of conversations. I also think this class will help me understanding how important it is to be assertive in these conversations.

Have you ever gotten a text that "sounded" rude or confusing, even though the person probably didn't mean it that way?