3 Strategies for Increasing Confidence, Status, & Assertiveness

Guest post by Beth Boynton, RN, MS


Confidence, status, and assertiveness are interrelated feelings and behaviors that  can be important for nurses and other healthcare professionals.  Showing confidence when performing a treatment can help a patient feel safe, expressing high status verbally and non-verbally is an effective leadership skill that ensures you are taken seriously by those you are supervising, and speaking-up when you have a concern can literally save lives.  Here are some examples followed by 3 strategies you can use to practice and develop your presence:

  • Raising concerns about safe staffing
  • Asking nurses and doctors if they’ve washed their hands
  • Preparing for a job interview or personnel evaluation
  • Speaking up to physicians about disruptive behavior
  • Facing conflict with a colleague
  • Saying “No” to overtime
  • Asking for, offering, refusing, or accepting help

Fake it until you become it!

pic1Did you know that using confident body language can actually increase your testosterone?  Harvard Business School Professor and Social Psychologist , Amy Cuddy has an inspiring message and some exciting research that contributes to development of assertiveness. “Don’t fake it til you make it, fake it til you become it!” states Professor Cuddy in her Ted Talk, Your Body Language Shapes Who You Are.  And not only does confident body language effect our hormones, but submissive or passive language does too. Take two minutes every day to build assertiveness and decrease stress.  She calls such stances, “power poses”  and a  two-minute pose can prepare us for all sorts of challenging situations that nurses and patient advocates face!

Avoid asking questions when you know the answers!

Do you ever notice nurses asking doctors, APRNs, or PA-C if they want to order a test, double-check a medication dose, or make a decision about end-of-life care?  When we ask, we imply that we know less than we know.  I’ve done it!

This contributes to a lack of awareness about the critical thinking and judgement that nurses are trained to use.  It is an insidious way that we give our power away.  Being more direct may feel scary at first or you may worry that you are threatening a physician or other’s ego, but in the long run it will help you to become more assertive and clinical leaders will learn that nurses are smart, educated professionals and often have years of experience that is of great valuable.  And if the APRN etc. doesn’t agree with your suggestion, there will be a teaching opportunity if she or he is willing to explain why not!  Besides, the “R” in SBAR stands for making a recommendation and is part of the overall effort to improve patient safety.

Next time you think Mrs. Jones needs an XRay, try saying:  Id like to suggest a chest Xray, Dr. Smith.  Mrs. Jones has been here twice for that cough and it isnt getting better.

 Doesn’t it seem more confident and truthful?

Become familiar w/ high and low status behaviors

In addition to Cuddy’s research about hormonal changes with body posture, there are all sorts of verbal and nonverbal cues that indicate a high or low status in any given relationship.  Knowing what they are can help you recognize when or if you are acting inferior or superior to another, whether it is helpful or harmful, and what you can do to change the dynamic.

Low status

  • Speak softly and mutter
  • Use a lot of words
  • Uncomfortable with silence
  • Apologize a lot
  • Hunch shoulders or try to make one’s self feel small
  • Use a lot of anxious gestures like covering mouth and fidgeting
  • Avoid eye contact
  • Facial expressions that indicate doubt, anxiety, and/or low self esteem.

High status

  • Speak clearly and audibly
  • Use few words
  • Comfortable with silence
  • Rarely apologize
  • Stand firm with legs apart and strong and open shoulders/arms
  • Seek out eye contact (unless contraindicated by cultural preference)
  • Confident, even impatient facial expressions

There are lots of fun ‘Medical Improv’ activities that can be used to raise awareness about wise and unwise ways we use status and work towards the positive!

Authors Bio

bethBeth is a national speaker and author of “Successful Nurse Communication: Safe Care, Healthy Workplaces, & Rewarding Careers”.  She specializes in teaching communication and interpersonal skills to healthcare professionals and incorporates ‘medical improv’ in many of her interactive workshops.  Learn more about her work at www.confidentvoices.com or contact her: beth@bethboynton.com.

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