Alberti R, Emmons M. Your perfect right. Assertiveness and equality in your life and relationships, 10th edn. Samnta Clarita (CA): Impact Publishing; 2017

Akinbode A. Teaching as lived experience: the value of exploring the hidden and emotional side of teaching through reflective narrative. Studying Teacher Education. 2013; 1:(9)62-73

Beauvais AM, Brady N, O'Shea ER, Griffin MTQ. Emotional intelligence and nursing performance among nursing students. Nurse Educ Today. 2011; 31:(4)396-401

Begley AM. On being a good nurse: reflections on the past and preparing for the future. Int J Nurs Pract. 2010; 16:(6)525-532

Bishop S. Develop your assertiveness, 3rd edn. London: Kogan Page; 2013

Butler-Kisber L, Poldma T. The power of visual approaches in qualitative inquiry: the use of collage making and concept mapping in experiential research. Journal of Research Practice. 2010; 2:(6)1-16

Care Quality Commission. Raising a concern with CQC. A quick guide for health and care staff about whistleblowing. 2017. (accessed 23 June 2022)

Cohen L, Manion L, Morrison K. Research methods in education, 6th edn. London: Routledge; 2007

Contreras JA, Edwards-Maddox S, Hall A, Lee MA. Effects of reflective practice on baccalaureate nursing students' stress, anxiety and competency: an integrative review. Worldviews Evid Based Nurs. 2020; 17:(3)239-245

de Souza Pereira S, Bastos Teixeira CA, Reisdorfer E, da Silva Gherardi-Donato EC, Juruena MF, Cardoso L. Burnout in nursing professionals: associations with early stress. British Journal of Mental Health Nursing. 2015; 6:(4)267-275

Duffy K, McCallum J, Ness V, Price L. Whistleblowing and student nurses - Are we asking too much?. Nurse Educ Pract. 2012; 12:(4)177-178

Edwards S, Lee M, Sluman K. Student-led simulation: preparing students for leadership. Nurs Manage. 2018; 25:(5)28-34

Ekebergh M. Lifeworld-based reflection and learning: a contribution to the reflective practice in nursing and nursing education. Reflective Pract. 2007; 8:(3)331-343

Ferguson LM. From the perspective of new nurses: what do effective mentors look like in practice?. Nurse Educ Pract. 2011; 11:(2)119-23

Fook J, Askeland GA. Challenges of critical reflection: ’nothing ventured, nothing gained.’. Social Work Education. 2007; 5:(26)520-533 10.1080/02615470601118662

Fuster Linares P, Rodriguez Higueras E, Martin-Ferreres ML, Cerezuela Torre MÁ, Wennberg Capellades L, Gallart Fernández-Puebla A. Dimensions of leadership in undergraduate nursing students. Validation of a tool. Nurse Educ Today. 2020; 95

Goleman D. Working with emotional intelligence.London: Bloomsbury; 1998

Greenwood J. The role of reflection in single and double loop learning. J Adv Nurs. 1998; 27:(5)1048-1053

Hudek K. Finding Voice. AORN J. 2012; 95:(5)648-652

Hutchison JS. Anti-oppressive practice and reflexive lifeworld-led approaches to care: a framework for teaching nurses about social justice. Nurs Res Pract. 2015; 2015:1-5

Ion R, Smith K, Moir J, Nimmo S. Accounting for actions and omissions: a discourse analysis of student nurse accounts of responding to instances of poor care. J Adv Nurs. 2016; 72:(5)1054-64

Johns C. Becoming a reflective practitioner, 4th edn. Chichester: Wiley-Blackwell; 2013

Kaihlanen AM, Lakanmaa RL, Salminen L. The transition from nursing student to registered nurse: the mentor's possibilities to act as a supporter. Nurse Educ Pract. 2013; 13:(5)418-422

Keeling J, Templeman J. An exploratory study: student nurses' perceptions of professionalism. Nurse Educ Pract. 2013; 13:(1)18-22

Krueger RA. Analyzing and reporting focus group results.London: Sage; 1998

Larijani TT, Aghajani M, Baheiraei A, Neiestanak NS. Relation of assertiveness and anxiety among Iranian University students. J Psychiatr Ment Health Nurs. 2010; 17:(10)893-839

Law BYS, Chan EA. The experience of learning to speak up: a narrative inquiry on newly graduated registered nurses. J Clin Nurs. 2015; 24:(13-14)1837-1848

Levett-Jones T, Lathlean J. ‘Don't rock the boat’: Nursing students' experiences of conformity and compliance. Nurse Educ Today. 2009; 29:(3)342-349

Malik D, Wilkinson D, Henwood S. Practical leadership in nursing and health care. In: Henwood S (ed). London: CRC Press; 2014

Moon J. Using story in higher education and professional development, 1st edn. London: Routledge; 2010

Mooney M. Professional socialization: the key to survival as a newly qualified nurse. Int J Nurs Pract. 2007; 13:(2)75-80

Nursing and Midwifery Council. Future nurse: Standards of proficiency for registered nurses. 2018a. (accessed 1 August 2022)

Nursing and Midwifery Council. The Code. 2018b. (accessed 24 June 2022)

Nursing and Midwifery Council. Standards framework for nursing and midwifery education. 2019. (accessed 1 August 2022)

Oxtoby K. Make yourself heard. Nurs Stand. 2015; 30:(15)

Por J, Barriball L, Fitzpatrick J, Roberts J. Emotional intelligence: its relationship to stress, coping, well-being and professional performance in nursing students. Nurse Educ Today. 2011; 31:(8)855-860

Poroch D, McIntosh W. Barriers to assertive skills in nurses. Aust N Z J Ment Health Nurs. 1995; 4:(3)113-123

Punch KF. Introduction to social research: quantitative and qualitative approaches, 3rd edn. London: Sage; 2014

Royal College of Nursing. Informed consent in health and social care research. RCN guidance for nurses. 2011. (accessed 1 August 2020)

Siviter B. The student nurse handbook, 3rd edn. London: Balliére-Tindall/Elsevier; 2013

Smith JA, Osborn M. Interpretive phenomenological analysis. In: Smith JA (ed). London: Sage; 2003

Stanley D. Clinical leadership characteristics confirmed. Journal of Research in Nursing. 2014; 19:(2)118-128

Timmins F, McCabe C. Nurses' and midwives' assertive behaviour in the workplace. J Adv Nurs. 2005; 51:(1)38-45

Tomietto M, Sartor A, Mazzocoli E, Palese A. Paradoxical effects of a hospital-based, multi-intervention programme aimed at reducing medication round interruptions. J Nurs Manag. 2012; 20:(3)335-343

Wadensten B, Engström M, Häggström E. Public nursing home staff 's experience of participating in an intervention aimed at enhancing their self-esteem. J Nurs Manag. 2009; 17:(7)833-842

Developing collective leadership for health care. 2014. (accessed 24 June 2022)

Willis Commission. Quality with compassion: the future of nursing education. Report of the Willis Commission. 2012. (accessed 24 June 2022)

Students' experience of the challenges of using assertive communication

11 August 2022
22 min read
Volume 31 · Issue 15


Assertive communication is a skill that many nurses, particularly nursing students, find challenging. This article describes the findings of phenomenological study that set out to explore third-year student nurses' experiences of using assertive communication in the clinical setting. A narrative enquiry approach reviewed six reflective written accounts of their experiences. In addition, seven students took part in an in-depth semi-structured group discussion of their clinical experiences. Data were analysed using a hybrid interpretive phenomenological analysis and discourse analysis framework. Three key themes emerged: a sense of responsibility/duty and a sense of failure when this is not upheld, the importance of mentors in promoting self-confidence and self-esteem, and a sense of belonging on placement. The students responded well to positive role models and were able to identify negative role models. Accurate, constructive feedback and support was important to help students reflect appropriately.

Nursing has historically been a submissive profession within health care. Today, changes in healthcare policy, the evolving nursing role and negative healthcare events publicised in the media, have made it essential for contemporary nurses to be leaders within the clinical environment, using assertive communication styles in their exchanges with patients, relatives and other healthcare staff. Individuals in leaderships positions motivate others, set clear goals and make decisions, using listening skills and articulating clearly. The Nursing and Midwifery Council (NMC) (2018a; 2019) standards consider that leadership principles, such as assertiveness, are an integral component in the delivery of high-quality care and there is an expectation that students will engage with this from the start of their education.

The Willis Commission (2012) recognised that nurse educators and qualified nurses are in a unique position to lead nursing as a competent and compassionate workforce. Nursing students must be proficient in recognising, challenging and reporting poor care, working as equal partners alongside other health professionals (NMC, 2018b). This is consistent with Cumming and Bennett's (2012) position that leadership must exist at every level, with each individual viewing themselves as a leader who role models compassion in day-to-day care and who is committed to speaking up when things are wrong.

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