Interactional problems among healthcare professionals in the workplace are an important area for research and development. These issues not only complicate and strain the work of healthcare professionals but also jeopardize patient safety if medical errors and poor practices cannot be addressed for various reasons. Typically, open communication principles are suggested as a solution to interaction problems, emphasizing that issues should be discussed directly and immediately. This allows for an immediate resolution of problematic situations without the risk of interpersonal conflict or, at least, preventing its escalation.
In our discourse-analytical study, we found that nursing professionals strongly align with these ideals of open communication when considering how challenging workplace interactions should—or should have been—handled. According to their views, in difficult interactional situations, feedback on problematic behavior should be given to a colleague directly and immediately. If everyone feels empowered to speak openly about matters that bother them, there’s no room left for interpreting others’ actions. The commitment to these ideals was strong even when they were acknowledged as difficult or even impossible to implement in practical situations.
The ideal of speaking directly was also found to be quite inequitable within the work community. For example, managers expressed dissatisfaction with subordinates’ reluctance to address problems directly with each other, viewing that not all communication issues in the workplace should fall on the managers. Instead, they hoped that their subordinates would feel empowered to resolve problems among themselves. However, not all members of the work community had an equal opportunity to express their problematic experiences directly, and they also questioned whether repeated direct feedback could realistically change their colleagues’ behavior. At the same time, in group discussion situations, attempts by nurses to challenge the community’s communication practices were often easily suppressed.
The ideal of speaking directly has unique features in nursing, as a good nursing professional is typically associated with the notion of a morally good person. In this sense, commenting on a colleague’s ways of working can easily be conflated with questioning their moral and ethical practices, which understandably might not be received as “neutral” feedback and can even lead to interpersonal conflict. Similarly, the central role of communication skills as part of professional competence can complicate ideal behavior. When criticism from a colleague touches on core professional skills, it may be more difficult to perceive the feedback as a simple corrective action. Although direct feedback on problematic behavior is necessary to promote patient safety, it may not at all foster a positive and safe workplace atmosphere.
These challenges can lead members of the work community to avoid the ideal of direct communication and instead use alternative methods in problematic situations, such as bypassing the issue, avoiding bringing it up, or talking behind someone’s back. At the same time, an employee who has been mistreated may experience a double burden when open communication is presented as the only correct approach. Not only do they suffer from the mistreatment, but they are also seen as having failed to handle the situation properly, as if the fault was originally theirs.
Based on our research findings, we suggest that more attention should be paid to the disparities in the ideals guiding communication practices within work communities. Workplace communication should be developed in ways that provide even those in weaker positions with an equal opportunity to influence the communication ideals in the workplace.
Read more in the open-access research publication:
Weiste, E., Stevanovic, M., Koskela, I., Paavolainen, M., Korkiakangas, E., Koivisto, T., Levonius, V. & Laitinen, J. (2024). “You should have addressed it directly”: the ideals and ideologies of managing interaction problems in healthcare work