How to Use Assertive Communication in Nursing

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Written by Morganne Skinner, BSN, RN Content Writer, IntelyCare
Two nurses put assertive communication in nursing into practice.

Historically, nursing has been known as a submissive profession. Gone are the days when nurses simply “follow the doctor’s orders.” Today, nursing education is more rigorous and arduous, nurses are more autonomous, and their responsibilities and areas of practice are more extensive.

These changes have resulted in the need for assertive communication in nursing. Ideally, all team members, regardless of assumed hierarchy or profession, are active participants in patient care discussions. Your communication style can enable or inhibit this process.

Eager to learn how to use this effective method of communication? We’ll explain what assertive communication is, why it’s important, and give you examples of how to use it in common nursing scenarios.

What Is Assertive Communication?

Assertive communication is a communication style that is direct, clear, concise, honest, confident, and respectful. It entails expressing thoughts, feelings, and opinions in a considerate way that respects others.

It is meant to foster and maintain healthy relationships, rectify conflicts, and prevent resentment due to unexpressed needs. This element of respect and directness is what separates assertiveness from passive-aggressive communication in nursing.

Aggressive vs. Assertive

Assertive communication is not being rude, blunt, or malicious, nor does it give you permission to say whatever you want. Respect is still alive and well here. The intent of assertiveness is to be straightforward and concise — not to be condescending, superior, or violent.

Aggressive communication, on the other hand, also allows you to express yourself and your opinions, but it violates the rights of others at the same time. Aggressiveness goes beyond being direct — it involves tactics to dominate, appear superior, and belittle others. Essentially, with aggressive communication the goal is to be “right” at any cost.

When to Use Assertive Communication

Assertiveness is needed in many situations. Nurses communicate time-sensitive, medically important information. These scenarios require direct, honest, and mutually respectful communication. Common examples include:

  • Providing nursing feedback (i.e., performance reviews, evaluating a preceptee)
  • Calling a doctor
  • Correcting or interrupting a colleague providing unsafe care
  • Multidisciplinary team rounding
  • Setting boundaries with patients’ family members
  • Rejecting a patient assignment

Why Is Assertive Communication in Nursing Important?

Effective communication is an essential skill in nursing. Think about it — being able to speak up when a provider orders an incorrect dose for a medication can prevent a devastating medication error. Not only does assertive communication positively impact patient safety and care, but it can also improve a nurse’s job satisfaction.

A lack of assertiveness in nursing can also lead to misunderstandings, resentment, overwork and burnout, increased staff turnover, distrust from patients and colleagues, irritation, and mistakes. Remember, nurses are communicating serious matters. Being able to speak concisely and candidly saves everyone time. The importance of assertive communication in nursing truly cannot be emphasized enough.

Benefits of Assertiveness in Nursing

Assertiveness helps you advocate for yourself and enables you to cope effectively with workplace stressors. Some benefits of assertive communication include:

  • Builds trust and rapport
  • Aids in conflict resolution
  • Boosts self-empowerment
  • Improves stress management

What Are the Components of Assertive Communication?

Communicating assertively means that you respect both yourself and others. To make it simple, think of these three C’s: clear, confident, and controlled.

Clear: Your message is easy to understand.

Confident: You are composed and believe in your ability to navigate this situation.

Controlled: You are self-regulating, calm, and level-headed.

Additional components include:

  • Advocacy (for yourself and your patient)
  • Using “I” statements
  • Making requests
  • High self-confidence and self-esteem

Examples of Assertive Communication in Nursing

1. Rejecting a Patient Assignment

Scenario: You arrive in the intensive care unit (ICU), go to check the assignment sheet, and get report. You notice that your second patient is in the OR for an open heart surgery and will be arriving later. You have not been trained on immediate post-op care for open heart surgery patients and you don’t feel equipped.

You find your charge nurse and say, “I cannot accept this assignment. I do not have the necessary training to care for this patient undergoing open heart surgery. Who can swap assignments with me?”

Takeaway: This gets straight to the point, uses “I” statements, includes a request, and firmly communicates the rejection of the assignment.

2. Setting Boundaries With Family

Scenario: You are caring for a patient with multiple IV infusions. You hear the IV pump alarming from the nurse’s station. As you enter the room, you notice the alarm has stopped. You ask the patient’s family member if another nurse came in the room. They say, “Oh no — I saw the nurse this morning hit this button to make the alarm quiet, so I hit it for you. I know how busy you are.”

You respond, “I appreciate your desire to help. It’s important for me to observe the pump, IV and tubing, and the IV site when this alarms so I can be sure no harm is done. Please do not turn off any alarms or touch the equipment.”

Takeaway: The nurse directly addresses the problem, makes a clear request, and provides the rationale in a respectful manner. Had the nurse ignored the situation, the family member may have innocently continued to silence the alarm and complications may have occurred as a result.

3. Correcting a Colleague

Scenario: Your colleague requested a witness for a medication administration. Their patient is receiving insulin. The nurse reports their blood glucose, says they need 4 units of insulin, and shows you the amount in the syringe. You observe 4 units, but per the orders, the patient should receive 6 units.

You say, “Yes, this is 4 units, however, this order states they need 6 units for a blood glucose in that range. Would you like me to go with you to the Pyxis and witness there?”

Takeaway: The nurse advocates for the patient and explicitly states the discrepancy observed in a respectful, objective way. The nurse also makes an offer to continue helping the nurse as a witness (which, as you know, can be a challenge when you are short staffed). This approach fosters a healthy workplace and assertive communication in nursing.

4. Multidisciplinary Team Rounding

Scenario: You are in the middle of rounding on your patient in room 9. The attending physician, dietitian, pharmacist, physical therapy, speech therapist, and respiratory therapist are present. The physical therapist says, “Let’s get the patient up to the chair twice today. They’re ready for it.” You know that today you are working short staffed and will have a busy morning.

You say, “That’s a great goal. My morning is very busy and we are short staffed, so I will need someone else to step in to make it happen. Are you or someone else on your team available to assist with transfers?”

Takeaway: This is straightforward, plainly stated, and makes a request. By stating the need, the nurse honors their boundaries and does not take on extra stress on top of a full workload.

Should Nurses Use Assertive Communication With Patients?

Yes — absolutely. In addition to being assertive with colleagues, nurses need to speak clearly and candidly to patients when providing education, such as how to take their medication. They need to speak confidently when answering questions to foster trust. They also need to set boundaries and make requests when a patient is behaving inappropriately.

Ready to Implement These Skills?

You’ve learned how to use assertive communication in nursing — are you ready to apply it? Start advocating for yourself now by selecting a job that fits your lifestyle. Take control of your work schedule by applying to IntelyCare today.