Become more assertive - your patients will thank you for it

A lack of assertiveness among nurses can affect job satisfaction and has a detrimental effect on patient care, according to a nurse educator.

People are often told they need to be assertive, particularly in the workplace, but they do not know how to, explains former colorectal nurse consultant and Coloplast UK head of education Terri Porrett.

She describes the quality as having the confidence to be able to have one’s voice heard and be able to speak freely.

However, there is a delicate balance between being assertive and being aggressive.

Dr Porrett says a lack of assertiveness in the nursing profession has been ‘its Achilles’ heel’. Some people may be reluctant to speak up because they want to please people and they fear confrontation.

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It can be helpful to say: ‘I’d like to be able to do that, but I just don’t have time at the moment’, rather than saying: ‘No, I don’t want to.’

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Use non-threatening phrases with managers, such as: ‘I realise the pressure you’re working under, but how can we change this?’

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If you feel you know the best way forward for your patient, share your knowledge with senior staff. Perhaps start by saying: ‘That’s a great plan, but I know that patient’s circumstances.’

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Repeat points in a calm way, but with a firm tone to help ensure your voice is heard.

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Sharing your concerns with a team may help other nurses and your wider team members to be more assertive.

‘Some nurses feel their opinion is of no value, so won’t even try to have their voice heard,’ she says.

However, as a nurse, not being assertive can have an effect on how you regard your job. ‘You may feel undervalued and demotivated, and this can significantly reduce your job satisfaction,’ says Dr Porrett.

She adds that the passive language used to describe what nurses do, such as ‘supporting and helping doctors’ is disempowering for many.

In contrast, career consultant and psychologist Sherridan Hughes says: ‘The language doctors use can be assertive to the point of being arrogant.’

According to Ms Hughes, the hierarchy in health care can result in nurses deferring to clinicians even when they see mistakes being made with patient care.

Nurses’ caring attributes may also mean that being assertive makes them feel uncomfortable and they can often be afraid to say no, or become people pleasers, she adds.

It is vital for nurses to speak up for patients, particularly if they have witnessed poor practice that is having a detrimental effect on their care, says Ms Hughes.

Thankfully there are simple and effective steps and techniques to help empower nurses and get their views heard.

Repeating points in a calm way but with a firm tone can help, as can carefully choosing the right language. Working as part of a team and sharing concerns can not only help individuals, but will encourage other team members to be more assertive as well.

This can help to create a more supportive working environment, suggests Ms Porrett.

‘As a profession we need to start valuing what we do and be assertive, but if we step up together we can amplify our voice’.

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Further information

Apollo Nursing Resource – a forum for nurses to speak up about their role and the challenges they face