If you’ve followed my work, you probably know I’m passionate about the need for communication-related skills in healthcare—and about medical improv as a vital teaching tool. In fact, I think it’s the most effective tool out there.
What you might not know is that I’m also deeply tuned to power dynamics—between professionals, with patients and families, and within teams or organizational cultures. I suspect that sensitivity has roots in two things: growing up with four brothers, and practicing as a nurse for nearly four decades. I can see—and even feel—power imbalances, how they show up in communication, and how they contribute to outcomes that hurt everyone involved.
All of my books speak to this in one way or another.
In this post, I want to share some quick points that nurse leaders and others can use to interrupt power struggles, even when real (or perceived) power differences exist. We’ll look at a real-world example and discuss how empowering language can change everything.
And—speaking of empowerment—I want to invite you to the upcoming (and FREE!) Empowered Nurse Leaders’ Summit on Nov 10th! I had a great conversation with founder Dr. Terry Carter. We even did a simple improv activity together.
Back to the topic. Here’s the real-world example!
Communication Reframe: Nurse Manager–Staff Nurse Power Struggle
- Exasperated Staff RN – We need 3 more nurses on this unit. I can’t work like this any more!
- Exasperated Nurse Manager – We don’t have the budget for that. We need you.
This conversation could be interrupted by an alarm, a call for help, or another urgent request—and repeated until something gives.
- Quiet quitting.
- Real quitting.
- A sentinel event.
- Staff injury.
You know what I mean.
What doesn’t happen?
✅ Clear understanding of the problem.
✅ Collaborative problem-solving.
✅ Trust.
Let’s reframe it!
Exasperated Staff RN: We need three more nurses on this unit. I can’t work like this anymore!
Empowering Nurse Manager: I can see you’re upset. What can I do right now to help you? We can talk more about staffing at the next team meeting.
This simple shift interrupts the power struggle. It validates the staff nurse, addresses the immediate situation, and opens the door for calmer, future-focused conversations. Of course, if the nurse leader wants to build trust, they must follow up—and actively raise the staffing issue with senior leadership.
Will this solve a chronic, systemic, expensive staffing issue overnight?
No.
But it opens the door to clearer diagnosis of the problem—and more honest, co-creative conversation about solutions.
And Now… Let’s Zoom Out One Layer
Chief Nursing Officer – Nurse Manager Power Struggle
Exasperated Nurse Manager: I need an assistant manager to get the scheduling and budget done on time.
Exasperated Chief Nursing Officer: We don’t have the budget for that, and I need those stats by Monday morning.
Same cycle. Same urgency. Same potential for breakdown.
But what if the conversation looked like this?
- Exasperated Nurse Manager – I need an assistant manager to get the scheduling and budget done on time.
- Empowering Chief Nursing Officer – You sound frustrated. What do you need right now in order to focus on your admin work?
Do you hear the difference? Feel it?
The shift in power dynamics flows toward problem-solving, instead of getting stuck in a power tug-of-war. The problems are real. They’re complex. But the shift in communication is deceptively simple.
With practice. It matters. And it’s within reach! Hope to see you at the Summit!
Image credits:
Feature ‘Tug of War” image by Rosy / Bad Homburg / Germany from Pixabay
Nurse Looking out Window image by Bob from Pixabay
