Of course, there are times you don’t want other staff members to question you. Often, especially in medical emergencies, you’ll be unwilling to debate the merits of your instructions.

But what about the other times—when you’re making requests of a co-worker or someone senior, when you know your patient is about to walk out the door and you want them to continue following your recommendations even after you’re out of earshot? How can you be most effective, when your patients or other staff members say no?

You don’t have to give up. And you don’t have to deliver ultimatums to exercise power. With these suggestions, you can redouble your effectiveness after hearing no.

1. Acknowledge the no, so you know where you stand. Don’t kid yourself that the person you’re talking to is going to do what you ask.

2. Remember that no’s are specific. The person hasn’t told you that he or she won’t do anything, just that they won’t do what you’ve asked. And, in fact, they may still change their mind if you work with them.

3. Explore the good reasons she has for saying no. Very often, we try to win over a recalcitrant person to our side. And the effort just raises her defenses. Instead, come around to her side. Acknowledge her good reasons for refusing: she’s tired, she’s afraid, she’s wants a say in how she spends her time.

4. Make another request taking into account what you’ve learned about her needs. If she’s tired, could she do a different task that takes less energy but could free up some other staff member. If she wants a say, can you review a variety of tasks she could take on.

Take the no not as a roadblock but simply as a sign of a lack of rapport. Then build rapport by finding out what her needs are.

Here’s an example. A nurse is talking to Samuel, a disgruntled husband who has a laundry list of complaints. Nothing the nurse suggests satisfies him. Finally, she says

Nurse: You look like you could use some rest.

Samuel: Not on your life! And leave you folks alone with my wife.

Nurse: [She doesn’t get defensive about the no. Rather she looks for the good reasons behind Samuel’s no.] This must be some dilemma for you. You want to be vigilant. And at the same time, you need to give your body a break.

Samuel: You’ve seen me. I’m here almost all the time. But how can I leave her? She’s just a bed to you, but she’s all I have.

Nurse: [The nurse doesn’t get defensive but speaks to his needs.] Samuel, your wife’s care is the most important thing to me. And I really want you to be healthy for her and for yourself. [She shifts her focus to trust, the need Samuel has indicated is most pressing for him.] Would you be willing to work something out with me so you can trust that we're watching her while you get some rest? Then we can work out these other issues.

It’s this request that Samuel agrees to.

Think of a no as an indication that the speaker’s most pressing needs are continuing to go unmet. Identify those needs and indicate your interest in meeting them, and you open up a new space for agreements.

* Always consult your risk management group first, when you're considering how to handle an interaction that could impact your medical group's liability.