Monday, January 28, 2019

Six Steps to Being a Better Nurse Communicator

One of the most important non-clinical skills for a nurse to develop is strong powers of communication. Nursing care is built on the foundation of communication -- both patients and colleagues figure largely in a nurse's world, and being able to listen well and speak your truth clearly is absolutely essential both on the job and in your daily life. 


Speak your truth
Photo by Jason Rosewell on Unsplash


Conversations Abound

The work of a nurse in the clinical space -- whether in home care, dialysis, entrepreneurship, ambulatory nursing, or the assisted living facility -- is informed by communication and conversation. Nursing is itself a highly collaborative practice in most instances, thus nurses need communication skills that will make this aspect of their work lives smoother to navigate. 

Think about it: how many conversations of varying lengths do you have during the course of an average work day as a nurse? If you're a nursing professor, you likely speak with your colleagues, students, and others for hours each day. In the ICU, you speak with family members, loved ones, physicians, ancillary medical staff, and a plethora of others. No matter what type of workplace you spend time in, communication is very likely to be key to what you do. 

For myself, my home-based work as a 100% self-employed nurse entrepreneur also involves a great deal of conversation with career coaching clients, my editors, my wife (and business partner), colleagues, friends, and myriad others. Even when I'm working solo at my desk, it's a rare day that I don't have at least one or two significant conversations. 

For nurses, the ability to speak and listen well is paramount, but do we naturally have the chance to learn such skills? What communication and conversational skills do you need to improve? Here are six steps to stronger communication skills as a nursing professional: 

Step 1: Electronic Communication


Electronic communication

In the 21st century, electronic conversation is part and parcel of many of our lives. And while many of these technologies don't allow for us to see one another's faces while communicating, how we relate with others in these ways is also important. 

Skype, Zoom, FaceTime, (the awful and mostly failed) Google Hangouts, Facebook video chat, and similar platforms allow for face-to-face conversations over streaming video, no matter how flawed they can seem at times. 

Current technology has most of us looking at the person's moving image rather than at the camera, thus losing the illusory notion of "direct" eye contact, but these types of conversations remain crucial despite their inherent shortcomings. In 10, 20, or 50 years, who knows how such technologies will develop so that we feel even more connected when using them (do I hear "scratch and sniff" Zoom calls or video cameras and censors embedded in our clothing, eyeglasses -- or even our very skin or eyes like cyborgs?)

Email and texting still hold sway over many of us, and they remain common modes of electronic communication (although some younger people seem to be eschewing email completely unless they're required to use email at work). So many people seem to not understand email etiquette (e.g.: being thoughtful and using blind carbon copy (BCC) for multiple recipients or not replying to all when recipients are not BCC'd -- don't get me started!)

For email and texting, emoticons and GIFs add some nuance and emotional context, but they can still be easily misconstrued. Without body language, tone of voice, and other factors that face-to-face conversations effortlessly benefit from, our electronic messages need to be as clear as we can possibly make them. Nuance may not be easy to achieve in this realm, so we do our best to be concise and descriptive. 

Step 2: Difficult People and Conflict


Managing conflict
Photo by rawpixel on Unsplash
The healthcare workplace can be stressful, and encountering difficult or anxious people is common. Physicians on rounds may be curt and harried; other nurses may seem like they can't even give you the time of day; and patients and their families may be wracked with worry and have many questions requiring complicated answers.

Learning to navigate conflict is what all nurses and healthcare professionals should learn, but we generally aren't taught these skills in school (nor any communication skills, for that matter). 
  • How do you handle conflict? 
  • Do you blame others or yourself as an easy way out? 
  • Are you averse to confronting someone when you have something to say about their behavior? 
  • Could you learn how to "do" conflict better? 
  • Can you avoid processing any hurt feelings or difficult issues via text or email? 

Step 3: Boundaries


Personal boundaries

Setting strong boundaries is essential in the midst of very full 21st-century lives. We nurses who are so tuned into the needs and desires of others must also learn how to care for our own needs by saying no when it's necessary to do. 

One important aspect of boundaries is to know our own limits. There is anecdotal evidence out there that Millennial nurses are much more adept at standing up for themselves and refusing overtime, extra shifts, or coming in to work when they have a planned day off. 

For various reasons, it's theorized that this younger generation just seems to have an easier time setting firm boundaries, especially where work is concerned. Meanwhile, anecdotal evidence also tells us that older nurses (Baby Boomers, Gen X'ers, etc) have a much harder time saying no and will bend over backwards to accommodate others even if it's not in their own best interest to do so. 

In states with strong nurse "safe harbor" laws, a nurse cannot be reprimanded or punished for refusing to work under unsafe conditions. This is a boundary that many nurses ignore at the peril of their licenses, their mental well-being, and patient safety. 

Boundaries don't just come into play with colleagues, supervisors, but also with patients and their families. We can become very emotionally tethered to our patients and their loved ones, especially in clinical situations where we work with patients over an extended period of time. And when we get close and feel more like friends, things can get sticky and it can become hard to say no or overextend ourselves. We all know that crossing the line into an emotionally or physically intimate relationship with a patient is a very bad idea at best, but we can also get into trouble when we decide to help a patient out financially, intervene in family dramas, or otherwise move outside of our mandate and scope of practice. 

Can you say no and still feel good about yourself? 

Step 4: The Written Word



In terms of the written word, there are numerous ways to take your skills to the next level. 

As mentioned above, being conscientious when emailing or texting is prudent. However, the written word also comes into play in your clinical documentation, any proposals or reports you may write, your resume, cover letters, your LinkedIn profile, and also your social media presence. Building a personal/professional brand is reflected in how you conduct yourself online and "in real life". 

Although writing skills are not in the forefront of nursing education (aside from research papers and the like), writing can be used to advance your career. 

Your reputation as a nurse can be impacted by the quality of your documentation, a master's thesis or doctoral dissertation, the publication of any articles or research you may participate in or author independently, or perhaps a blog or website you create to share about your nursing career. 

Writing is a powerful medium that many nurses have leveraged to their advantage, whether as entrepreneurs or not.

Step 5: Emotional and Relational Intelligence


Emotional intelligence

Developing your level of emotional and relational intelligence is crucial to being able to communicate with a high level of skill. As I once wrote in an article for AUSMed, a nursing website based in Australia: 
Emotional intelligence, a term originally coined by author Daniel Goleman, is basically defined as the ability to be aware of, and control, one’s own emotions, and to read and respond empathetically to the emotions of others 
One’s emotional quotient (EQ) is the measure of one’s EI. 
In nursing and healthcare, relationships and communication are everything; thus, a nurse with a high EQ is more likely to have successful interactions with colleagues, managers, and patients and their families.
Being sensitive to the feelings of others while also acknowledging one’s own emotional state is a gift, and nursing leaders and hiring managers would be prudent indeed to hire staff with a high EQ. 
And since emotional intelligence can actually be taught, it is in the best interest of every healthcare institution to offer trainings and in-services that will increase the EQ of those staff members who need it most.
The emotionally intelligent nurse can listen to a patient’s explosive angry outburst, assess the patient’s emotional state, and keep her own reactions in check. The nurse can then respond in a calm and rational manner that demonstrates understanding of, and empathy for, the feelings of the patient, without any reactivity on the part of the nurse.
This is a skill that is difficult to master but essential to learn. 
This nurse with a high EQ can also relate to her colleagues in a similar fashion. She’s a strong, assertive team member, a good friend, and a reliable emotional barometer in terms of the health of the group.
Relational intelligence is where the rubber hits the road and your emotional intelligence is utilized in order to navigate relationships and their inherent need for clear, kind communication. A relationally intelligence nurse can use his or her emotional intelligence to create lines of communication with patients and colleagues that usher in greater understanding, stronger relationships, clear conversation, and feelings of connection.

Step Six: Miscellaneous Communication Strategies

Communication strategies

There are plenty of other strategies and techniques to learn and employ in your communication as a nurse, including but not limited to:
  • Body language: Your posture, facial expressions, and other forms of body language are crucial to understand and have under your control. Does your facial expression match your words? Are your arms crossed while speaking? Is your posture open or closed? Are you making direct eye contact? 
  • Cultural differences: Understanding cultural norms in terms of communication, body language, and eye contact are important. If you don't know, ask!
  • Language: If you're coming into contact with the transgender community or other marginalized groups, be aware of the language you use. If you don't know how a patient should be addressed, ask them what they prefer. If you have a man who is transitioning to female, ask what pronoun they prefer and school your colleagues about what you've learned.
  • Listen: It's been said that we have two ears and one mouth so that we'll listen twice as much as we speak. 
  • Ask questions and be curious! 
Communication is key in any industry or any relationship. If you show curiosity, listen well, show kindness, and practice these other strategies and techniques will get you moving in the right direction. 

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Keith Carlson, RN, BSN, NC-BC, is the Board Certified Nurse Coach behind NurseKeith.com and the well-known nursing blog, Digital Doorway. Please visit his online platforms and reach out for his support when you need it most.

Keith is the host of The Nurse Keith Show, his solo podcast focused on career advice and inspiration for nurses. From 2012 until its sunset in 2017, Keith co-hosted RNFMRadio, a groundbreaking nursing podcast.

A widely published nurse writer, Keith is the author of Savvy Networking For Nurses: Getting Connected and Staying Connected in the 21st Century and Aspire to be Inspired: Creating a Nursing Career That Matters. He has contributed chapters to a number of books related to the  nursing profession. Keith has written for Nurse.com, Nurse.org, MultiBriefs News Service, LPNtoBSNOnline, StaffGarden, AUSMed, American Sentinel University, Black Doctor, Diabetes Lifestyle, the ANA blog, NursingCE.com, American Nurse Today, Working Nurse Magazine, and other online and print publications.


Mr. Carlson brings a plethora of experience as a nurse thought leader, keynote speaker, online nurse personality, social media influencer, podcaster, holistic career coach, writer, and well-known nurse entrepreneur. He lives in Santa Fe, New Mexico with his lovely and talented wife, Mary Rives, and his adorable and remarkably intelligent cat, George.

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