NURS 220 Week 3 Discussion Board Forum 1 Example

Discussion Board Forum 1: Silence, Violence and Safety in a Clinical Conversation

NURS 220 Advanced Nursing Communication, Discussion Board Forum 1

Thread by [Student Name]

The clinical scene and classmates are composites; the textbook and journal articles cited are real.

During my clinical rotation, I watched a new graduate nurse call a physician about a patient whose heart rate had climbed from 88 to 126 over two hours. She began, "I'm sorry to bother you," and before she reached the trend, he interrupted: "Is he symptomatic? Then I don't know why you're calling." She answered, "No, it's fine, sorry," and hung up. The patient was later found to be bleeding internally.

Patterson et al. (2012) teach that the first skill in a high-stakes conversation is to watch for the moment it turns from routine to risky and, above all, for signs that people no longer feel safe. When safety goes, people move toward silence or violence. Silence withholds meaning: masking, avoiding and withdrawing. Violence tries to force meaning: controlling, labeling and attacking. In this call, the physician's interruption moved toward violence by controlling the conversation, and the nurse moved immediately to silence. Her "it's fine" was masking, since she did not believe it was fine, and hanging up was withdrawing. The authors also ask us to watch ourselves; her apology at the start suggested she expected to be unwelcome before she spoke.

This pattern is not only about one nurse's courage. Abousoliman and Elgamal (2026) surveyed 288 clinical nurses and found that courageous leadership was positively associated with speaking up, with just culture and psychological safety helping to explain that link. When nurses believe that raising a concern will be met fairly, they are more likely to do it. I have started to watch for my own first signs of silence, such as apologizing before I have said anything. If I were in her place, I would want a sentence ready that states the trend and the request plainly: "His heart rate has risen from 88 to 126 over two hours, and I'm concerned about bleeding; I'd like you to evaluate him." Silence that protects the nurse from an uncomfortable minute can leave the patient unprotected for hours.

Reply to Taylor

Taylor, your account of an experienced nurse rolling her eyes and saying "Good luck with that" when you asked for help sounds like the bullying many new nurses describe. Matousek et al. (2026) report that some in nursing still treat bullying of new graduates as a rite of passage, even though it erodes confidence and is linked to errors and falls. Their project used cognitive rehearsal training, in which new nurses practiced scripted responses to scenarios such as gossip, negative nonverbal behavior and direct remarks. A rehearsed sentence, such as "I'd like to learn this the right way; could you show me?", might give you a way to respond that is neither silence nor violence. Would your unit educator be open to practicing a few scenarios?

Reply to Jordan

Jordan, you described a unit where night and day shift blame each other at every handoff. That sounds like violence on both sides, mostly labeling. Sims et al. (2026) describe a critical care unit where leaders met monthly with nurses and nursing assistants to discuss teamwork barriers, decide on strategies and deliver the chosen solutions, a structured approach they call the Triple D Method, while also promoting well-being practices. Bringing the conflict into a regular, structured meeting may make it safer to talk about than at the bedside at 7 a.m. It also matches the chapter's advice to step out of the content and restore safety before continuing. Does your unit have a forum like that?

References

Abousoliman, A. D., & Elgamal, H. G. (2026). Courageous leadership and nurses' speaking-up behavior: The indirect roles of just culture and psychological safety: A cross-sectional study. International Journal of Nursing Studies Advances, 11, 100663. https://doi.org/10.1016/j.ijnsa.2026.100663

Matousek, C. M., Brooks, D., Elwell, J., Carafeno, T., & Alexander, I. M. (2026). Reducing ambulatory new graduate nurse bullying. American Journal of Nursing, 126(10), 44-49. https://doi.org/10.1097/AJN.0000000000000375

Patterson, K., Grenny, J., McMillan, R., & Switzler, A. (2012). Crucial conversations: Tools for talking when stakes are high (2nd ed.). McGraw-Hill.

Sims, T., Bacchus, M., Johnson, S., Adigler, B., Howard, L., Thomas, S., Maldonado, M., Ayabazu-Okoye, N., Ali, M., Linscheid, Y., & Spikes, K. (2026). Impact of the Triple D Method on conflict management and workplace engagement. Critical Care Nurse, 46(4), 62-70. https://doi.org/10.4037/ccn2026391