Here's how you can strike the right balance when working assertively with physicians.

Being upfront and honest allows rapport to be built. I had a physician ask me to assist with a GYN exam in the ED. I was new on the unit and said "if you can talk me through it, sure. I have never assisted before." Own what you can and cannot safely perform. If asked a question you do not know the answer to, you should take the time to find the answer. They thought enough of the problem to ask the question, you should know the answer too. Keep learning - academically, via continuing education, from physicans, other nurses, RTs, Rad Techs, anyone and everyone. If you are seen as knowledgeable, flexible, and willing to learn, a physician is more likely to add weight to your communications with them. You will have developed a rapport.

Communicating clearly is essential , but the delivery is also essential. I noted a physician making an inaccurate decision. To address it, I approached it from a teach me rather than I am telling you perspective. I said to the physician "I see that you are recommending X in this situation, you are obviously seeing something I missed because in nursing school they taught us Y. Will you tell me what you are seeing that I missed? He then said I was correct and adjusted his orders accordingly. I suppose what I am saying is an aggressive approach isn't necessary; tact has a place in physician - nurse communications. Also, one of our HRO techniques is CUS - I am concerned, uncomfortable, this is a safety concern. CUSing works too:-)

Assertive communication should never escalate to aggressive communication, it turns a professional discussion into a threatening interaction and has no place in the work environment. That being said, to keep an assertive communication assertive, you need to pull in respect of boundaries, the offering of solutions, and professionalism. Similar to the 5 rights of med. administration, consider the 5 rights of communication: right time to have the conversation, right place to have the converstation, the right reason to have the conversation, right person to have the conversation with (keep it "in house" so to speak), and the right proposed solution. You should always have a solution in mind if you are going to question/challange someone.