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Healthcare Training Institute - Quality Education since 1979

Section 21
Strategies for Replying to "Not Now," Irrelevant Chatter, Silence, and Denying

Table of Contents | NCCAP/NCTRC CE Booklet

The “Not Now” Diversion

One of the simplest ways for the other staff member to avoid taking action regarding your mutual challenge of Culture Change compliance is to avoid discussing it. If you begin by saying to Sue, your Physical Therapist, “I’d like to discuss rescheduling Mary and Harry’s therapy time to allow them to attend the Crafts Group,” she may say “Not now. I’m too busy,” or ‘Let’s not go into that now,” or “Some other time; I’m busy.” You have two options.

Your first option is to negotiate a specific later time to discuss the problem. This is always a good first response if Sue has only put you off a few times.  You could say, “If not now, when would be a good time for you to discuss Mary and Harry’s treatment schedule with me. (persist)” When she gives you a time for the meeting, be sure you have a notebook or calendar to write down the meeting time.  Repeat the meeting time to make sure you heard her correctly.  Thank her, then drop the subject. By her seeing you write the meeting time down on your calendar that shows you will definitely be expecting a meeting at that time.  However, also be sure to send her an e-mail reminder and, of course, keep the appointment and be on time. 

Second, you can push to have the issue taken up right then.  Only use this strategy as a last resort, if Sue hedges on scheduling a later meeting by stating, “I’m always busy, I’m not sure when I would have time.”  If this is the fifth time Sue has detoured or diverted you with the “Not Now” diversion, you might state, “It’s important to me that we discuss this before next week’s crafts.  It will only take a minute. (persist)”  This statement may increase Sue’s interest to listen, because it tells Sue her put-offs aren’t working, and you have placed a deadline on the change.

If the other staff member says, “I don’t ever want to discuss that,”
1. Consider restating your Broken Record script. For example, “My department needs to be prepared for Survey.”
2. Or consider saying the change is important to you for some resident-focused reason like increased alertness or increased quality of life.
3. You could promise being brief to induce your Sue to discuss the problem.

List the name of a staff member who may use the “Not Now” diversion  from whom you will be seeking support.  Then state the words he or she uses to indicate, “Not Now,” for example, “I’m busy.”  Then, write your reply.

The  “Irrelevant Chatter” Diversion

Your Sue can divert you from delivering your script by inserting…
A. incidental comments about you, (“You have only been here two months haven’t you.”)
B. incidental comments about your script, (Gee, I cannot believe what CMS requires us/me/you/the facility to do!”
C. or adding irrelevant questions.  (“Are you asking nursing to change their med schedule as well?”)

These irrelevant comments can serve as distractions.  One way to deal with them is to refuse to respond to them with longwinded answers. However, see if you can find a way that your replies help you continue with your script regarding Culture Change Compliance and not be sidetracked.  Here are some examples:
A. incidental comments about you, (“You have only been here two months haven’t you.”)  Your reply, “Yes.  Now about Mary and Harry’s PT schedule…”
B. incidental comments about your script, (Gee I cannot believe what CMS requires us/me/you/the facility to do!”) Your reply, “Yes.  Now about the Mary and Harry’s PT schedule…”
C. or adding irrelevant questions.  (“Are you asking nursing to change their med schedule as well?”)  Your reply, “Yes.  Now about the Mary and Harry’s PT schedule…”

Now, anticipate how the other staff member might distract you. What are the characteristic remarks your Sue might interject to block or sidetrack you during your script? How will you reply to these?  Make her imaginary remarks plausible or realistic, as well as characteristic of what that staff member might say.  But make your imaginary remarks irrelevant or not relevant to the Culture Change compliance or staff support topic you want to discuss. Perhaps she might try to beat you to the punch by bringing up a problem she wants to discuss; like how noise from your monthly Kitchen Band makes it hard for them to hear in the Physical Therapy room.  If this happens, how will you deal with that?  How about, “I was not aware of that.  Let’s see what we can work out.  But regarding Mary and Harry’s PT schedule…”  In short, briefly comment on the irrelevant chatter then move back to your script.

The “Silence” Diversion

Another distracter or diversion a staff member may use is silence.  Silence will be distracting to you especially if you are expecting or requesting a response from the other staff member.  He or she listens to your script requesting support, then the other staff member simply clams up and does not say a word.  She sits perhaps with a seemingly disapproving facial expression, or in deep thought, or seemingly looks pessimistic, or has a glazed-over thoughtless expression.   In short, the Physical Therapist won’t agree or disagree with your request for supportive action. What do you do?

To deal with silence, you might ask questions as you go through your script. For example, in the case of a med schedule change, after you describe to Carol what you want, you might ask “Do you agree with my observation that Joe's medication causes him to become drowsy?” After your question, you might ask “What do you think?” If you continue to get no response from your Carol, then you can ignore the silence and interpret it explicitly as her consenting to your proposal or idea.

Have your script so worded that it requires no response from the non-responsive staff member.  State your script so that it goes into effect unless he or she objects explicitly to the terms of what you have stated. You can say, for clarification, “I guess I will consider your silence to be your agreement to talk to the Medication Nurse to give Joe his medication after the morning activity”. If Carol continues to be unresponsive, leave and act as if you have agreement. If your Carol doesn’t agree, she will have to break out of her silence and begin discussing alternatives with you to your proposal regarding, for example, the medication schedule. The important point in dealing with the “silent treat­ment” is to interpret silence as you wish, rather than to let it entangle you in the department heads or staff member's inner conflict or their inability to express what they are thinking or feeling.  Remember, in the case of “the silent treatment,” the talker has the upper hand in structuring the way the interaction goes.

The "Denying" Diversion

Another diversion you may receive as a response to the script you developed in the previous sections is for them to deny what you are saying.  Or the other staff member may say that your perspective or information regarding the situation is inaccurate, or some how incorrect.  However, it might be noted at this time steps have been taken to avoid the “Denying” diversion.  In the previous sections of this Manual, your description of the area of noncompliance refers only to concrete observable behaviors of the other staff member (rather than to statements about other staff's motives or feelings) in order to avoid the “denying” diversion.  It is kind of hard to deny that a resident wasn’t transported or missed an activity due to his or her shower schedule.  

Getting back to my P.T. example, nonetheless, if your Sue denies the behavior, use the “Broken Record” script and state your observation. "I noticed Mary and Harry were not at Crafts because they were in a PT session."  Follow this with your reason for your concern listed in a previous Section, "The problem this creates is, once again I am unable to check Mary and Harry as having attended the Crafts Group that I had indicated in their Care Plan Goal."

As a way of denying her area of noncompliance to your request, she may state, "Mary and Harry could have attended Crafts if they wanted to."  However, as we all know, most residents are very compliant and merely go where they are transported, feeling they have no choice.  So don’t be sidetracked into arguing whose perspective is “correct.” Your reply to her denial may be simply to deny her denial by using your Broken Record statement. 

Instead of getting sidetracked, respond by making your reply again, perhaps paraphrasing it in different words.  You can note her opposing view, but turn it aside temporarily (you agree. . . but). You say in effect, “That’s one way to look at it, but here is what I noticed… Mary and Harry were not at Crafts this morning.”

Here are two possible denials to your script, and two possible replies.  You state, "I noticed Mary and Harry were not at Crafts because the were in a PT session." 
Denying diversion example 1:  “That’s not true.” (you persist) “I'm confused.  These residents were not at Crafts and were in PT today at that time.  Are you saying they weren’t in PT today at 10:00?”
Denying diversion example 2:  “You don’t know what you are talking about… these residents must attend PT on schedule for billing purposes."   Don’t attack her opinion. Reply in a friendly unemotional even tone with a “yes… but” type of response.  “Yes, Sue, I know they must attend P.T.  Doctor’s orders must be followed.  However,  what can we work out regarding the timing of their PT sessions to allow them to attend Crafts?”