The Art of Saying “No” Without Guilt

Nancy Dias, PhD, RN, Assistant ProfessorEast Carolina University

114th Annual ConventionConcord, NC | September 23-24, 2021

OutlineWhy do I say "No"

Be a Visionary

Plot a Plan

Prioritize: More is not always better

Stay Focused

Maintain Work-Life Balance

Recognize: "My Plate is Full!"

How do I say "No"

Why say “No”

Healthcare systemOrganizationPatient CareSelf

Why say “No”: Healthcare System• Nurse Turnover

• 30% of new nurses leave in the 1st year and 57% by 2nd

• 50% of current workforce is 50 or older• 1 million RN’s will retire in the next 10-

15 years

https://medium.com/scout-design/millennial-driven-design-292c3328c72

HEALTHCARE WORKERS: The Millennials

Why say “No”: Organization

Nurse Turnover: 8.8 – 37 %; average of 17.1% Staffing Ratios

Cost: Average cost of turnover is $ 37,000 - $ 59,000 and $5 –8 Million annually

Onboarding and trainingCareer development and continuing education Meaningful recognition

Work Engagement Loss of teamwork, trust, and effective communication

Why say “No”: Patient Care• Patient outcomes• Quality of care

Why say “No”: Self

• Self Care• Prevent Burnout• So, you can say “YES”

SelfcareBe a Visionary

Plot a Plan

Prioritize: More is not always better

Stay Focused

Maintain Work-Life Balance

Recognize: "My Plate is Full!"

Be a Visionary

• Presbyopic view: – Long-term vision (Clinical Ladder)– Focus on short-term goals

• Education (degrees and certification)• Research (EBP, QI, or Research)• Clinical skills• Leadership

Plot a Plan: Clinical Ladder Set Goals Strategize Interconnect areas Education, research, service, & Clinical expertise

be Selective Organizational memberships & networks Leadership roles Be informed of roles and responsibilities Walk before you run

Year 1 Year 2 Year 3 Year 4 Clinical Ladder

Say “Yes” if…

Clinical Ladder: Novice to ExpertLevel Degree Experience Clinical Education Professional

/Leadership

Level INovice

Level IICompetent

Level IIIProficient

Level IVExpert

Level VAdvanced Expert

Level VIVirtuoso

Area Annual Goals/Specific ObjectivesSMART

Outcome Measures(evidence that objectives have been met)

Education 1. Attain Level II criteria (MSN) 2. Attain certification in Medsurg nursing

1. Enrolled in an MSN program. Will graduate in 2023.

2. Enrolled in the certification program. Will complete certification in December 2021

Research/EBP/QI 1. Develop an EBP project related to reducing length of stay for neonates with NAS

1. Conducted literature review by <date> 2. Build a team by <date>

Clinical 1. Serve in at least 2 committees: Unit, hospital wide, state, national

1. Serve on the EBP committee 2. Serve on the audit and compliance committee

Professional/Leadership

1. Join a professional organization: State, National a. Become a member of NCNAb. Serve as the advisory member of NCNA Triangle

region

Prioritize : Avoid Saying "Yes" On the Spot• Be Strategic: Review your calendar/Goals

– Institutional Mission– Individual Goals

• Clinical ladder• Personal dreams/wish

– 360 evaluation (self, peers, supervisors)• Determine:

– Time commitmentSay “Yes” if…

Stay Focused: Keep the Eye on the Prize

Opportunity vs. distraction Goals Clinical LadderCertificationsCommitteesCreative ideas/projects

Strengths/Weaknesses

Say “Yes” if…

Maintain Work-Life Balance Family vs. Career? Involve the family Inform important

deadlines Follow your passion Set work time

boundaries Self-Care: Have fun

Say “Yes” if…

Recognize if “My Plate is Full!”• Do I meet deadlines?• Quality vs. Quantity• Am I enjoying what I do?• Am I stressed? Irritable Tired Sleeplessness Recognize your “stress” sign

• Greater Good of the group?

How do you say “No”• "That sounds like a really great opportunity, but I have

multiple commitments at this time and may not be able to do justice …….”

• "I am in the middle of _________, ____________, and ___________ [fill in the blanks with your most status-enhancing and high-profile service commitments] and I would like to give this opportunity the deserved time commitment, but these other commitments will take a lot of my time….

• “I appreciate you reaching out to me. I'm not sure I have the expertise you are looking for. Why don't you ask ______________?”

• "If you can find a way to eliminate one of my existing service obligations, I will consider your request.”

What keeps you from saying “no”

• What keeps you from saying “no” Technical Errors, Psychological Blocks, and External Constraints

Technical Errors

You literally don't know how to say "no" in a manner

appropriate to the context.

"Yes” is your default response (and you feel must

have an extraordinary reason to say "no”).

You have no idea how much time "yes” takes.

You haven’t recognized the connection between the

time required to fulfill "yes” commitments and the time you feel you’re missing for truly important activities.

You don’t have a clear and consistent filter to help you

decide when to say "yes” and when to say "no.”

Psychological Blocks• Self grandiosity???

– You’re trying to be super-nurse (i.e., trying to do a little of everything but not doing any one thing well).

– You’re a perfectionist– You feel overly responsible for things that aren’t entirely your

responsibility.– You believe everything will fall apart unless you do the work.– You’re overcompensating and/or trying to prove you belong.

• Altruistic???– You always put other people’s needs before your own.– You’re a pleaser (i.e., you prioritize your concern about people

liking you more than you are about meeting your own goals).

External Constraints

• You just have to say YES– Job requirements– Expectations from your supervisor– Other situations e.g., Pandemic

Challenge Yourself• Reflect on your past academic year, and gently

ask yourself: Do I have a tendency to blurt out "yes” whenever I get a request?

• If you determine that you are over-functioning relative to your colleagues, take 10 minutes to identify what keeps you from saying "no” more often.

• Make an appointment with a friend and literally practice saying “no” just to see how it feels.

OPPORTUNITYISNOWHERE

IS IT ALL ABOUT

MAINTAINING A BALANCE?

This Photo by Unknown Author is licensed under CC BY-NC-ND

This Photo by Unknown Author is licensed under CC BY-NC-ND

References• Monday updates in September from National Center

for Faculty Development and Diversity (https://www.facultydiversity.org/home)

• The Black Academic's Guide to Winning Tenure--Without Losing Your Soul by Kerry Ann Rockquemore (Author), Tracey Laszloffy (Author)

• https://medium.com/scout-design/millennial-driven-design-292c3328c72

• https://www.relias.com/blog/how-to-reduce-healthcare-turnover