Nurses and the Art of Communication


Nurses and the Art of Communication

Six surefire ways to improve nursing team interactions

By By Tyler Faust, RN, MSN, PHN
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Does this scenario sound familiar?  You clock in at 1900 for your 12-hour shift and pick up four patients from two different nurses on the previous shift. The nurses you’re relieving give you quick reports, tell you everything is fine and then dash out the door to their next assignment or to pick up their kids.

A half hour later, everything goes haywire. One patient is becoming confused and another, who a care assistant reports is at 7 out of 10 on the pain scale, is accusing you of missing his scheduled pain medication, which you knew nothing about. Your patients are unhappy and you’re seething mad at your colleagues for not giving you basic information that should have been discussed at the shift change. As your frustration mounts, your attitude goes down the drain and you’re ready to snap at anyone who looks at you cross-eyed.

We’ve all experienced scenarios like this and we’ve seen the impact they can have on how well you care for your patients. Any job has its share of lapses in communication, but in most professions, the worst consequences are lost time and revenue. For nurses, miscommunication can be much more dangerous.

Barriers to Understanding

What causes communication breakdowns like these? David Shirley, MBA, PMP, author of the 2011 book Project Management for Healthcare, identifies these common communication barriers:

Preconceived notions: At one time or another, we’ve all been guilty of tuning out when someone is talking because we think we already know what they’re saying. For instance, when a doctor comes in after rounds and gives you the plan for the day, you might assume you already know the plan because it’s so similar to the one from the day before. However, if you don’t pay close attention, you’re likely to miss small but crucial changes.

Lack of motivation/interest: As with any job, nursing sometimes presents us with tasks we don’t want to do at times when our hearts aren’t in it or we’re dead on our feet. For example, if you’re just getting off the night shift and want to go home to bed, giving the nurses relieving you a detailed rundown of the night’s events is probably not at the top of your priority list. Unfortunately, cutting corners in those situations can put patients in jeopardy.  

Distractions: Healthcare environments are full of distractions, from alerts and codes to the supervisor who insists on pulling you aside for a project update even though you have three patients waiting for you. Those distractions and the stress and emotional toll they take on you can make it easy to lose focus during communication, causing you to forget important details or say one thing when you mean another.

Distrust: Nurses are no strangers to adversarial working relationships, whether it’s with that flaky colleague who never seems to follow through, the micromanaging supervisor or the arrogant doctor who treats nurses like servants. If you’re like me, you generally don’t interact much with people you don’t trust or don’t like. When you do, it’s brief and probably not what most people would define as quality communication.

Information overload: Almost as bad as not getting enough information is having someone bombard you with so much data that you become overwhelmed and lose track of the details. I recently had a doctor walk up to me and immediately start rattling off information about a patient’s situation and the doctor’s recommendations. It caught me completely off-guard, and he quickly left before I had a chance to grasp most of what he’d said. Needless to say, we had to readdress most of what he had just told me.

This is not an exhaustive list of barriers to communication, but it does include many of the most common ones. The question is, what can you do about them?

Six Ways to Improve Communication in Practic

You might not be able to remove all the communication barriers in your workplace, but you can help to overcome them by following these tips:

  1. Listen attentively when communicating with others: It may take effort to cut through the distractions, but if you make eye contact with the other person, listen closely when they’re talking and stay focused, you’ll avoid missing important details and, better still, set a respectful tone that will encourage those around you to behave in kind. The small things count!

  2. Ask questions: In a busy, noisy working environment like a hospital ward, it’s easy for a conversation to degenerate into two or more people talking at each other rather than really communicating. An easy way to avoid that is to ask appropriate questions — even if you’re pretty sure you already know the answers. (Don’t presume you know everything!)

  3. Clarify action items: Most professional communication is supposed to lead to action, so make sure everyone involved comes away knowing what they need to do next. If you’re not sure or you think the other person isn’t, do everyone a favor and clarify things before you walk away. One of the most common reasons people don’t follow through on tasks is that they misunderstand their role. (“I thought you were going to do that!”)

  4. Take notes: Carry a pocket-size notebook or use the memo function in your smartphone to jot down notes and action items. It might take you a few extra minutes, but when you’re into the 10th hour of a 12-hour shift, you’ll be grateful that you don’t have to rely on your memory. If you have a meeting with someone, consider following up with an email message recapping the important points.

  5. Clear the air: If you consistently have communication problems with a particular person, take a few minutes when neither of you is busy or harried and see if you can clear the air. Sometimes, the problem may be a simple misunderstanding that can be easily resolved when you’re both calm and rational. Even if it’s apparent that the two of you will never see eye to eye, you may be able to strike a truce.

  6. Look for additional training: Some hospitals and healthcare facilities offer training or classes in professional team building or management principles, which not only teach useful communications skills, but may also help you move up the professional ladder. If you can take those classes for free or even get paid for taking them, why not seize the opportunity?

These are good tips for engaging with patients as well as coworkers. In my experience, effective communication with patients — even when you bear bad news — is the best way to build a rapport. Conversely, poor communication is the easiest way to damage the patient’s trust and confidence, which makes it harder for you to provide quality care.

Remember, whatever distractions, inconveniences, uncertainty and pressures you may face, at the end of the day, your patients are counting on you to look out for their well-being. The beauty of the craft we call nursing lies in nurses’ ability to make the best of that chaos and provide the highest level of care possible.

Quality communication will help us get there — and significantly improve relationships with ourcoworkers in the process. After all, who doesn't appreciate respectful interactions, clear expectations and attentive listening?  

Tyler Faust, RN, MSN, PHN, recently completed his master’s degree in nursing organizational leadership. He works at Mayo Clinic.

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