Developing Assertiveness During Orientation

Steps to Develop Healthy Assertiveness in the OR

Many new OR nurses are told to “Be more assertive!” or “Speak up!”—and all the seasoned OR nurses nod their heads in agreement. But as a new OR nurse who is just learning the craft of perioperative nursing, it can be extremely difficult to develop a healthy assertiveness that is helpful and not a hindrance. There are four steps that you can take to effectively develop an assertive attitude that will allow you to be the advocate that you need to be in the OR—both for your patients and for your team members.

1. Respect Others
   
   It must be established that being assertive is different than being aggressive. We all know OR nurses who are more than a bit salty and have put their finger in numerous faces with loud concerns. While these nurses get things done and (usually) have the best interest of their patient at heart, there is a better way.
   
   Aggressiveness and assertiveness are different in one major facet: the treatment of others. Both assertive people and aggressive people are bold and confident, but the assertive person never lets their confidence degrade those around them. The assertive person respects the diversity of experience and different approaches in the coworkers who surround them. They use others’ differences to inform and educate themselves on their way to becoming more effective and intelligent. This individual also uses their confidence to build up others by offering insights or advice in a way that isn’t insulting.

2. Listen Closely
   
   This can be difficult, but it is more effective than you would think. To be assertive, you must be bold and confident. The amount of knowledge you possess directly correlates to how confident you will be. Many new nurses feel a pressure to show that they are not stupid. As a result, the new nurse inadvertently deflects information. When a more experienced staff member tells a new nurse to do certain tasks, the new nurse often instinctively responds with “I know” to prove their competence. But when this is done repeatedly, staff members take note that the nurse isn’t open to information and eventually stop offering helpful reminders.
   
   It will be difficult, but whenever someone asks you do to something or reminds you of a task needing completion, just answer with “Thank you” or “I appreciate the reminder.” This will give you a reputation of listening, and more and more staff members will offer more and more tips and reminders. You may already know 90% of those reminders but responding with “Thank you” all those times is worth learning the 10% that you didn’t already know.
   
   Your teammates won’t make a judgment call on your competence by how much you assure them you already know. They will assess your competence by your performance and your attitude.
   
   You also need to listen closely to the field. There is a lot to do on the perimeter of a surgery suite, but don’t get distracted with nonessential tasks. Even if you are in an hours-long case, keep your eyes and ears on the field. You will learn so much by just being attentive. This not only adds to your knowledge but also increase your credibility by being actively engaged with the sterile team. Both will give you more confidence.

3. Stop Giving Options
   
   When you ask someone if they would like to do something, you put the power in their hands. In asking the question, you have given all authority to them and unintentionally agreed to go along with their decision. If it is non-negotiable, don’t give an option; give a request. Keep it kind but be (pleasantly) firm.
   
   For example: if a surgeon gowns up, but then doesn’t spin to finish tying up their gown, don’t ask, “Do you want to spin?” It’s non-negotiable. They should spin or the card will likely contaminate the field. Instead, give a request: “Hand me your card so you can spin, please.”
   
   Another example: if the drape has become contaminated, do not ask, “Do you want to cover the drape?” Instead, give a request, “Please put this three-quarter sheet over the far end of your drape. The original drape is contaminated.”
   
   It cannot be stressed enough how your ongoing respect of your fellow team members plays into this strategy. If you constantly berate, argue with, or put down your team members, then these requests will come across as belligerent. But if you consistently respect your team members and treat them with kindness, then these requests will be received as collaborative efforts to keep patients safe.

4. Choose Wisely
   
   There are a lot of small battles in the OR. If you continually engage in confrontation over issues that are personal preference or individual practice choices, your voice will lose power. If, however, you save your assertiveness for true issues of safety and importance, then your team members will notice that you have a high bar for quality care and your voice will retain its power.

Conclusion

Practice respecting your team. Practice listening to and accepting feedback from others. Increase your knowledge by being attentive to the field. Practice making reasonable, kind requests for non-negotiable items instead of giving options. Practice choosing your battles wisely. The more you implement these steps, the more you will find yourself growing in boldness and confidence.

Assertiveness is essential to being a successful nurse in the surgical theatre. Wielding your boldness and confidence in a healthy way and avoiding aggressiveness will make you a strong advocate, a helpful and contributive team member, and a respected voice of accountability.