How did you come to write a book?

I was dean of nursing at Marquette University in Milwaukee, but I had become more and more involved in work on conflict resolution and wanted to put more time into that. I wanted to write.

Your book is called Negotiating at an Uneven Table; Developing Moral Courage in Resolving our Conflicts. Whose conflicts?

Ours. It is deliberately not directed at any given audience. The focus of the book is to find and discuss constructive ways to be at an uneven table.

In conflict negotiation, the assumption is that you are sitting at an even table, and I've never seen one. If the unevenness isn't acknowledged, then resolution [of the conflict] depends on who has the most advantage.

There are tables where people pretend it is even, and people go to that table thinking evenness will be assumed or pursued, and that is not the case. There is structured inequity at the beginning. The intent at the end of the negotiation is that no matter how the conflict is resolved, the structured inequity will be sustained. The consequences of that are extremely damaging--the conflict doesn't really meet resolution.

Why did you write the book?

My interest was in the disadvantaged person, the silent voice at the table. I was particularly committed to my discipline, health care. The discipline had been crafted by Caucasian men, and there weren't other voices because they didn't speak up. My intent was to say something 180 degrees from the rest of the literature- that the even table doesn't exist, and that we need to know what to do at a table that is uneven.

I'm a nurse and I'm passionate about nursing. But my sense was that it would be valuable to talk about the uneven table to as many people who want to learn about that.

Of course, I did talk to nurses in the process. It was a way to tell the story about uneven tables and what to do at them, but also tell the story of nurses.

A second edition is in production and I'm writing a second book--Negotiation Skills for Those Not Born to the Table. The intent is to record and discuss specific skills that I find people lack if they weren't trained to assume they are the advantaged faction.

Our society is fixated on control and power, and a lot of negotiations erode into who can control. Take the average staff nurse trying to talk to a physician about a difference of opinion. There isn't going to be a moment halfway through when the physician suddenly says the nurse is in control.

Do you hear from many nurses about the book?

More than I thought I would, frankly. I think they are my primary buying group, although it is not advertised in any nursing journals. It has all been by word-of-mouth.

I do a lot of workshops and move on from one group to another. The seriousness of the conflict that nurses are confronted with today and the absolute absence of any tools to deal with it are shocking to me.

Think of the time and effort we put into teaching someone to do an injection, which is a fairly simple mechanical process. Then look at the amount of conflict nurses deal with every day, and they've had almost no training on it.

Research indicates that our primary behavior is avoidance, and if that doesn't work, accommodation, and then compromise. We confuse accommodation with collaboration-we think that when we accommodate, we are collaborating. We don't realize that our accommodation harms us. We aren't really team players, we're people who went along with the politics.

We accommodate to look like we're on board and productive. We now can speak fluent MBA, but somewhere in there, the soul of nursing--what happens to the patient--gets lost.

Was better patient care a goal in
writing the book?

Unquestionably. Until nurses' voices can be heard at the table, what nurses bring to patients has no assurance of being part of the health care plan. Touch, presence, compassion--those are all nonreimbursable, they haven't been built into the equation.

We're the best group of people to talk about the human part of health care, but if we don't have a voice at the table, then it is silenced.

Nurses understand these things better than anyone. We have the expertise, but aren't heard because we don't know how to voice ourselves. We're scared of conflict. I applaud NurseWeek for being willing to even talk about this.