On your way back to the ICU from your afternoon coffee break, you heard from the paging system a call for emergency medical response. You immediately responded by going to the area and found the medical resident and the consultant trying to intubate the cyanotic female client who suddenly had an arrest. Looking at the cardiac monitor, you noticed that the oxygen saturation is below 70%. Noticing that everybody else who responded to the call seemed to have a role already, you decided to prepare a bed at the ICU. After preparing the ICU room for a possible transfer of the patient who was being intubated, you went back to the area and checked the team and the patient. In the busy room, you noticed that the doctors were still trying to get the endotracheal tube into the trachea. You are now thinking that they are having difficulty intubating the patient.
You then suddenly blurted, “I have prepared a bed for the patient at the ICU.” Everybody in the team just looked at you dismissively as if telling you: “Get lost. You are overreacting. We’re doing fine here.” You start to doubt whether you said anything wrong and if you actually got a wrong impression that they needed help to stabilize the patient. You felt uncomfortable under everyone’s puzzled glare who were still trying to figure out what to do next since the client’s oxygen saturation is still not responding well. You felt uneasy but suggested anyway that the patient be wheeled into the ICU. You are applying assertiveness.
When the patient got into the ICU and you had the chance to assess her, you instinctively listened to the breath sounds with a stethoscope and you doubted whether the endotracheal tube is really in the trachea. You can barely hear breath sounds after you hooked the patient to the mechanical ventilator and you notice that the oxygen saturation is still not rising. You were in a dilemma whether to call the attention of the doctors again and suggest that they reintubate the patient.
You are a novice nurse but you know something is not right. You are afraid that you might be assessing the client incorrectly but even with the anxiety, you manage to be assertive and asked the doctor to reassess the client. You tell him, “Doc, I cannot clearly hear any breathsounds in the lung fields and the oxygen saturation is still not rising. Is it possible that the tube may not be in the trachea?” The doctor reassessed the client and asked for a second opinion from another physician. They both agreed to reintubate the patient. The patient’s pupils are now size 5, fixed and dilated. You know she is now comatose. The patient died the next day. Could the patient have survived if there was quicker assessment and immediate assertiveness on the part of the nurse? If the healthcare profession is more appreciative of one another as a significant partner in the team, would it encourage each member to speak up and freely communicate with each other? Can this affect patient outcome and patient safety as well as effectiveness of care?
It is every member of the healthcare team’s business to speak up in the face of potential breach of patient safety. You have the right to assert what is right for your patient. Assertiveness in the health profession is integral to professional accountability and responsible action. According to Reid & Bromiley (2012) in their research article, “Clinical Human Factors: the need to speak up to improve patient safety,” found in the Nursing Standard journal, there are few absolute rules and it is a matter of individual professional judgement when you decide what to assert about and when to do it.
In order to ensure competent and safe nursing practice, effective communication is essential with everyone involved in the healthcare organization. That includes assertiveness which enables you to assist individuals and is an expression of your rights, thoughts and feelings in a way that neither denies nor demeans but recognizes and respects other people. It is a communication style which is considered as an important behaviour for today’s professional nurse and the key to successful relationships with clients, families, and colleagues. According to Unal (2012) in the article, “Evaluating the effect of self-awareness and communication techniques on nurses’ assertiveness and self-esteem,” individuals who have assertive behaviours generally have higher self-esteem. Individuals with high self-esteem behave more sensitively, positively, tolerantly and independently in relationships with other individuals and can accept other individuals more easily. High self-esteem is therefore a factor with a positive inﬂuence on assertiveness. Assertiveness is an expression of self-esteem. An individual with high self-esteem demands respect for his/her own rights while respecting others’ rights and demands.