Getting to Yes: The Art of Negotiation for Nurses

One of the American Nurses Association’s seven Bill of Rights for Registered Nurses is to “freely and openly advocate for themselves and their patients.” Yet, women and minorities may not be as effective advocating because they’re less likely to negotiate. There is a “win-win” negotiating style, developed at Harvard’s famed Negotiation Project, which may be more appealing. Practice them in small ways until they become second nature. Then when it’s necessary to advocate about safety, staffing, workplace violence, etc., you will be ready with a collaborative, problem-solving approach.

But if you don’t negotiate? Nurses who accept poor ­compensation or working conditions can end up feeling victimized, devalued, and unmotivated. With that attitude, they are less likely to provide excellent patient care and to get promotions. Don’t let that happen to you. Elevating your negotiation skills will lead to better communication, collaboration, and results for you and every other party.

Reframe the Concept of Negotiations

Given the overwhelming percentage of female nurses, it’s important to consider how

gender plays into negotiation. Research shows that women are two and a half times more apprehensive about negotiating, while men are four times more likely to initiate a negotiation. In fact, 20% of women say they don’t ever negotiate, even when the situation necessitates it, according to Linda Babcock and Sara Laschever, authors of Women Don’t Ask: Negotiation and the Gender ­Divide.

That apprehension keeps many nurses from learning and practicing this important communication competency. “Negotiation is in the top five life skills that everyone should have,” insists Donna ­Cardillo, RN, author of The Ultimate ­Career Guide for Nurses.

“We negotiate all the time—with our kids, ­partners, ­patients, and coworkers, often without even realizing it. The word can have a negative connotation but only because most people don’t understand what it really is,” explains Cardillo. In health care, there is an additional connotation, and that’s terms of negotiation and union contracts, she adds.

According to Webster’s Dictionary, “negotiation” is defined as “to meet and discuss with another in order to reach an agreement.” But many of us suspect that in order to do that, one party must dominate, trick, or pressure the other into submission.

Sometimes, we have to reframe an uncomfortable concept, like negotiation, and perceive it in a new way, to make it more palatable, notes Cardillo.

“For example, say a nurse wants to attend a national nursing conference, and get paid time off, and expenses covered and so on. I’ll advise explaining the benefit to the hospital and the nurse manager. ‘By going, I’ll be able to bring back information from national speakers and experts to share. I will do an in-service session, or write a paper on it, and I’ll bring back printed materials,’” she explains. Nurses needn’t let a “No” response discourage them, either, adds Cardillo, because it may take repeated requests to get what you want. But if you don’t ask, the answer is always “No.”

Another way to reframe it, Cardillo says, is that by asking you’re planting seeds of change for the future, so you’re advocating for yourself and for your profession.

“Many of us were raised not to ask for what we want and to feel satisfied with whatever we got. I just saw a tweet from a nurse: ‘People say I need this job. I say this job needs me.’ That’s so true. Everyone is entitled to feel valued in the workplace,” she says.

Steven P. Cohen, author of The Practical ­Negotiator, has trained health care ­professionals in negotiation skills globally and agrees that nurses must self-advocate. “Your number one job is to look out for your own interests. Self-interest means maximizing circumstances to help you get what you need: good pay and benefits, rewards and resources that let you serve the patient. You must be well served.” He notes that if a nurse is treated badly, then he or she can’t function well, and patients suffer.

There are three kinds of interests to consider and prioritize in a negotiation—in conflict, complementary, or in common, according to Cohen. “If you’re going on vacation with a multigenerational family, how likely is it that you have common interests and all want to do the same things? Not likely. But you may have complementary interests. Your goal could be that everyone in the family will have a good time on the vacation.” He advises nurses to look for where there are complementary interests and no conflict, and to build step-by-step to a win-win solution. “Most anyone in a hospital, from aide to CEO, has similar objectives,” he adds “and is asking the same questions: How can I make the most of my job? How can I take care of the people I need to take care of?”

Negotiate in Your Off-Hours

One of the best ways for nurses to become empowered is for them to learn and ­practice good negotiation skills, asserts Michelle Podlesni, RN, president of the National Nurses in Business Association. “Why are we having nurses that don’t last two years in a hospital setting? Because they aren’t empowered and negotiation starts with assuming your power. I help nurses to understand their power,” she explains.

Podlesni believes that negotiation skills can be learned, like other important nursing skills. Earlier in her career she read The Power of Nice by Ronald Shapiro and Mark Jankowski, and it made a big impression on her. The book defines negotiation as using knowledge to get what you want, using the “three P’s” of preparing, probing, and proposing.

“Say a new nurse is getting scheduled in a certain way. How do they know it’s fair? You ask: ‘How is the schedule made?’ Nurses don’t always assess their own situation and propose what works better for them. We need to make a paradigm shift—your license is a license to start practicing in your business as a nurse,” Podlesni says.

Negotiate with Coworkers

Whether delivering direct patient care as a manager, researcher, or as an entrepreneur, nurses need effective negotiation skills. Not every nurse is in a role that requires negotiating with patients, students, vendors, clients, or external agencies. But almost universally, nurses must negotiate with colleagues and coworkers.

“I’m a double minority, a male nurse and an ethnic minority,” says Usama Saleh, RN, BSN, MSN, PhD, a nurse educator.

Usama was working as an RN in oncology and often negotiated with colleagues about the assignment of patients, for instance, and to resolve conflict so all parties are satisfied. In addition to ensuring an equitable workload, “it’s important to negotiate with your nurse mates on the team in order to deliver effective care. I always look at it in terms of quality of care,” he explains.

Usama came to the U.S. from the Gaza Strip and also had to become accustomed to the negotiation style of Americans who were born and raised here. “Culture and religion influence the etiquette of negotiation,” he says. “I wasn’t able to be aggressive; I was a soft negotiator. I admired it when negotiators were more assertive, but because of cultural factors I couldn’t do it.”

Usama also taught in China for short while and saw how negotiation is different there, as it is throughout the Middle East. Though he can adjust his individual style to the culture, overall, he’s happy with it. “I believe using a softer negotiating style has given me good results. It’s softer than usual in the U.S., but it is still effective and I’m very satisfied with the outcomes,” he adds.

Now You’re Ready for Salary Negotiations

“When I speak to groups of nurses I have a joke: ­Everything in life is negotiable except for the salary of a staff nurse,” says Cardillo. Most hospitals have set salary ranges for nurses, sometimes negotiated by unions, until you go on to be a case ­manager, supervisor, or manager.

If you’re not sure if salary negotiation is appropriate in your role or organization, Cardillo suggests you probe with these phrases:

• Is there any way to … ? (Boost salary, add benefits, etc.)
• Are any adjustments available?
• Is there any room for negotiation?

Where to get salary survey info: professional associations, National Association of Colleges and Employers (NACE), Salary.com, jobstar.org, bls.gov, medzilla.com, career fairs, career development centers, and coworkers.

Even if you can’t negotiate your initial salary, you may be able to negotiate during a wage and performance review or an improvement plan meeting. “Most of the time, nurses are nervous going in to that type of meeting,” says Podlesni. “Take ownership of the discussion and go in prepared with information and knowing your desired outcome.”

For example, in a performance evaluation where a nurse is judged poorly, he or she doesn’t have to accept an unfair assessment. In one such situation, “an emergency room nurse was told she did not have timely emergency room skills such as inserting NG tubes,” Podlesni recounts. “I advised her that evaluations need to be conducted fairly and use consistent criteria across that board…I recommended that she request a video or documentation of someone doing the skill in the timeframe suggested. They were unable to provide this, and as a result, she received her $10,000 annual salary increase.”

During a wage evaluation, you can always negotiate for a higher salary or better benefits package. “Say your salary is $60,000 a year,” Podlesni says. “What stops you from saying ‘I love my job and want to keep working here, but I need to get to $65,000 a year to spend that much time out of my home and to pay childcare expenses’?” You may not get that raise but at least it starts a conversation and then you can decide if you want to stay in the job or if it’s time to find a better paying employer.

Believe in Your Value

Minority nurses bring an extra dimension to their work that they may not recognize and value highly enough. “Being Latina and bilingual, bicultural, we’re typically in a culture that doesn’t boast,” says Adriana Perez, PhD, ANP-BC, FAAN, assistant professor of nursing at the University of Pennsylvania School of Nursing. “We’re taught that you have to be modest, don’t call attention to yourself. It’s about building relationships and taking care of others. We have to balance humility with self-confidence.”

At the National Hartford Centers of Gerontological Nursing Excellence leadership development program, Perez learned the essentials of career success, including salary negotiation.

“AACN publishes mid-to-average salaries for professors that might not factor in additional skills or expertise,” she explains. “I’m bilingual, board-certified adult nurse practitioner, and researcher addressing health equity issues that are national research priorities. There aren’t that many Latina nurse scientists so it puts me in a great bargaining position. I can help the school meet its inclusion and diversity mission. But that’s not enough. I have to produce results and demonstrate a measurable impact.”

Polish Your Negotiating Skills

Many organizations offer professional development workshops that focus on cultural diversity, communication skills, negotiation, and conflict resolution. The leadership program that Perez benefited from included a career-enhancing mentorship relationship.

“We grew from mentor and mentee to now colleagues and friends. I attribute a lot of my growth to that program,” she says. “I recommend finding mentors. Study the leaders in your organization whose style you like and who are well-respected. Ask them for coffee: ‘Can we schedule some time?’ Nurses are giving and want to help. They’ll share lessons learned and will tell you about programs, scholarships, training, and other resources out there.”

It’s true that some nurses will never enjoy advocating for themselves. But it doesn’t have to be that way, with a little practice they can increase their confidence and ability. The end result: Better outcomes for everyone.