In an article published in the June 2023 issue of the Clinical Journal of Oncology Nursing, Elizabeth E. McNulty, DNP, RN, NE-BC, reported on the outcomes of a DNP project implementing a Fierce Conversations training program to improve communication among oncology nursing staff. “Fierce Conversations is a communication development training that teaches leaders how to have meaningful conversations,” McNulty said. 

Core Competencies of Nurse Communication 

The American Organization for Nursing Leadership identified 24 core competencies across 5 domains for nurse managers, and Fierce Conversations training addresses 15 of them, McNulty said. Her institution “has been offering Fierce Conversations training programs as a framework to build a common language and improve RN-to-RN interactions and peer reviews among clinical nurses” since 2018, she said, but nurse leader participation is voluntary and only one-third had engaged with the training prior to her DNP project. 

“If nurse executives are educated in Fierce Conversations, will a top-down approach to change promote open communication, consistency, and accountability?” McNulty posited. She chose seven Fierce Conversations programs for nurse leader training during her project: 

• Foundations: defines the role and impact of conversations 
• Accountability: describes the victim mindset and provides tools for power and confidence 
• Confront: provides a framework to approach tough conversations with confidence and skill 
• Coach: provides a framework to realize solutions and potential 
• Delegate: promotes role clarity to end micromanagement and support professional development 
• Feedback: teaches strategies to provide direction to help employees move toward goals 
• Team: facilitates decision-making and aligns teams for action 

McNulty’s project was the first time her institution used the Accountability Program, she said. 

Implementing Fierce Conversations for Oncology Nurse Leaders 

McNulty delivered the training to 24 nurse executives at her institution through one virtual session followed by two self-directed assignments and two in-person sessions. Participants completed the Foundations Program during the virtual session, then the Accountability and Delegate programs on their own. They reconvened in person for the Coach, Confront, Feedback, and Team programs as well as a practice session for the Accountability Program. 

From pre- to postintervention, 13 of 15 participants improved their knowledge assessment scores, McNulty said, with median scores increasing by two points from 8 to 10 on a 15-point scale. 

“Project participants scored higher on knowledge recall questions than on behavior-based questions. These results indicate that knowledge of communication techniques was gained, but understanding of their practice and application must be strengthened,” McNulty said. 

“Improving communication requires not just education but also practice, reflection, and integration of feedback,” she continued. “Teaching nurse leaders the techniques to have effective conversations is just the beginning. Future work must include organizational changes to build accountability and create a just culture to drive quality and safety in patient care.” 

For more information about McNulty’s DNP project, refer to the full report in the Clinical Journal of Oncology Nursing. You can also learn about just culture, reporting culture, and other ways oncology nurse leaders can promote healthy cultures of safety on the Oncology Nursing Podcast and ONS Voice.