Communication seems like such an overused word, and its continued emphasis and importance in healthcare means that nurses and leaders, as well as others in the healthcare environment, continue to miss the level of effectiveness needed to meet patient and organizational goals. Leaders must reflect on their communication patterns by reviewing interactions and determining what they could have done to improve their effectiveness. Communicating effectively is an art beyond general verbalization between people and should be a top priority for nurses and leaders.
Research with nurse and physician groups has determined there are several significant components that must be apparent for communication to be effective (Robinson, Gorman, Slimmer, & Yudkowsky, 2010). First, there needs to be a clear and concise message. The person receiving the message needs to verify and confirm that the message has been heard correctly. Some techniques that have been used include beginning phrases with “what I hear you saying is” or “the message that I heard was.” Additionally, when taking a message, repeating the speaker’s words helps to ensure that what was heard is correct. Next, the message sender and receiver should collaborate to come to a decision. The communicators need to feel that they are a team in decision making, where each would seek the advice of the other in specific instances. The third component is to remain calm in a crisis. The volume, tone, and directness of the communication must be modulated so that the communication does not add additional tension or stress in the environment. Also, it is important to be appreciative of support and help offered by others, such as extending a thank you. Fourth is the need for ongoing demonstration of mutual respect. An extension of respect is trust. Those communicating with each other need to be able to trust and rely on the information that is being shared. Lastly, each of those who communicate in healthcare want to understand the professional role of the other person.
The most detrimental components leading to ineffective communication come when there is an attempt by one communicator to belittle the other, due to position, education, or licensure (Robinson, Gorman, Slimmer, & Yudkowsky, 2010). These types of communications can be viewed as bullying. Another concern is the reliance on the use of electronic devices to communicate. Although an order may be placed into the electronic health record, the nurse must go to the record and note it; if this does not happen, there is a missed communication and delay in care. Some healthcare professionals believe that devices have taken the place of the face-to-face interactions that are imperative to ensure understanding and create dialogue about patient care. A consistently echoed concern is the variation in levels of understanding when communicating with individuals from other cultures and different languages. The concerns focus on individuals who have English as a second language.
Manager Communication Patterns
Leaders must be aware in all of their communications that they are in positions of power over those who report to them. Understanding power makes communication with subordinates more effective because the leader can anticipate potential responses to his or her message from a content standpoint and from a power-relation standpoint. Some reactions can be related to intimidation or defensiveness. Nonverbal messages, such as eye rolling, shoulder shrugging, frowning, and angry looks, all indicate that the message was not well received (Schermerhorn, Osborn, Uhl-Bien & Hunt, 2012).
Leaders’ communication with their subordinates requires preparation of a carefully crafted message that is articulate, clear, and concise. Additionally, the nurse leader must appreciate the audience. If addressing peers, technologists, or registered nurses, there may be a different approach, different vocabulary, and a different message about the same topic.
During communication, it is a good rule to pace the discussion with breaks in order to answer questions and allow the audience to clarify your meaning. Be careful with the phrasing of the questions to avoid seeming insolent or disrespectful. Such phrases as “do you really believe that?” imply that you question the sincerity of someone’s inquiry or believe that the question or statement cannot be true. Thus it is better to avoid such words as really, never, always, and other, similar words. A good question to ask at the pause in the discussion is “does that make sense to you?” or “does anyone want me to expand on any of this?”
Leaders know that nearly 80% of the population has high appreciation for visual learning. Leaders will want to follow up any verbal communications in writing to ensure that the message is clarified and readily available for reference (Schermerhorn, Osborn, Uhl-Bien & Hunt, 2012). During the discussion, leaders should make an effort to give a clear example. If the issue is related to patient care, telling a story about a patient who commented about the great service after instituting hourly rounding lets the staff know the impact of what you are asking. Another technique that can quiet tension is to let the message be serious even as the presenter is relaxed. Consider a humorous anecdote, or if you mix up slides or lose your place in the speaker notes, make a joke about yourself to gain a laugh and relax the group. Leaders often find that they are in a lonely spot at the top of their sphere of influence, and having a laugh at your own expense makes you more human and approachable to your staff. It says to them, “my leader is just like me; getting nervous in front of a crowd.” This identification with the leader is helpful because it demonstrates the leader’s humility (Schermerhorn, Osborn, Uhl-Bien & Hunt, 2012).
In the discussion, leaders need to attend to the audience and ensure that they stop when necessary. Additionally, the leader must ensure that the manner, vocabulary, tone, and presentation to the audience are respectful, that the audience feels a sense of inclusion, and, when they speak, that you have heard their message. Leaders who have been berated by their leaders tend to roll the anger and disrespect downhill to their staff. Be sure that you take time to catch your breath and center your emotions and attitude as you acknowledge how poorly you feel; you do not want to impact your staff in the same manner. If the leader goes into the staff room demanding changes and accusing the staff of purposefully creating a negative environment, the leader has just made the situation 10 times worse.
Leaders often miss the opportunity to have their audience evaluate their approach. It is easy to do; just ask them. At the end of the message, ask them how you did, if the format is the best for them to receive this message, and what you can do better next time. While self-reflection is very important, leaders need to understand and appreciate the perception that others have of them. Just ask.
Many leaders find that they do not always elect to confront difficult situations and difficult discussions. Some of this hesitancy can come from gender, culture, and socialization. However, the leader is in a role in which having difficult discussions is part of the job; part of the responsibility. When an issue comes up, every leader should address the issue at the very first opportunity. If the issue is related to direct-care delivery, immediate intervention is crucial. If the issue is one of interstaff conflict, a cooling-down period may be appropriate. However, leaders must address the issue! Remember that whatever you fail to address as a problem is seen as condoning the behavior. Condoning the behavior means that you will be seeing more of it, not less, and that others will believe that these behaviors are sanctioned and do them as well.
The difficult discussion is when leaders have the opportunity to correct behaviors and mentor for new behaviors. In every area of healthcare, there are difficult employees who require leader management. The Studor Group (2010) indicates that leaders will spend 80% of their time with 5% of their staff. This means that leaders must quickly identify the problems, make every effort to correct them, and, if not correctable, release the person from employment.
Leaders will adjust their discussions with subordinates based on the subordinates’ current levels of performance. For those who are at the highest level and very valuable, there will be a different approach than with the mid-level staff member whom the leader is working to improve than to the low-level staff member whom the leader is working to bring up to the minimum standard.
It is the low-level staff member who will be the most challenging and require the most skill. Leaders with low-level staff members must understand that these employees may be very skilled at diverting the difficult discussions. Often, these low-level employees have done so through several leaders in the past (The Studer Group, 2010). The employee must be called in to speak with the leader. If this will be a contentious conversation, having a human-resources representative in the meeting as an observer would be preferable. The discussion should begin with a serious tone because it is a serious matter. As such, the manner of greeting the employee should be in alignment with the seriousness. Saying “Thank you for making this meeting” would be appropriate.
The leader’s goal is to change behavior. Some of the low-level staff members will step up and meet the standards: the expectations. Some will elect to leave, and some will be fired. One method to construct these difficult discussions is through the use of the DESK model (The Studer Group, n.d.). This model guides the leader through the discussion. The D is for describe what needs to change and what has been observed. Give a concrete example. The E is for explain or evaluate how the described behavior impacts the unit or the patient. The leader should explain how the behavior has actually impacted the patient. The S is for show or tell clearly and concisely exactly what the staff member must do to correct the situation. The K is for know the consequences. The staff member must be told what will happen if the behavior does not change.
For example: “Doug, I have found that the hourly rounding is not being completed on your patients. Failing to complete hourly rounding led Mrs. Smith to fall getting out of bed to use the bathroom. From this time forward, hourly rounding must be completed as expected and outlined in the procedure. If hourly rounding is not completed, this verbal warning will escalate to a level-one disciplinary action.”
The need for effective communication in difficult situations is clear. Managing the communication between and among others falls to the leader whenever a conflict occurs. Leaders who perfect many communication styles and options of response will find that they will become very successful in conflict resolution.
Robinson, F. P., Gorman, G., Slimmer, L. W., & Yudkowsky, R. (2010). Perceptions of effective and ineffective nurse-physician communication in hospitals. Nursing Forum, 45(3), 206–216.
Schermerhorn, J. R., Osborn, R. N., Uhl-Bien, M. & Hunt, J. G. (2012). Organizational behavior (12th ed.). Hoboken, NJ: John Wiley & Sons, Inc.
The Studer Group. (n.d.). Glossary of terms. Retrieved from https://www.studergroup.com/who-we-are/glossary-of-terms/
The Studer Group. (2010). The nurse leader handbook. Gulf Breeze, FL: Fire Starter Publishing
Marquis, B. L. & Huston, C. J. (2014). Leadership roles and management functions in nursing: Theory and application (8th ed.).Philadelphia, PA: Lippincott, Williams & Wilkins.
• Chapter 19: Organizational, Interpersonal and Group Communication
Anderson, L. (2013). Why communication in the nursing profession is important. Nursing Together.com link to article
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Julian Treasure: 5 ways to listen better. (2011). TEDGlobal. link to article
Pujari, S. (2014). 9 important measures to overcome the barriers of communication. YourArticleLibrary.com. link to article
Sherry Turkle: Connected, but alone? (2012). TEDx. link to article
Williams, M. (2011). 7 ways to overcome barriers to communication. Mtd-Management Training Specialists. link to article
Wright, R. (2012). Effective communication skills for the ‘caring’ nurse. The Great Teachers Tertiary Place. link to article
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