This paper examines three distinct communication styles — aggressive, nonassertive, and assertive — as demonstrated by healthcare personnel in workplace scenarios. The first scenario involves a psychiatric nurse who humiliates an aide, triggering passive-aggressive resentment. The second depicts a school nurse who bypasses a colleague rather than addressing concerns directly. The third shows a surgical center manager assertively upholding job expectations against an entitled technician. For each scenario, the paper proposes improved communication strategies and explains why effective communication is critical to patient safety, team cohesion, and overall healthcare outcomes.
Effective communication is one of the most critical competencies in any healthcare setting. The manner in which healthcare workers interact — whether assertively, aggressively, or nonassertively — directly shapes team dynamics, staff morale, and ultimately patient outcomes. The following three scenarios illustrate each of these communication styles and highlight the consequences of each approach within a professional care environment.
Rashad attended a team meeting along with the rest of the staff. When the topic of role clarification for assistive personnel arose, he stated that he believed part of his role was to anticipate patients' needs for toileting and personal hygienic care. Robin, one of the staff RNs in their psychiatric care group home, raised her voice and firmly stated, "You are only an aide. That is in the RN role. We don't expect you to think, just to do what we tell you to when we tell you." Rashad sat quietly without responding because he needed to keep his job, but he began planning how he would make Robin pay for her statement — perhaps by refusing to act without being explicitly told.
Robin, the psychiatric nurse, was being aggressive. She humiliated Rashad and belittled him in front of colleagues. Her behavior is detrimental to the healthcare environment because it demotivates staff and breeds conflict. Rashad responded passively in the moment but planned to become passive-aggressive in the future. The entire situation is destructive to the harmony that a healthcare environment requires.
A school nurse working in a rural county was following up on vision and hearing testing that had been conducted by a volunteer named Brigit. She was concerned about the accuracy of the results, given how the readings compared to previous ones. Rather than discussing her concerns openly with Brigit, she decided to redo all the testing herself without informing anyone.
This school nurse was being nonassertive. She also demonstrated a lack of trust in her colleague. Instead of openly discussing her assumptions with Brigit and, in a non-threatening way, probing for feedback, she acted on her own without informing her peer of her intention. This behavior is potentially destructive to the health of the workplace environment, as it may seed dissension and introduce errors and miscommunication — or a complete absence of communication — in the workplace.
Rosa managed the ambulatory care surgical center for a large healthcare organization. Mabel, one of the surgical technicians, informed her that she would not scrub in on any orthopedic cases, citing the physical demands as her rationale. When Rosa explained that, while she valued each staff member's strengths, participation in orthopedic cases was part of Mabel's job description and essential to delivering the best patient care, Mabel responded menacingly — declaring that she was the granddaughter of the chairman of the board and that she would "get Rosa's head on a platter."
Mabel was behaving aggressively. Her unwillingness to participate in cases that did not suit her personal preferences, combined with her invocation of family connections as leverage, made her a disruptive presence on the team. Rosa, by contrast, was being assertive. She handled the situation skillfully by articulating the reasons Mabel's participation was needed and grounding her expectations in the formal job description. Understanding the difference between assertive and aggressive communication is essential for any healthcare manager navigating such interpersonal challenges.
In the first scenario, if I were Robin, I would calmly explain to Rashad the distinction between the RN role and the tasks he had in mind. I would clearly, calmly, and patiently inform him of the expectations the hospital has for his position. I would do so in a warm, sympathetic manner so that he would not feel embarrassed. At the same time, I would keep the explanation brief so as not to frustrate or tire the others present at the meeting. I might also add that if Rashad had further questions or difficulties, he was welcome to consult me at a later time.
Were I in Rashad's position, I would face a more difficult situation. I would justifiably feel hurt. I might consider discussing my feelings with Robin directly, though given her personality, this approach would likely only escalate the matter. Depending on the circumstances, I might bring the issue to Robin's supervisor. Alternatively, I might work through my feelings by talking with trusted friends or reminding myself that Robin's reaction likely reflects a personal character flaw or some difficulty she herself is experiencing, rather than any failing on my part. I might choose to raise the matter with her at a later time, or I might decide to let it go entirely.
In the second scenario, if I were the school nurse, I would take Brigit aside and ask her, in a non-intimidating manner, to walk me through how she conducted the testing. I would ask her to describe her procedure and listen closely and empathetically, making sure I understood every detail before deciding whether a retest was necessary. Applying the principles of assertive communication would allow for an honest, respectful exchange rather than a unilateral decision that bypasses the colleague entirely.
I would also probe for contextual details and any potential confounding factors to ensure I had a complete picture of the situation. If Brigit needed corrective guidance, I would offer it gently and sensitively, focusing on specific behaviors rather than general criticism.
In the third scenario, I would largely affirm Rosa's approach to Mabel. If Mabel continued to disregard expectations after Rosa's initial response, I would clearly outline the consequences. The situation is particularly delicate because Mabel may feel emboldened by her family connections. Nevertheless, Rosa is bound by professional and ethical obligations, and all employees must be held to the same standards. If Rosa genuinely feared adverse consequences from Mabel's connections, she might need to conduct future interactions in the presence of witnesses and take additional protective steps to safeguard her own position and the integrity of the team.
"Communication failures risk patient safety and team cohesion"
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