How We Can Enhance Nurses’ Assertiveness: A Literature Review

Objective : Assertiveness is important for effective team building in nursing. This article aims at evaluating the results of the previous studies on nurses’ assertiveness in each decade in order to discuss the possible ways for enhancing nurses’ assertiveness. Methods : Five databases (PubMed, MEDLINE, CINAHL, Web of Science, and the Cochrane Library) were searched for English-language articles published from 1946 to December 2012. Article which described the assertiveness of nurses and relevant factors related to assertiveness in a clinical setting or evaluated assertiveness training. Results : Twenty-five studies in 26 articles were identified. In the 1970s and 1980s, research demonstrated that nurses perceived they are submissive helper and were less assertive. These studies indicated that educational achievement was regarded as a key factor in nurses’ assertiveness. The study in 1990s demonstrated that at least one population of nurses was assertive. The studies after 2000 suggested that nurses behave in a passive way, conforming to the stereotype of a ‘nice’ nurse, and were less likely to disagree with others. A sense of responsibility for patients, managers’ leadership, organisational culture, and relationship between colleagues were reported as influencing factors of nurses’ assertiveness. Conclusion : Recently, the number of nurses who are trained in higher educational institutions has increased. Despite this, nurses still experience some difficulties assessing themselves. Nurses should understand their role at the recent health care environment as a professional. Nurse managers should take a leadership to avoid nurses’ concerns of voicing their opinions in order to improve nurses’ assertiveness.