As nurses we face numerous challenges in our daily working lives, and these can affect our physical and emotional wellbeing. However, it is also important to consider how those challenges affect our relationships with our colleagues. In a high-pressure environment, tensions among team members can rapidly escalate. The worse the problem gets, the more difficult a conversation can appear and the more likely we are to try to avoid it. Having difficult conversations with colleagues isn’t easy.
Avoiding the problem will not make it go away. Instead, we need to equip ourselves with the skills to navigate challenging conversations with grace and empathetic communication. In this article I will share some practical techniques to help you manage difficult conversations in a way which is beneficial to you and your colleagues.
Nurses are reporting an increase in workplace-related stress. From 2019 to 2021 the number of nurses who reported that they had been unwell due to stress or mental health problems increased from 56.7% to 66.8% (RCN 2021). Stress, anxiety, depression and other psychiatric illnesses are responsible for around a quarter of sickness absence across the NHS, accounting for over 620,820 full time equivalent days lost in one month alone last year (NHS England 2023).
This increase in stress can have serious implications for workplace communication. It can mean tensions escalate more rapidly, leading to strained relationships and less effective team working. It can also limit emotional resilience, making us more likely to avoid difficult conversations, and make it harder to consider the implications of our actions on those around us.
A phrase I hear a lot when delivering communication training is: “I don’t like confrontation.” When healthcare professionals say this, it is often because they are grappling with a challenging situation with a colleague. For example, a staff member who is not performing their role effectively or a surgeon who is complaining about how a clinic is run in a public setting. However, avoiding discussing these issues will not solve the underlying problems and, if anything, they are likely to get worse.
Instead of viewing difficult conversations as a confrontation we need to see them as a tool to navigate challenging situations with colleagues in a non-confrontational manner and constructively foster a more positive work environment.
Having a communication strategy in place can help you to navigate a range of different conversations. Here are six steps to help you get started.
Step one – empathise. Consider the situation from the other person’s perspective and try to understand what might be driving their behaviour. We will explore techniques to do this effectively later in the article.
Step two – prepare for the conversation. Consider how you can create the best possible chance of the conversation reaching a positive outcome. Choose a neutral location and a time which will allow both of you to concentrate on the topic at hand. Put your emotion to one side and write down the key facts you need to discuss. Try to limit this to a couple of short sentences. You can take these notes with you into the meeting.
Step three – clearly outline the problem. Before you begin, acknowledge your colleague’s willingness to meet and thank them for engaging with you. Then, set out why you wanted to meet. Be descriptive and avoid personal attacks. For example: “When you express your frustration to me about how the clinic is organised in the corridor, the impact on me and the team is… and this leaves me/us feeling…”.
Step four – pause and gather information. Let your colleague absorb the information you have given them and encourage them to share their perspective. It can be useful to ask open questions, for example: “How do you feel about what I have said?”.
Step five – practice active listening. Listen carefully to what your colleague is saying and try to observe both verbal and non-verbal cues. Summarise what you have heard them say and ask if they feel your summation reflects their point of view. Reflect on their responses, offering empathy and acknowledgment where appropriate. For example: “I can see you are under a lot of pressure.” We will look at active listening in more detail in the next section of the article.
Step six – work together to find a mutually-beneficial way forward.
Active listening is one of the most important strategies for good communication with colleagues. It involves giving your colleagues your full attention and engaging with what they are saying. This can help to build trust, leading to more open and honest communication.
There are several techniques you can use to help make sure you are actively listening during difficult conversation. Maintain eye contact and use minimal prompts such as nodding to show engagement. Refrain from interrupting even if you feel unhappy about the opinions being expressed. Allow your colleague time to fully explain their position before responding. Utilise silence and pauses. It can help to do a slow count in your head once someone has finished talking to avoid rushing to fill the silence. Ask open-ended questions to encourage elaboration. Questions that start with “how” or “what” elicit more details. Avoid asking ‘why’ questions as they can sound confrontational.
Once your colleague has finished speaking, summarise what they have said to confirm understanding. Practice empathy to show you are trying to understand things from their perspective. For example: “It sounds like you are feeling very stressed at the moment.” You may need to ask clarifying questions. These can include educated guesses, for example: “Based on what you have told me it sounds like you are feeling isolated from the rest of the team. Is that right?”
Crucially, make sure you choose a setting where you will be able to avoid distractions and focus entirely on the conversation. Eliminate multitasking.
The words you use can increase, or decrease, your chances of successfully navigating a difficult conversation. Avoid the use of the word “but” or ‘however’ which can be considered negative and erase previous positive statements. For example, say: “You did a good job, and it would be helpful in future if you could…” rather than: “You did a good job but/however…”.
“I” statements are another useful way to outline how a colleague’s behaviour affects you or your team and help you avoid personal attacks. For example: “What I would like to talk about is…” rather than “You are not doing…”. They can also be helpful when responding to a colleague’s experiences. For example: “I value you being open with me.”
When dealing with challenging behaviour from a colleague it is easy to judge the other person solely on their behaviour and how it impacts on you. However, to change the status quo, it is important to consider their motivations and circumstances. A simple phrase to help us be more empathetic and practice kindness in our communications is “Step onto the other person’s planet.”
Imagine you are facing a difficult conversation with a colleague. Instead of approaching it solely from your own perspective, take a moment to step onto their planet and ask yourself some simple questions.
By making a genuine effort to understand their perspective, you create a space for empathy and compassion. It is a powerful tool that can transform difficult conversations into opportunities for growth and understanding.
When planning for a conversation with a colleague it can help to consider whether they are displaying signs of stress. This may affect how you approach the conversation, particularly if you are in a management position. While some team members will approach you for help if they have a problem, many will not.
The Chartered Institute of Personnel and Development has useful information on identifying signs of stress in the workplace (CIPD 2023). You may notice some of the following behaviours in your colleagues: uncharacteristic errors, lapses in memory, increased absences, reduced social contacts, difficulty relaxing and lack of interest in their appearance.
You may also notice emotional signs of stress in your colleagues. These can include irritability, over-reaction to problems, increased personality clashes and aggressive behaviour, including increased criticism of others.
Initiating a positive conversation and creating a plan for future actions can be part of early interventions to help colleagues cope with stress before a problem becomes significant. As with all challenging conversations, it is important you have a clear plan and use empathy in your communications.
While it is important to recognise and acknowledge your colleague’s feelings, it can also be helpful to outline the emotional impact their behaviour or actions has on you. A simple technique to do this is BIF – outline the behaviour, describe the impact it has on you or your team and say what feelings the behaviour evokes in you.
People cannot argue against the feelings because they are your feelings. Often people do not realise how their behaviours impact on those around them. Once they understand that their actions are harmful to others, most people will want to correct them. This can be a useful way to help you reach a point of negotiation.
For example, a scenario we use when delivering training involves a nurse (Nurse A) confronting a surgeon (Surgeon A) about their behaviour in the operating theatre. Surgeon A has a tendency to get angry in the operating theatre and throw instruments which makes the nurses uncomfortable.
The meeting has been pre-planned and, despite being nervous, Nurse A outlines the surgeon’s behaviour and explains it makes her and other members of the nursing team feel scared and intimidated.
Surgeon A is surprised to hear how her behaviour impacts on the rest of the team. She explains the pressure she is under and how she wants things to be efficient but that it is not her intention to make anyone feel nervous. Nurse A acknowledges what has been said and thanks Surgeon A for sharing her feelings.
The pair agree to schedule a meeting to allow the whole team to discuss how they can work more efficiently in the operating theatre. Surgeon A also thanks Nurse A for initiating the conversation as it is the first time she has been able to talk about her feelings of burnout.
Hopefully, the outcome of Nurse A initiating this difficult conversation will be Surgeon A feeling more supported and all staff feeling more comfortable in the operating theatre.
In this case study we gain insight into the experiences of an individual (Nurse B) who faced the task of preparing for a difficult conversation with a colleague. It also offers an insight into the transitional phase one undergoes when moving into a more senior role.
Nurse B had always considered herself an open person, who was approachable and a team player. But when she became a manager, she realised how people see you differently when you are in a position of authority. She had not appreciated how overwhelming it would be and how lonely she would feel no longer having the same place within the team.
One thing Nurse B found particularly challenging was managing conversations with colleagues, especially when things were not going well. However, applying the communication skills and strategies outlined above boosted her confidence and provided a structured approach for such discussions, allowing her to negotiate a plan with a colleague and help them both move forward.
Nurse B’s three top tips for effectively managing difficult conversations are:
Approaching difficult conversations with empathy and a clear strategy allows us to address problems earlier and prevent workplace tensions from escalating. We need to view these conversations with colleagues as cathartic experiences and not as confrontations to be avoided. Using the communication skills and strategies outlined in this paper provide valuable tools to create a more positive working environment for all healthcare staff.
CIPD (Chartered Institute of Personnel and Development), 2023. Stress in the workplace. [Cited April 2024]. Available from https://www.cipd.org/uk/knowledge/factsheets/stress-factsheet/
NHS England, 2023. NHS Sickness Absence Rates, May 2023. [Cited February 2025]. Available from NHS Sickness Absence Rates, December 2023 – NHS England Digital
RCN (Royal College of Nursing), 2021. Employment Survey 2021. [Cited April 2024]. Available from https://www.rcn.org.uk/Professional-Development/publications/employment-survey-2021-uk-pub-010-075
