Staying Safe Starts with Your Voice — Podcast

“Staying Safe Starts with Your Voice” — Episode 22

Co-host: Marcus—former healthcare security director

Co-host: Natalie—nurse practitioner and clinical team leader

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Hospitals are often seen as places of healing, but for healthcare workers, they can also be high-stakes environments where tension runs high and safety can be unpredictable. While much attention is given to alarms, protocols, and security presence, one of the most powerful tools for preventing conflict is something every healthcare worker already has: their voice.

In this episode, Marcus (former healthcare security director) and Natalie (nurse practitioner and clinical team leader) explore how verbal communication—tone, word choice, pacing, and presence—can dramatically influence safety and outcomes in clinical settings. Drawing on real-world examples and evidence-based practices, they break down how intentional language can prevent escalation, build trust, and transform even the most challenging interactions.

Some key takeaways from the discussion include:

• Why the way you say something often matters more than what you say
• How to use tone, volume, and pacing to calm agitated patients
• The concept of “emotional acknowledgment before information”
• What to say when you don’t have all the answers
• How small verbal shifts—like offering choices or validating emotions—can make healthcare safer for everyone

Whether you're on the front lines or supporting those who are, this episode is a masterclass in how skilled communication protects both patients and providers.

MARCUS: Welcome back to "Confidence in Conflict," the podcast where we explore evidence-based strategies for creating safer healthcare environments. I'm Marcus, former healthcare security director, and today we're diving into something fundamental yet often overlooked: how your voice can be your most powerful tool for staying safe.

NATALIE: And I'm Natalie, nurse practitioner and clinical team leader. Marcus, when people think about safety in healthcare, they often think about alarms, security guards, or physical barriers. But what we're talking about today is something every single healthcare worker already has - their voice and their presence.

MARCUS: That's exactly right, Natalie. Throughout my healthcare security career, I've seen countless situations where the right words, delivered the right way, completely transformed what could have been a dangerous encounter. Today, we're exploring how verbal strategies and presence can prevent conflict before it even starts.

NATALIE: And this isn't just theory, Marcus. As someone who's worked in emergency departments and trauma units, I can tell you that how we use our voice - our tone, our word choice, our timing - can literally be the difference between a peaceful interaction and a violent one.

MARCUS: Let's start with the foundation. Natalie, when we discuss using your voice for safety, what exactly are we talking about? What makes the difference between words that calm and words that escalate?

NATALIE: It starts with understanding that what we say is not nearly as important as how we say it. Every word we say carries emotional weight, especially when someone is stressed, frightened, or frustrated, which describes most patients and families we encounter in healthcare settings. They're not just hearing our words. They're feeling them. They're interpreting not just our words, but our tone and body language.

MARCUS: That's such an important point. From a security perspective, I learned that people often react more to the emotion behind words than to the actual content. You can say the exact same sentence in two different ways, by simply varying the tone or your facial expression, and convey two completely different meanings and intentions. 

NATALIE: Sure, just depending on the tone you use, you can sound distracted, uncaring, dismissive, or judgmental. But if you use the right tone, you can sound empathetic and caring. 

MARCUS: That's right. But the words you choose also have a lot of impact on your meaning and intentions. 

NATALIE: Exactly. Let me give you a real example from last week. A patient had been waiting in the emergency department for six hours with chest pain. He was getting increasingly agitated, demanding to know when he'd be seen. A newer nurse approached him and said, "Sir, you need to calm down. There are people ahead of you." The patient exploded.

From Escalation to Empathy: Language That Calms

MARCUS: I can imagine. That response, while factually accurate, probably felt dismissive and controlling to someone who was already scared about his symptoms.

NATALIE: Exactly. Later, I approached the same patient using what I've learned about verbal de-escalation. I said, "I can see you're really worried about your chest pain, and six hours feels like forever when you're scared. Let me explain exactly what's happening with your care and what we're monitoring for." His entire demeanor changed instantly.

MARCUS: That's a perfect example of how the same information can be delivered in completely different ways. Natalie, let's break down what you did differently in that second approach.

NATALIE: Well, first, I acknowledged his emotion - his worry and fear. Then I validated his experience - that six hours really does feel like forever, especially when you're scared. Only then did I move to providing information and reassurance. The sequence matters, Marcus.

MARCUS: That sequence is crucial. It's what Vistelar calls "emotional acknowledgment before information." When people feel heard and understood emotionally, they become much more receptive to factual information. If you try to give facts to someone who feels dismissed, they often can't even process what you're saying.

NATALIE: And there's something else important in that example - I used what they call "empathetic language." Instead of saying "you need to calm down," which puts the responsibility on the patient and implies they're doing something wrong, I focused on acknowledging their legitimate concerns.

MARCUS: Let's talk more about tone of voice, because this is something that can make or break any interaction. Natalie, what have you learned about how tone affects safety in clinical settings?

NATALIE: Absolutely, tone is critical, Marcus. I've seen situations where someone said all the right words, but their tone was impatient or condescending, so they escalated the situation anyway. Your tone needs to match your intent. If you want to convey respect and concern, your voice needs to sound respectful and concerned.

MARCUS: And tone is one of those things that people pick up on unconsciously but immediately. Even if someone can't articulate why, they know when someone's tone feels authentic versus when it feels fake or forced.

NATALIE: That's so true. And it's not about being artificially sweet or overly cheerful. In healthcare, people want to feel like you're taking their situation seriously. A calm, steady, genuinely concerned tone often works much better than an overly bright "customer service" voice.

MARCUS: Let's discuss pacing, because this is another vocal element that significantly impacts safety. Natalie, how does the speed and rhythm of your speech affect patient interactions?

NATALIE: Pacing is huge, Marcus. When we're busy or stressed, we tend to speak faster, but that can make patients feel rushed or unimportant. I've learned to deliberately slow down my speech when I'm dealing with someone who seems agitated or confused. It has a calming effect.

MARCUS: There's a lot of good psychological research behind that. When you speak slowly and calmly, it can help regulate the other person's nervous system. It's like your calm energy becomes contagious.

NATALIE: Exactly. Vistelar calls that “modeling.” It's based on the understanding that our behavior sets the tone and pace for others to naturally follow. Pausing is another form of pacing that models positive communication. When someone asks a question or expresses a concern, I've learned to pause for a moment before responding. It shows that I'm considering what they've said, rather than just waiting for my turn to talk. That way, I can set the tone of the conversation and send it in a good direction. 

MARCUS: That pause also gives you time to choose your words more carefully. In high-stress situations, our tendency is often to react quickly, but that quick reaction isn't always the most helpful response.

NATALIE: So true. And let's talk about volume, because that's another vocal element that affects safety. Marcus, what have you observed about how loudness or softness impacts conflict situations?

MARCUS: Volume is fascinating because it can either escalate or de-escalate so quickly. If someone is shouting and you shout back, you've just created a shouting match. But if someone is agitated and you deliberately lower your voice, they often unconsciously lower theirs to match you.

NATALIE: I use that technique all the time. When a patient or family member is getting loud, I actually speak more quietly. Not so quietly that they can't hear me, but noticeably softer than their volume. It's amazing how often they adjust their volume to match mine.

MARCUS: And there's something about a calm, quiet voice that suggests confidence and control. It communicates that you're not threatened or overwhelmed by their emotions, which can be very reassuring to someone who feels out of control themselves.

Setting Boundaries Without Provoking Conflict

NATALIE: Let's talk more about word choice. This is another place where we can make a major difference in preventing conflicts. Certain words tend to escalate situations, while others naturally de-escalate. Like the phrase “calm down,” we mentioned before. What are some other words or phrases you have noticed that may escalate others?

MARCUS: One of the biggest escalators I've observed is the word "no" when it's used without context or alternatives. "No, you can't do that" immediately creates an adversarial dynamic. But "I understand why you'd want to do that, and here's what we can do instead" provides the same boundary while maintaining partnership.

NATALIE: That's such a good point. I've learned to replace commands with explanations and options whenever possible. Instead of "You have to wait," I might say, "The good news is we're monitoring your condition carefully. While we're waiting for your test results, would you like me to explain what we're watching for?"

MARCUS: That approach turns waiting into active care rather than passive delay. You're reframing the experience entirely. Natalie, what about language that acknowledges uncertainty? Healthcare is full of situations where we don't have immediate answers.

NATALIE: Oh, that's so important, Marcus. Early in my career, I felt like I had to have all the answers immediately, so I'd sometimes give vague or overly optimistic responses. But I've learned that honest uncertainty, expressed with confidence in the process, is much more trusted than false certainty.

MARCUS: Can you give us an example of how you handle uncertainty now?

NATALIE: Sure. If a family asks when their loved one will be discharged and I don't know yet, I might say, "That's exactly the question we're working to answer right now. Dr. Smith is reviewing the latest test results, and I expect to have an update for you within the next hour. I'll come find you as soon as I know more."

MARCUS: That's brilliant because you're acknowledging their question, explaining why you don't have the answer yet, showing that work is actively being done, and giving them a timeframe for when they'll get information. It turns uncertainty into a transparent process.

NATALIE: And it prevents them from feeling ignored or forgotten. Marcus, let's talk about something that's really important - how we respond when someone is upset or emotional. What language patterns help versus hurt in those situations?

MARCUS: This is where I see the biggest differences between effective and ineffective responses. Phrases like "calm down" or "don't be upset" rarely work because they invalidate the person's emotions. Instead, acknowledging the emotion first creates connection.

NATALIE: Exactly. I've learned to use phrases like "I can see this is really frustrating" or "It makes sense that you'd be worried about this." It's not agreeing that their response is proportionate, but it's validating that their emotion is understandable given their perspective.

MARCUS: And there's something powerful about naming emotions accurately. If someone is scared but expressing it as anger, gently identifying the underlying fear can shift the entire conversation.

NATALIE: That's so true. I had a patient last month who was yelling at me about the pain medication not working. But when I said, "It sounds like you're really scared that the pain isn't getting better," he broke down and admitted he was terrified that something was seriously wrong. Once we addressed the fear, we could have a much more productive conversation about pain management.

MARCUS: That's a perfect example of how the right words can reveal what's really going on underneath the surface behavior. Let's talk about questions, Natalie. How we ask questions can dramatically affect both safety and outcomes.

NATALIE: Questions are so powerful, Marcus. Open-ended questions that invite someone to share their perspective can completely change the dynamic of an interaction. Instead of "Are you having pain?" which gets a yes or no answer, I might ask "Tell me about how you're feeling right now" or "What's your biggest concern today?"

MARCUS: Those broader questions give people space to tell their story, which often reveals important information we wouldn't get from narrow, closed questions.

NATALIE: And they make the person feel like a partner in their care rather than just a passive recipient. When people feel heard and involved, they're much less likely to become confrontational.

MARCUS: Let's discuss something that's crucial but often overlooked - how we communicate policies and rules. Natalie, there's a huge difference between explaining a policy and just enforcing it.

NATALIE: Absolutely. When I have to communicate a rule or limitation, I've learned to explain the "why" behind it, not just the "what." For example, instead of "Visiting hours are over," I might say, "We end visiting hours at 8 PM because our patients need uninterrupted rest for healing, and it helps our night shift nurses provide the best care."

MARCUS: That explanation helps people understand that the rule serves a purpose beyond just control. It's about patient care, not arbitrary authority.

NATALIE: And when possible, I try to offer alternatives or compromises. "Visiting hours are ending, but you're welcome to call in the morning to check on how the night went, and visiting starts again at 9 AM."

MARCUS: Speaking of alternatives, let's talk about the power of offering choices. Even small choices can help people feel like they have some control in an otherwise powerless situation.

NATALIE: Choices are amazing for preventing conflicts, Marcus. Even something as simple as "Would you prefer to wait in the family lounge or would you like me to update you by phone?" gives people agency. When people feel like they have some control, they're much less likely to act out.

MARCUS: And choices work even in situations where the main outcome isn't negotiable. You might not be able to change what needs to happen, but you can often offer choices about how it happens.

NATALIE: Exactly. "We do need to get this blood draw done, but would you prefer to sit up or lie down?” Another example might be, “Would you like me to explain what I'm doing as I go, or would you prefer to talk about something else?"

Handling Uncertainty, Mistakes, and Bad News

MARCUS: Let's talk about something that's particularly relevant in healthcare - how we communicate bad news or difficult information. This is where verbal skills can literally prevent violent reactions.

NATALIE: This is so critical, Marcus. The way we deliver difficult information can determine whether someone falls apart, gets angry, or is able to process and cope with what they're hearing. I've learned to use what's called the "warning shot" approach.

MARCUS: Can you explain that for our listeners?

NATALIE: Instead of just blurting out bad news, I prepare people for what they're about to hear. "I have some test results to share with you, and I'm afraid they're not what we were hoping for." That gives their brain a moment to brace for impact rather than being blindsided.

MARCUS: And then you follow up with support and next steps, right? You don't just deliver the bad news and leave them hanging.

NATALIE: Exactly. "The scan shows that the cancer has spread. I know this is devastating news. Dr. Johnson is going to come talk with you about treatment options, and I'm going to make sure you have all the support resources you need."

MARCUS: That structure - warning, news, immediate support, and next steps - helps people process difficult information without feeling abandoned or hopeless.

NATALIE: Let's talk about something that happens frequently in healthcare - when we make mistakes or when things don't go as planned. How we communicate about errors or complications can prevent or trigger angry reactions.

MARCUS: This is where honesty, accountability, and immediate action plans become crucial. People can usually handle mistakes if they feel like you're being honest about what happened and taking responsibility for fixing it.

NATALIE: I've learned to use what I call the "acknowledge, apologize, act" approach. "I realize I told you the doctor would be in within an hour, and it's been two hours now. I apologize for the delay and for not updating you sooner. Let me go find out exactly when she'll be available and get you a realistic timeframe."

MARCUS: That approach prevents defensiveness and shows that you take their time and concerns seriously. It also demonstrates that you're actively working to solve the problem rather than just making excuses.

NATALIE: Marcus, let's address something that many healthcare workers struggle with - how to set boundaries or say no while maintaining rapport and safety.

MARCUS: Boundary setting is definitely an art form. The key is communicating the boundary clearly while showing that you understand and care about their needs, even if you can't meet their specific request.

NATALIE: I use what I call "empathetic limits." For example, "I can see how much you love your mom and want to stay with her. Unfortunately, we can only allow one visitor overnight in the ICU, but let me see if we can arrange for you to have some extra time with her during the day."

MARCUS: That acknowledges their motivation, explains the limitation, and offers an alternative. It shows that you're trying to work with them, not against them.

NATALIE: And sometimes the boundary is about safety. "I understand you're frustrated, but can I ask you to lower your voice while we work together to solve this problem. This has to be a calm and healing environment for our patients.” 

MARCUS: That frames the boundary in terms of mutual benefit rather than just control. Let's talk about body language and how it interacts with verbal communication. Natalie, how does your physical presence support or undermine your words?

NATALIE: Body language is huge, Marcus. You can say all the right words, but if your body language contradicts them, people will believe your body over your words every time. If I'm saying I have time to listen, but I'm checking my watch or looking at my phone, my words become meaningless.

MARCUS: And positioning matters too. Standing over someone who's sitting can feel intimidating, even if that's not your intention. Sitting down or positioning yourself at their eye level creates a more collaborative feel.

NATALIE: Absolutely. And eye contact is crucial. Not staring, which can feel aggressive, but making regular, comfortable eye contact that shows you're present and engaged with what they're saying.

MARCUS: What about facial expressions? How do they support verbal de-escalation?

NATALIE: Your face needs to match your words and your intent. If someone is telling you about their pain or fear, and you have a neutral or distracted expression, it contradicts any empathetic words you might be saying. Your face should reflect appropriate concern and engagement.

Adapting to Crisis, Culture, and Cognitive Challenges

MARCUS: Let's discuss something that's particularly challenging - dealing with people who are under the influence of substances or experiencing mental health crises. How do verbal strategies adapt to these situations?

NATALIE: These situations require extra patience and modified communication strategies, Marcus. With someone who's intoxicated, I speak more slowly, use simpler sentences, and repeat important information. I also avoid arguing with distorted perceptions and instead focus on keeping them safe.

MARCUS: And with mental health crises, it's often about entering their reality rather than trying to correct their perception, at least initially.

NATALIE: Exactly. If someone is paranoid and thinks the staff is trying to hurt them, saying "No, we're not" doesn't help. But saying "That sounds really scary. What would help you feel safer right now?" acknowledges their experience and opens up problem-solving.

MARCUS: Let's talk about cultural considerations, because healthcare serves incredibly diverse populations. How do cultural differences affect verbal safety strategies?

NATALIE: Cultural awareness is so important, Marcus. Different cultures have different norms around eye contact, personal space, authority, family involvement in medical decisions, and emotional expression. What feels respectful in one culture might feel disrespectful in another.

MARCUS: And when you're not sure about cultural preferences, it's often okay to ask directly. "I want to make sure I'm communicating in a way that's comfortable for you. Is there anything I should know about how you prefer to receive medical information?"

NATALIE: That's such a good approach. It shows respect for their cultural background and gives them permission to guide the interaction in a way that works for them.

MARCUS: Let's address something practical - what about when verbal strategies aren't working? How do you know when to try a different approach or when to call for help?

NATALIE: Great question, Marcus. People will sometimes escalate despite my best efforts, and if someone's voice is getting louder, if they're making threats, if they're becoming physically agitated, or if they're not responding to redirection. That's when I might pause the conversation and get additional support.

MARCUS: And there's no shame in getting help. Sometimes, a fresh person with a different communication style or approach can make all the difference. It's not a failure of your verbal skills - it's smart safety management.

NATALIE: Exactly. And sometimes you need to be direct about safety. "I want to keep working with you on this, but I need to feel safe to do my best thinking. Can we agree to keep our voices calm so we can focus on solving this together?"

MARCUS: That's a great example of setting a safety boundary while keeping the focus on collaboration and problem-solving.

Modeling for Colleagues and Practicing Under Pressure

NATALIE: Marcus, let's talk about something that's often overlooked - how we talk to colleagues about difficult patient interactions. The way we discuss challenging patients can affect how the whole team approaches those interactions.

MARCUS: That's such an important point. If the shift report describes someone as "difficult" or "non-compliant," it can create negative expectations that become self-fulfilling prophecies.

NATALIE: I've started using more descriptive, non-judgmental language in handoffs. Instead of "Mr. Jones is difficult," I might say "Mr. Jones is really anxious about his diagnosis and tends to ask a lot of questions. He responds well when you take time to explain things step by step."

MARCUS: That gives the next nurse useful information about how to approach the patient successfully rather than just warning them to expect problems. It's another way of modeling, except this time we are modeling safe and appropriate attitudes for peers.

NATALIE: And it helps maintain our empathy and professionalism. When we label patients negatively, it becomes harder to see them as individual people with legitimate needs and concerns.

MARCUS: Let's discuss something practical for our listeners - how do you practice and improve your verbal de-escalation skills? These aren't abilities you're born with; they're skills that can be developed.

NATALIE: Practice is so important, Marcus. I actually practice phrases and responses at home, thinking through different scenarios I might encounter. It's like rehearsing for a play - the more you practice the words, the more natural they become under pressure.

MARCUS: And role-playing with colleagues can be incredibly valuable. You can practice difficult conversations in a safe environment and get feedback on your approach.

NATALIE: I also pay attention to interactions throughout my day, and not just with patients, but with family, friends, cashiers, anyone. Every interaction is an opportunity to practice respectful, empathetic communication.

MARCUS: Recording yourself can be eye-opening, too, though obviously not with actual patients. But practicing responses and then listening back can help you notice things like tone, pacing, or word choice that you might not be aware of in the moment.

NATALIE: And studying successful interactions is just as important as analyzing the difficult ones. When an interaction goes really well, take a moment to think about what you did that worked, so you can replicate it in the future.

Final Takeaways: Start Small, Stay Intentional

MARCUS: Let's talk about self-care in relation to verbal safety strategies. Using these techniques effectively requires emotional and mental energy. How do you maintain your capacity to communicate effectively throughout long, stressful shifts?

NATALIE: That's such an important question, Marcus. Compassionate communication is emotionally demanding. I've learned that I need to actively recharge between difficult interactions - even if it's just taking three deep breaths or stepping outside for a minute.

MARCUS: And recognizing when you're too depleted to communicate effectively is crucial. If you're exhausted or emotionally overwhelmed, your verbal skills are going to suffer, which can actually create safety risks.

NATALIE: Absolutely. Sometimes the safest thing you can do is ask a colleague to take over an interaction if you're not in the right headspace to handle it well.

MARCUS: As we start to wrap up, let's give our listeners some concrete takeaways. Natalie, what are the most important things someone can start implementing immediately to use their voice more effectively for safety?

NATALIE: First, slow down your rate of speech, especially in tense situations. Second, acknowledge emotions before trying to provide information or solutions. Third, explain the "why" behind policies and procedures rather than just enforcing them.

MARCUS: I'd add: practice active listening by pausing before responding, use "I" statements instead of "you" statements when possible, and always offer choices when you can, even small ones.

NATALIE: And remember that your tone matters more than your words. People will remember how you made them feel long after they've forgotten what you said.

MARCUS: For our listeners who want to develop these skills further, what resources would you recommend?

NATALIE: Vistelar's training programs are excellent, of course. But also look for de-escalation training in your organization, practice with colleagues, and pay attention to healthcare workers who seem to handle difficult situations well - learn from their approaches.

MARCUS: And remember that these skills are useful for interacting with everyone, not just your patients. Better communication reduces stress and improves relationships across all areas of life.

NATALIE: Before we close, Marcus, I want to emphasize something important: your voice and your presence are powerful tools that you already possess. You don't need special equipment or training to start using them more effectively. Small changes in how you communicate can make huge differences in safety and outcomes.

MARCUS: That's exactly right. Every healthcare worker has the ability to create safer environments through their words and their presence. It's not about perfection - it's about intentional practice and continuous improvement.

NATALIE: And remember, when you use your voice to create safety and show respect, you're not just protecting yourself and your patients - you're modeling these skills for your colleagues and contributing to a culture where everyone feels safer and more valued.

MARCUS: For our listeners, we encourage you to start small. Pick one technique we've discussed today and practice it during your next shift. Notice what happens when you slow down your speech, or when you acknowledge someone's emotions before providing information.

NATALIE: That's all for today's episode of "Confidence in Conflict." Thanks for joining us. If you enjoyed this episode, don’t forget to follow, rate, and leave a review on your favorite podcast platform.

MARCUS: Remember - your voice is one of your most powerful tools for staying safe and helping others feel safe, too. Use it intentionally, use it with compassion, and use it with confidence.