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Documenting Dilemmas

Documenting dilemmas via email

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By: Connie J. Perkins, PhD, RN, CNE

Use this simple acronym to get results. 

Takeaways:

  • When faced with a workplace dilemma, communication is key to achieving resolution.
  • Clear communication requires emotional intelligence.
  • Documenting communication should include details of the dilemma, opportunities to resolve it, and consequences of not resolving it.

Regardless of position or specialty, nurses face workplace dilemmas ranging from patient care workflow to safe staffing issues. Effectively communicating these dilemmas to the stakeholders who have the power to enact change makes all the difference.

If used properly, email can document the consequences of not resolving a workplace dilemma. When crafting a documentation email, be brief, intentional, and informative. As a guide, use the DOC acronym (Details of the dilemma, Opportunities to resolve it, Consequences of not resolving it) while also practicing emotional intelligence (EI). (See DOC in action.)

DOC in action

This example uses the DOC acronym as a guide for drafting an email message to start the dilemma resolution process.

Details of the dilemma:

Hello, Francis [chief nurse executive].

My name is Bonnie, and I’m a charge nurse on the inpatient behavioral health unit. We’ve been experiencing a staffing shortage during the last quarter, which has directly affected my coworkers and me, resulting in overtime, exhaustion, increased turnover, and decreased patient satisfaction.

Opportunities to resolve it 

I believe we have an opportunity to resolve this issue by lifting the per diem rule surrounding required weekend coverage, which is a typical per diem position deterrent. With the full-time staff already working every other weekend, getting help on the weekdays will defer some overtime.

Consequences of not resolving it 

If this dilemma isn’t resolved by the next quarter, burnout will consume our unit and our patient satisfaction scores will continue to decline. This concern is supported by the Agency for Healthcare Research and Quality in the attached report. I urge you to consider the opportunity I mentioned and discuss this further with your team. Thank you, and please let me know if you have any questions.

Sincerely,
Bonnie Venture, MS, RN, CNL

Emotional intelligence

EI principles, including self-management and relationship management, can help you solve problems and keep you action focused rather than reaction driven. Self-management means separating yourself from the likely personal and emotional aspects of the dilemma through anchoring practices such as taking deep breaths and pausing. Relationship management encourages reflection and the use of assertive, not aggressive, communication. The key to using assertive communication is maintaining mutual respect. You respect yourself for standing up for what you believe in and you respect the other person by sharing your ideas and trusting that they’ll consider them.

Details of the dilemma

Keep your email brief but provide enough factual information to ensure the recipient clearly understands why the dilemma is worthy of attention. Avoid emotional language. For example, you wouldn’t document how angry you felt at a patient who didn’t listen to you and as a result fell. Instead, you would document the facts of what happened with details related only to the fall. Do the same when emailing a stakeholder to document a dilemma.

If you’re not sure who the best stakeholder is for the dilemma you’re trying to resolve, follow your chain of command. If you aren’t familiar with the person you’re emailing, briefly introduce yourself to help them understand why the dilemma is important to you.

Opportunities to resolve the dilemma

The next portion of the email should contain at least one opportunity that you believe will resolve the dilemma. Use “I” more than “you” and choose positive words such as “opportunity,” “resolution,” or “improvement” to ensure you’re being assertive rather than aggressive. If you have more than one suggestion, keep them to one sentence each.

If the stakeholder agrees with your suggestion, you’ll be asked for more details. If you don’t have all the details right now, that’s okay. Start brainstorming in preparation for a follow-up meeting. Make a list of information—such as financial implications—you need from the stakeholder to develop the resolution details. Take the team approach by considering what you both bring to the table—you have hands-on experience with the dilemma while the stakeholder can anticipate barriers to implementing the change.

Consequences of not resolving the dilemma

Your conclusion provides the most important piece of your documentation. It should include a consequence of not resolving the dilemma. Using the word “consequence” can help get your point across. Keep in mind that this section isn’t about the consequences of not taking your suggestion but rather the consequences of not resolving the dilemma quickly. Be clear about what you perceive as the consequences without exaggerating. Consider including respected professional resources, with hyperlinks or attached articles, to support your conclusions. Information specific to the situation (such as patient satisfaction scores for your unit) also will help support your conclusions.

Use EI to edit

After you’ve crafted your email message, take a deep breath and read it to ensure you’ve used assertive language and that your points are clear. An indication that you let your emotions do the typing is if the message is longer than a paragraph. You want the stakeholder to read the message, and a long, overly detailed email likely won’t evoke that response. If you’re having trouble trimming it down, save it and reread in 24 hours.

Practice empathy by imagining how the stakeholder might react to the email. If your imagined reaction isn’t what you aimed for, draft a second version and compare the two before you send anything. Remember that you can explain your ideas further if you can’t fit everything into this one email.

Don’t be concerned if you don’t get an immediate response. Consider this email as the first step in the resolution process, and reach out again after a week to provide an update on the dilemma and ask for a face-to-face meeting. If the stakeholder is someone you see regularly, ask if they received the email and offer additional information if prompted. Continue to use positive language to solidify your dedication to resolving the dilemma.

If you’re not comfortable emailing, using the DOC outline to prepare an elevator speech will help keep you on track and dedicated to a resolution. Similar to preparing an email, write it out and review it before you present it.

Ensure your message is heard

Email serves as a useful tool for communicating with stakeholders about dilemmas you encounter in practice. Be brief, respectful, and assertive to deliver the message effectively and resolve the dilemma quickly.

Connie J. Perkins is founding director of nursing at St. Bonaventure University in St. Bonaventure, New York. 

References

Bush M. The six rules of conscious emailing. Mindful. July 9, 2019. mindful.org/the-six-rules-of-conscious-emailing

Goleman D. Working with Emotional Intelligence. New York, NY: Bantam Books; 1998.

Mayo Clinic. Being assertive: Reduce stress, communicate better. May 29, 2020.

Patient Safety Network. Nursing and patient safety. April 21, 2021.

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