What led you to nursing, the law, mediation and being an improvisational comedian?

I went to nursing school after teaching high school biology and feeling like a surrogate nurse for the students. I went through an accelerated nursing program [one-year BSN] at Creighton University.

While working as an ICU nurse, I saw how systems were failing patients, making it hard for clinicians to do their work. I became interested in health policy and political campaigns, which led me to law school. I had the idea that if we just had good health policy, the systems would work better. I was young.

After law school, I completed a congressional fellowship in the U.S. Senate, but found this was too distant from the clinical setting and that most people writing health policy had little knowledge of health care. So I went into management at UCLA and worked at implementing policies and regulations.

My mediation and improvisation training happened close together, and I realized that they both required the same skill set: being present, listening, agreement, openness and mutuality. Improv games that we performed on stage were great for teaching conflict management skills to hospital staff. These methods became a natural vehicle for showing how assumptions and miscommunication can get us into conflict situations.

What are the rules of mediation?

Be present in the moment. Listen with an open mind. Solve the problem together. Make the other person look good.

Are nurses good mediators?

Nurses are naturally good listeners so they have a basic ability to mediate. The challenge is to let go of control. Parties will come up with creative options. The mediator helps them reach an agreement they can live with. Once external control over the parties or the conflict is mastered, the mediator becomes a conduit for communication. The problem is solved. The process is powerful.

What was your most challenging and interesting case for mediation?

There was a patient who received the wrong medication from the pharmacy. The husband-and-wife team of pharmacists had made a mistake in giving her the wrong bag of medications. She had taken some medication before finding out that a mix-up had occurred. The pharmacists brought the correct package and tried to recover the wrong medication, but the patient wanted to keep it as evidence.

The patient originally wanted to sue, but decided to try mediation. During the mediation, the pharmacists apologized and were willing to do whatever it took to help, but the patient wanted compensation for her emotional turmoil and fear. She said she could not understand how "they could do that to her."

After a break, the pharmacists came back and shared their story. They explained that they had been robbed at gunpoint a few days before the error. The robber had held a gun to their son's head and stolen their money. The wife was shot and showed her scarred arm as evidence. The pharmacists were upset by the robbery and were having difficulty concentrating. This distraction contributed to the error. They described how they had taken steps to use safer systems for checking medications. It was a powerful moment when the patient heard what had happened and realized that steps were taken to prevent any recurrence. An agreement was reached. The patient was able to have empathy and to see how the pharmacists had suffered as well from their mistake.

Shared understanding is what mediation does best. It goes beyond litigation and gives people things they are really looking for: acknowledgement, apology, explanations and a plan for the future.

Is there anything you would like to add?

Yes. Improvisation is really a part of every day. Clinical settings don't have scripts. No one tells us what to say, who we will meet, what events will occur. Good improvising comes with practice. Becoming better improvisers makes us better at resolving conflicts. Resolving conflicts removes barriers to improving patient safety. Safer environments bring less litigation, less blame and increased opportunities to create healing spaces for patients as well as one another.

Reflecting and examining what processes are used for resolving differences creates a shift in focus from what went wrong to what we are doing right. That is mediation. That is nursing.