Navigating confrontation at Work as an NP
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Confrontation in Leadership: Navigating Difficult Conversations
Dealing with confrontation is one of the toughest parts of being a leader, especially for new nurse practitioners stepping into clinical practice. Addressing these situations directly and respectfully can improve teamwork and create a better environment for everyone—including patients.
In this podcast episode, a new nurse practitioner from the Real World NP community shared a common challenge: overhearing nurses critiquing their work but not sharing feedback directly with them. Their question was how to handle this without making things worse.
Why Address Confrontation?
Avoiding confrontation can create tension and damage trust within a team. Facing issues head-on shows you care about teamwork and open communication. It also sets an example for others.
A Simple Method to Handle Conflict
A helpful approach is the Nonviolent Communication (NVC) framework by Dr. Marshall Rosenberg. It has four steps:
Observation: Describe what you noticed without adding opinions. For example, “I overheard comments in the nursing room about some of my notes.”
Feelings: Share how it made you feel, like, “I felt unsupported when I heard that.”
Needs: Explain what’s important to you. For example, “I need to feel like we’re working as a team to give the best care.”
Request: Clearly say what you’d like to happen. For instance, “If you have feedback about my work, please talk to me directly— I want to do my best work and work well together as a team.”
Why This Works
This method focuses on facts and feelings without blaming others. It helps turn a tense situation into a conversation about solving problems and working together better.
What’s Next?
If the issue keeps happening, involve your manager so they can help create a more supportive environment. Leadership is also about looking at the bigger picture—like why the problem happened in the first place—and finding ways to prevent it in the future.
Handling confrontation isn’t easy, but it’s an important skill. With practice, you can turn challenging moments into opportunities to build stronger teams and better care for your patients.
Resources mentioned in this episode:
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Liz Rohr (they/she) (00:00)
This week's episode is about leadership and role transition questions. So this is a real scenario that someone brought to me from the audience that I thought would be really helpful to share because I remember going through stuff like this myself, and I'm sure that other people are experiencing the same thing. So this is de -identified. This is just somebody in the audience, and I feel like so many people could have written the same exact thing. So I'll just read what their message shared.
and it's about them kind of like being in this leadership role and then how to kind of have confrontations or conversations that could potentially feel confrontational with other staff members. And then what my kind of thoughts or recommendations were based on that. Because I've both been a new nurse practitioner and experienced nurse practitioner and I've also been a manager and I currently am a manager managing a team. And I've learned a lot. So I would love to share just my two cents about it and hopefully that's helpful for you.
I think that leadership is a tricky thing to navigate and we all have to find our kind of leadership styles. But I think like maybe one bottom line is that we direct and clear is kind. And sometimes when there are breakdowns in our team relationships, there's an opportunity to like rebuild that and reconnect.
So and then I'm going to give you like a framework that is helpful, that has been helpful for me. And I still continue to practice both in my work life, but also in my personal life. So let's get to the question. So the question was from an nurse practitioner. And this was given to me through my team. And so I actually don't know like their gender, where they live, what their age is. So like this could be like so many different people from so many different backgrounds. just like, it really like, it really just resonates, I think.
So this person was saying they're having a really tough time adjusting to being a new nurse practitioner in family medicine and primary care. They're finding that the providers are all very supportive and the nursing staff are supportive to their face, but their office is actually quite close to the nursing office where the nurses answer the phones and call patients. And there was a situation where they overheard them or maybe on multiple occasions have overheard them complaining or critiquing some of the messages that they sent them.
Unfortunately, they have never actually directly said anything to this nurse practitioner to their face, and they're very nice to their face, right? It sounds like they want to support this provider, but they're having some kind of critiquing things in the background. And then this nurse practitioner was also saying, I remember being a nurse myself and getting annoyed with certain orders from providers, but I'd always directly address that to them. And so what they said is they were debating on being very bold and going directly to them the next time it happens.
and letting them know that I overheard them and would love to talk about it together versus talking to management. So first of all, I just really want to acknowledge that leadership is not easy. At least I have not found it easy and I don't think I got very much training in it. And it's been a little bit of trial and error along the way. And I've gotten some support and I've gotten some coaching and I've gotten some things to help me be a better leader. But I just want to acknowledge that I can feel really hard in addition to the fact that you're learning how to be an interspec -tioner in the first place.
kudos to you for taking that initiative to have that conversation potentially with the staff members and try to really be kind of problem solving. So I'll share with you what I shared with them, but then I'll also share a resource that hopefully can help you if you're in a similar situation. So I just said thank you for the question. It takes a lot of courage to be in this leadership role. It's not easy and we don't really get a lot of training. So personally, from my perspective, both being an employee in the past
Well, I'm still an employee, sort of, but I have my own company, so I'm a little bit, anyway. Being an employee and being a manager, I said that I would personally talk to them individually first. So not even walk into the nurse's room and talk to all the people, just like one person at a time. Like, hey, can I talk to you real quick? And before it happened again, like not in the moment, because there can be a lot of feelings that happen amongst everybody in those moments. It's actually...
Sometimes I find it helps to be diffused when it's outside of it. So even before it potentially happens again, like I said, I think this is an opportunity for rapport building and for communication building. And all of it is in service of everyone having a good time at work, but also very importantly for patient care, right? Because that's all what we're here for. So if we can kind of remember that, keep that in the front of our minds, is like the goal of this is to...
communicate more clearly, to work better together so that we can support our patients together. It's not about blame or criticism or anything like that. It's just like, how can we facilitate this? And I'll talk about a model to use. So usually what I do is it takes a lot of courage to be direct in your communication, but you can use this framework model of how to communicate basically what you observed, what your feelings are, what you need.
and then what your request is.
And so this was a framework developed by Marshall Rosenberg, I believe is a therapist, PhD. And so I just want to walk through the NVC nonviolent communication process because at both, I've practiced this both as a deliverer of messages, but also as a receiver of messages using this model and things that typically can feel really confrontational and scary have felt so much better. And it doesn't.
have to be. I've helped people do this and use this model. And I'm just so proud of them for people who are so afraid of confrontation and directionists and using this and watching them just really step into it. It's just beautiful. So anyway, hopefully you can use this. you can, I'm going to walk through it, but basically you can express how you are, but also you can empathetic, it says empathetically receive how you're hearing without blame or criticism.
So if somebody is giving you information, you can reflect back that you're hearing them in a way that's non -threatening, basically. But let's talk about it from the I am feeling perspective. So basically, there's four steps here. So observations, what you observe, see, hear, feel. Sorry, not feel. See, hear, remember, imagine. There's no evaluations here. There's no judgment. It's just objectively what happened. And I think sometimes that can be hard to separate what is fact and what is feeling.
especially when we get really charged up. So the other piece of this is I recommend taking some time if we're getting that kind of nervous system reaction of fight or flight of like, my gosh, this is so scary. Like just giving yourself some time to settle and ground and then just really work through this and even practice it if you need to, right? If this is the first time you're having these kinds of conversations, absolutely practice, right? So what is your observation? What I observe is something that I might say, just guessing from the scenario is that pulling somebody aside, one of the nurses, hey, so the other day I overheard
voices in the nursing staff room. I thought it might have been you. I didn't see it happen, right? Like I, whatever, we're just being objective here. I heard voices saying this, this and this about this, this and this. And that's just, that's the observation part. The feelings part is an opportunity for connection, like I said, and it's not about they have to take on your feelings or anything like that, but it's just sort of like, I feel unsupported when I hear people talking
about my work, but not coming to me directly. The next piece is needs. And I think this can be tricky sometimes because sometimes we think like, I need, like the, the next two steps are needs and requests. So request is like something that you desire to have, but that's not necessarily the need. The need for you to identify in yourself is like what it's like a, it's a, it's what you need or you value. And so for example, in this situation, like I need to feel safe in this clinic.
with supportive providers, supportive staff, so that I can give the best care to my patient. So that's just an internal need that you have that is not dependent on somebody else. And then the last part is the request. And so my request is if you have feedback about the way that a note was written or an order was placed, please come to me directly. So whatever variation would come up for you in those situations, just like again, walking through those steps, like what are the objective
facts and the observations. How do you feel? What is your internal need or value that is not dependent on somebody else? And then what is your request of that person? then it goes more into it. So there's a whole book on this. And it goes more into that in terms of the back and forth. Because just because we make a request of somebody doesn't mean that they can fulfill it. But theoretically, if you're asking somebody in their job role to do something that's part of their job, they should be able to fulfill that, right?
Because this model can also be applied to personal relationships, and I absolutely used it in my personal life as well.
So just speaking from having my own leadership experience at this point, the place that I would go from there, it can feel really awkward when you first start using it, and it's maybe a little bit robotic. But you'd be surprised how well it tends to be received by people. I think that from my own leadership experience, where I would potentially go next is how can we best facilitate that to happen? If they're like, I'm so sorry.
like I just get really frustrated sometimes because we're so busy and we don't have enough staffing or whatever, right? However the conversation goes. But as a leader, I typically am like, how do we facilitate this to go forward? is there, like why did that happen in the first place? I tend to think about like that systems approach. And not necessarily that you have to ask that person that, but like having that conversation of like, how do we make it easiest, right? Because did they not feel safe to come to you? Was there not like a system to let you know? Did you
They were just, they didn't want to bother you, but they were just like venting like a little frustrated. Right. So I think that's kind of where I'd go for that kind of conversation. And then I think that if that were to repeat, like you could, I'm not an expert on leadership, right? But if I'm thinking about it, if I am the manager of the clinic and one of my staff nurse practitioners came to me and told me that that was a conversation that they had had, I at least would be clued into the conversation at that point of like what had happened.
And so I can be on the lookout for like making sure that it's a cohesive working environment and we have the system set up in place so that people aren't getting frustrated and we get the information that we need and the new nurse practitioner is learning how to do the things that they need to do in the right way, right? So those are your choices. If you wanna tell your manager, I probably would just to let them know you had that conversation with those people
Because even if they're not your direct report, you are on the ground on the day to day. And so maybe that's something that they're going to continue to need feedback on, in which case you can involve them if it's continuing to be a problem.
So I'll link to the tool in the show notes. And hopefully this is a model that can help you. And then if you wanted to learn more about it, like I said, you can read that book. It goes into it in even more detail. But it is such a nice thing to practice. And you can even just do simple one -liners of writing some stuff out. And hopefully this is a helpful model for you to use when you're talking with your staff.
Cause I think that's like really like the next piece that I'm not really addressing in this particular episode is like, when it comes that that's how to have the conversation, but then there's like other levels and layers about like how to supervise your team members and be clear about expectations and, give them feedback and then corrective feedback, like things like that. Like there's a little bit more involved there, but it sounds like in this situation and probably your situation, you don't actually have them as a direct report to you. Like you're not actually their manager.
You just need to collaborate with them effectively. I have some other leadership related episodes, which I'll also link to down below or in the blog post of this episode. So yeah, hopefully this is helpful for you to move forward with those kind of tricky conversations.
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