Communication Skills: Moving Beyond the Basics

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By Jennifer Larson, contributor

August 26, 2011 - The act of communicating a piece of information is not considered complete until the receiver has understood the message. Yet, how often do messages inadvertently get misconstrued by the receiver, through verbal or nonverbal confusions in the communication process?

Clear communications can improve your daily work environment, as it is often those unintended misunderstandings that create conflict. If you strive to develop and use good communication skills with the people you encounter every day, your professional relationships will benefit. And your patients will, too.

“We’re all here for the same purpose, and that is to help someone,” said Jane Barnsteiner, Ph.D., FAAN, professor of pediatric nursing at the University of Pennsylvania School of Nursing.

Understanding your co-workers

One of the most important things you can do to help establish good work relationships--or improve existing ones--is to figure out certain basic characteristics of your colleagues. Are they people-oriented or task-oriented? Do they work quickly or more slowly and methodically? Are they introverted or extroverted, verbally and socially, and are they likely to be motivated by social recognition?

Knowing those characteristics can help you when you need to approach a co-worker to discuss a situation, said Patsy McLaughlin, a performance consultant and trainer with Mediation Training Institute International.

Generational differences can be a potential barrier to good communication in some circumstances.

According to K. Lynn Wieck, Ph.D., RN, chief executive officer of Management Solutions for Healthcare, different generations tend to approach work differently. Ignoring the different approaches won’t solve problems that may have arisen; it will just cause further alienation if you pretend that everyone is the same.

“You have to figure out how the other people view the problem,” said Wieck, whose research focuses on generational differences in the workplace. So, if you’re a member of Generation X, take the time to get to know your co-workers from the Baby Boomer and Millennial generations. Learn how they definite “good communication” and also how that incorporates technology. When in doubt, ask them what they prefer. A younger colleague might prefer a brief text message, while an older co-worker might choose face-to-face conversations to convey information and discuss problems.

Handling conflict

It would be nice if everyone got along all the time. But that’s not realistic. Conflict in the workforce unfortunately does exist.

Do you prefer to avoid conflict rather than address it head on? You’re not alone. In fact, that’s a common reaction, but it is not always the best option.

Patricia Walters-Fischer, RN, a Texas-based writer who worked as a nurse for 10 years, said, “You have to be willing to step up and confront the situation, and that is very hard for a lot of nurses,” she said.

“We have choices as to how we respond to (conflict), and we can respond constructively or we can respond destructively,” McLaughlin said, adding that it’s best to present your concern over the conflict as a business problem instead of a personal problem because it can diffuse some of the natural defensiveness that might develop.

Being able to articulate problematic behaviors in a neutral way is a very important communication skill to have, noted Barnsteiner. She also recommended being willing to give the other person the benefit of the doubt.

Believe that the other person is also there to help people and keep the patient and his family at the center of the discussion, she said.

McLaughlin also recommended that nurses approach conflict resolution by remembering that the ultimate goal is providing excellent patient care—and to remind the other person that they both share that common goal.

“Whenever you go in to resolve a conflict with somebody, you want to reach out and express an optimism that the problem can be solved,” she said.

It can get a little dicey when the conflict exists between a nurse and a physician or someone else in a position of authority. Walters-Fischer suggested that nurses document any instances of abuse from other colleagues or physicians. Discuss the matter with a nurse manager and make sure you have back-up, she said.

Still uncertain about the benefit of addressing conflict, rather than just hoping it will dissipate all by itself? Unresolved conflict can have a negative impact on productivity and morale, as well as patient and family satisfaction.

“It needs to be resolved because it’s costly,” McLaughlin said.

Many of the same skills can be used when handling confrontational patients, too, noted Walters-Fischer. When a patient is yelling at you at something that seems minor, take a moment to remember that he may be in pain, scared and stressed out—and like everyone, he has emotional baggage that he brings to the situation.

But she added, “You have to be able to listen, but that doesn’t mean you have to be abused.”

“You have to know where your line is,” she said. “You have to know where your boundaries are.”


Another important type of communication skill that nurses should master in order to do their jobs efficiently involves delegating tasks to others.

“It allows the nurse to do nursing, as opposed to other types of nursing tasks that somebody else can do,” explained Maureen Marthaler, RN, MS, associate professor at the school of nursing at Purdue University Calumet in Indiana.

Marthaler recommended that nurses become familiar with their state’s nurse practice act to see what is covered under scope of practice, then check out their health care agency’s policies. That way they’ll know what is appropriate to delegate and what isn’t. (Another good resource is the National Council of State Boards of Nursing, which developed a Medication Assistant-Certified (MA-C) Model Curriculum in 2006.)

Not all nurses are natural delegators, however. Some nurses, especially new nurses, try to do it all—and they get completely bogged down. They have to learn this important type of communication and practice until it becomes comfortable.

And consider what you are doing when you delegate a task.

“It’s not only your verbal communication,” Marthaler said. “It’s your body (language), your nonverbal communication.”

© 2011. AMN Healthcare, Inc. All Rights Reserved.