1. Assertiveness: Your Responsibility
Chapter 14
Assertiveness: Your Responsibility

2. Learning Objectives
Explain why assertiveness is a nursing responsibility.
Differentiate among assertive, aggressive, and nonassertive (passive) behavior.
Describe three negative interactions in which nurses can get involved.
Maintain a daily journal that reflects your personal interactions and responses.
Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

3. Assertiveness: Expected in Nursing
Helps nurse advocate for the patient
Promotes honest, open communication and behavior
Considers others’ feelings and needs
Benefits nurse, patient, and staff
What do you think of when you hear the term “assertive behavior”?
What are some misconceptions about assertive behavior? (Might be perceived as pushy, refusing to give ground, unwilling to compromise, stubborn on some issues, inflexible)
Assertiveness is a style of interaction that is direct, honest, and respectful of self and others.
Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

4. Communication Styles Translate into behavior patterns
Nonassertive (passive)
Aggressive
Assertive
Most people demonstrate each of these communication styles.
What do you think of when you think of (a) nonassertive, or passive, and (b) aggressive behaviors?
How can nonassertive and aggressive behaviors cause problems in work, personal, and family situations?
Most people have to make a conscious effort to develop consistent assertive behaviors.
The nurse who communicates assertively can help minimize conflict and reduce stress, which can lead to more positive outcomes.
Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

5. Nonassertive (Passive) Behavior
Automatic response not based on choice
Emotional response based on fear
Dishonest, self-defeating
Overall message: “I do not count. You count.”
Consequence: nurse unable to recognize and meet patient needs
This behavior is indirect and passive and communicates a self-perception of inferiority.
Allowing the wants, needs, and rights of others to be more important creates a “lose-win” situation.
What is an example of a “lose-win” interaction in a nursing environment?
Who loses? Who wins? Is it a real win? What is the impact on the patient?
Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

6. Aggressive Behavior Automatic response not based on choice
Emotional behavior based in anger
Violates the rights of others
Attacks person instead of behavior
Overall message: “You do not count. I count.”
Consequence: distances aggressor from staff and patients
Aggressive behavior can be active or passive, direct or indirect, honest or dishonest.
What does it always communicate?
An aggressive communicator aims to get his or her own way and not allow others a choice.
People behaving aggressively try to set up a “win-lose” situation.
How do you feel if you are the recipient of aggressive behavior?
What examples have you encountered at work, school, on the road, shopping? Who is the real loser? The real winner?
Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

7. Assertive Behavior Assertiveness: current name for honesty
Pro-active, not emotional response
Positive, confident, open stand
Overall message: “I count. You count.”
Consequence: Nurse feels in control of emotions and responses, and can be more effective patient advocate.
Assertive behavior is active, direct, and honest.
It communicates self-respect and respect for others.
An assertive communicator views his or her wants, needs, and rights as equal to those of other people.
What are some examples of assertiveness in a nursing environment? Who are the beneficiaries?
Goal is to have a “win-win” interaction. How is this accomplished?
Encourages honest, open interactions and relationships.
How can assertive behavior contribute to better patient care and help reduce caregiver burnout?
Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

8. Assertiveness: Key Points
Nonassertive (passive) and aggressive behaviors are based on emotional hooks.
These styles are ultimately damaging to all parties.
Be alert to unresolved feelings that can lead to a cycle of:
worry > fear > anger > rage
Effective communication helps the nurse develop the trust and respect of colleagues and patients.
The nurse must be aware of verbal and nonverbal messages—the nurse’s own and others’.
Be alert to unspoken messages—the thoughts behind the words.
When interacting with fearful, angry, or frustrated people, avoid getting involved with their emotions.
If someone speaks or behaves aggressively, how can the nurse avoid becoming part of a negative cycle?
Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

9. Assertiveness: Key Points (cont’d)
Own your own feelings.
Don’t blame others.
Be direct.
Use “I” statements to make your feelings known.
Make sure verbal and non-verbal messages are consistent.
What are the benefits of using “I feel” statements?
How can “I” statements be useful in more complex situations?
What to avoid:
(a) expressing a belief or judgment
(b) “you” statements
(c) expressing only negative feelings
(d) using nonverbal body language that contradicts your words
What are some examples of contradictory voice-body messages?
Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.