Crucial conversations

Crucial conversations

Sometimes providing feedback can be very challenging, depending on the type of feedback and the student and preceptor personalities. Crucial conversations are a way to describe those conversations that preceptors and students find difficult, for example, when there may be a problem requiring attention, a safety issue, or a major concern with performance.

Crucial Conversations: Tools for Talking When the Stakes Are High (2011, 2nd ed.), by Patterson and Grenny defines these conversations as a "discussion between two or more people where: (a) stakes are high, (b) opinions vary, and (c) emotions run strong" (p. 3).

Most nurses have encountered students or new nurses who are overly confident in their skills or knowledge, which can at times lead to unsafe practice as well as conflict between the preceptor and the student or the student with staff on the unit. Sometimes when a student has been a practicing RN for a period of time prior to starting the MSN program, the transition from practicing in the RN role to being a student again can be challenging as well. When a preceptor tries to address overconfidence, a student may become defensive or confrontational and may feel as if the preceptor does not trust her/him. Alternatively, some sensitive students struggle with receiving constructive feedback and may react by crying, withdrawing, acting angry, or feeling attacked.

Crucial conversation skills that preceptors can employ when students are either overly confident or overly sensitive include:

  1. Clarifying the facts before talking to the student.
  2. Gathering the student's point of view or 'story.'
  3. Keeping personal emotions in check and understanding how your own emotions are informing the situation.
  4. Finishing with a plan or "next steps" that are agreed upon by both preceptor and student can keep the discussion moving in a productive way while hopefully calming the student's emotions.

Student red flags

It is essential to identify student red flags early in the experience and discuss these with the faculty so remediation can be provided. These "red flags” may vary depending on where the student is in the program and might change as the student progresses. Some red flags may include:

  1. Any unsafe practice
  2. Not following standards of practice
  3. Absenteeism, leaving early, arriving late, taking extended breaks
  4. Poor communication skills (i.e., defensive to criticism or monopolizing conversation)
  5. Missing essential components of a patient’s medical history or physical exam or conversation
  6. Inability to present cases clearly
  7. Inability to prioritize
  8. Inability to independently develop a patient’s treatment plan
  9. Inability to determine tests to order for a patient
  10. Missing opportunities for anticipatory guidance and patient/family education