Choosing between “yes” and “no”

Nurses are professional nixers—in other words, we know how to say “No.” Take the other night, I spent an entire shift nixing everything in sight:
No, you can’t get an epidural yet–you’re not even in labor!

No, I won’t increase the Pitocin on my patient who has an ugly fetal monitoring strip.

No, I won’t work an extra shift this week.

No, I don’t want to order out for dinner.

No, you can’t have ten visitors in your room at 2 AM.

No, eating Mexican food right before pushing your baby out may not be a good idea.

No, I don’t want more coffee at 0600 (though I really did)!

Interestingly enough, my typical response before becoming a nurse was to agree to EVERYTHING—I just didn’t want to upset anyone. When I first started on the floor as a GN I found myself intimidated by certain people and situations and saying, “yes” when clearly saying no was a safer and better answer.

So how have I learned to disagree in a way that is still professional while still getting the point across? I think saying, “nope” can be done in a pleasant way—with patients I always use humor and that seems to go over well (“I don’t think you want to see that Mexican food again anytime soon so let’s make a better choice for refreshment while pushing!”)

The assertive NO to a fellow nurse or doc can be done with firmness and civility. You just have to mean what you say and stick to it! I work with one nurse who instead of disagreeing will tell the docs frequently “I’m not doing such-and-such: if you want it done, do it yourself!” It’s no wonder the docs ask to work with other nurses—saying no is an art form. The admirable thing about this nurse is that everyone knows she means it when she takes a stance: I wouldn’t mess with her!

Sometimes an angry “NO! Absolutely not!” is needed for patient safety. Co-workers need to know I mean what I say and in an emergent moment, I’m not budging. This has been the hardest lesson in saying “No” because I have to have absolute confidence in my choices at the moment—pretty hard for new nurses!

At times I still get really nervous about telling doctors “No” but I am learning that patient advocacy trumps any emotion I have. I’m getting better at refutation and honestly, my practice is improving because of it! In the end, it is all about context—oh, and learning when to say yes!