Effective Communication - 2 Nursing CEs

Author: Kristi Hudson RN MSN CCRN

Written: December 10, 2006

Updated: September 28, 2009

Course Description

This course is designed to provide information for effective communication. Focus will be placed on providing simple and basic communication techniques as well as helpful “peer to peer” communication tips. Important information transfer techniques such as explaining the game, listening, asking the right questions, building trust and getting the entire story will be presented. Thinking “outside of the box” to improve department communication will be the final focus of this course.

Course Objectives

Upon completion of this course the student will be able to:

• List 3 basic and simple techniques to assure effective communication.
• Describe 2 effective “peer to peer” communication tips.
• Discuss how “explaining the game” to staff members improves communication.
• Explain the benefits of listening, asking questions and getting the entire story when attempting to effectively communicate with staff members.
• Have a better understanding of the benefit of being able to “think outside of the box” in order to effectively communicate.

“Only when everyone (from the cashier in the cafeteria to the vice president) has the same information about an organizations goals and direction, can they say they have a good communication system.” (Quint Studer, 2003)

“Historically, hundreds of definitions and a variety of paradigms have been developed to describe communication. What has come to be accepted as a basic assumption by communication experts is that communication is a process with no beginning or end.” (Susan Grover, 2005)

Starting with Basic Communication Skills (Plain and Simple):

• Listening (Considerate listening that focuses on understanding).
• Asking open-ended questions (These are questions that are asked to gain a wider view point).
• Asking closed questions (These type of questions allow nurse managers to get quick and hard facts).
• Clarifying (The purpose of clarifying is to reinforce what is being said and gain additional information).
• Paraphrasing (This takes the original message and transforms it by interpreting and clarifying the meaning of what is being said).
• Using Facilitators (Facilitators such as “nodding” or saying “go on” encourage the person you are talking with to continue without directing the conversation in any one direction).
• Assessing non-verbals (noting what is not being said by watching body language really helps the nurse manager better understand the “content level of the message” such as the element of emotion or conviction.
• Silence (This allows the person speaking to time to continue their thought and think about what it is they would like to say. If silent pauses are too long, the speaker may become uncomfortable).

Helpful Peer to Peer Communication Tips:

• Effective communication means “not” being focused on being right.
• If your mind wanders (we are all distracted at times), ask the person you are talking to repeat what they were saying.
• Be honest but in doing so; be mindful of the other person’s feelings. It is possible to be truthful and polite.
• Get comfortable with “gray” (rarely are things truly black or white).
• Have integrity and build trust.

Note: While providing the right tools for effective communication; nurse managers must enforce a “zero tolerance” for those who refuse to control their anger, exhibit aggressive behavior, disallow questions and shut down collaboration with poor communication.

Effective Communication Using the “Power Exchange” Approach:

A power exchange is the intentional, continuous transfer of information that leads to staff motivation as well as improved performance and accountability!

The new workforce dynamics (with majority of employee being from the X/Y generation) will require strong nurse leaders who have the ability to exchange “power” for “employee performance” in order to develop and lead successful and productive teams. The ability to be successful will require “strong” communication skills on the part to the nurse manager. The “Power Exchange” is a simple four concept plan (we will be introducing two concepts) that will assist nurse leaders to develop clinical leaders, increase motivation and instill accountability in staff members. These first two concepts are as follows:

Concept # 1 (Explain the Game):

Explaining is the most fundamental form of information exchange. In explaining the game; such assumptions such as “I am sure they already know that” or “it is part of his/her job to know that”, need to be avoided. Leadership research supports that there is an “explanation gap” between nurse leaders and employees. A ground breaking Harris Poll conducted in over 11,000 households found the following results:

• Only 15% of workers could identify their organizations most important goals.
• A majority of workers (51%) did not understand what they were supposed to be doing in order to help their organization prosper.
• Less then ½ of the available work time (49%) was estimated to be spent on the organizations most important goals.

Note: With results like this it is easy to see why there is not just an explanation gap, but more like an “execution gap”.

Answering Fundamental Questions:

Explaining the game is thought to be a “pay me now or pay me later” philosophy. In other words if staff members understand where in the big picture they fit; they will naturally feel more accountable for their performance. Powerful leaders communicate or explain the game by consistently answering four questions that are commonly asked by employees. The following table shows what it is that employees really want to know when mangers ask these specific questions:

Note: A nurse manager’s ability to answer these questions effectively is what turns today’s possibilities into tomorrow’s results.

The Rules of Engagement:

It is important for the nurse manager to share the rules of engagement with team members (similar to the teacher on the first day of school saying “raise your hand and don’t write on your desk”). In defining the rules of engagement, employees will have a better understanding of what is expected of them. Rules should be individualized depending on specific unit or department issues and problems, but general rules often address the following:

• Decision Making
• Sharing Information
• Considering Ideas for Improvement
• Coordinating Managers “Hands Off”
• Reviewing Work
• Challenging Prevailing Thoughts
• Prioritizing
• Resolving Conflict

Note: Look at the group of team members for specific needs. For example, if your team has trouble getting all the input on the table during a staff meeting, make a rule to “Speak your mind during the meeting, not after.”

Concept # 2 (Ask the Right Questions and Then Listen):

“Learn from yesterday, live for today and hope for tomorrow. The important thing is to never stop questioning.” (Albert Einstein)

While explaining the game is a “one-way” process to boosting performance, asking questions becomes the first “two-way” process. Asking questions does the following:

• Demonstrates Respect
• Diffuses Tension
• Obtains Buy-in
• Makes Employee’s Feel Valued

Questions should be focused around the following two types of organizational knowledge:

• Dashboard Knowledge – Just as a cars dashboard provides data (speed, mileage, oil level), the organizational dashboard provides similar data (productivity, budget variance, projects on schedule). While dashboard knowledge is important for understanding and making general plans, it is not effective in developing specific actions or improvements.
• Under the Hood Knowledge – This type of knowledge is specific to a given job, time, place and set of circumstances. Under the hood knowledge answers why your team’s engine is running hot, why your car veers to the right and why it is not responding to the brake pedal like it should.

Getting the Full Story:

Getting the full story requires work on the part of the nurse manager. It is imperative in order to boost productivity and accountability. This sometimes (most times) requires some detective work. For example; look for dissenting opinions, assumptions and perspectives. If everyone is saying “yes” to everything, it is time to worry. Remember these opinions, assumptions and perspectives are not going to fall on your desk, you must seek them out! Good questions to assure truthful answers include:

• What can I do better to support you?
• What makes it hard to get your job done?
• What was the best/worst part of your day?
• If nothing was holding you back, what would you do differently?

Gathering all information before making any recommendations or offering any solutions will boost performance. Clarifying questions that are open ended, specific and not imbedded with solutions will help to transfer power to the team.

Building Trust:

If your staff doesn’t “trust” that you are sincere in your attempts to communicate better, your efforts will be for not! The following are necessary requirements in order to promote an environment of honesty and trust:

• Being Open
• Being Fair
• Speaking your true feelings
• Telling the truth
• Showing consistency
• Fulfilling your promises
• Maintaining confidences
• Demonstrating competence

Thinking “Outside” of the Suggestion Box:

If the suggestion box is full of good ideas that no one has time to implement, it is not a very effective method of communication. Thinking outside of the box requires nurse managers to develop and implement more effective ways for team members to communicate. The following are just a few ideas to increase communication throughout the department (keep it simple):

• Posting and emailing staff meeting minutes (Be prompt in posting).
• Posting meeting minutes from other groups (practice councils etc.) so staff members are up to date on events outside of the department.
• Encouraging staff to come to staff meetings to get first hand knowledge of what’s going on (have a potluck).
• Having outings away from the department (people feel more at ease to talk in a neutral setting sometimes).
• Having impromptu team meetings to discuss upcoming plans or events.
• Looking at the schedule and plan “ahead” to talk to key players.
• There is always the posting of important memos on the bathroom wall.
• Remember, email is only an effective way to communicate for people who read their email. In most situations there are still employees who do not read email.

References

Dorchak, D,. (2007). How to communicate with people: Seven keys to effective communication. Retrieved on September 6, 2009 at:

http://www.lifescript.com/Soul/Self/Growth/How_To_Communicate...

Allen, G., (1998). Management modern: Leading. Retrieved on January 15, 2006 at:

http://ollie.dcccd.edu/mgmt1374/book_contents/4directing/leading/lead.htm

Chan, A., O, & Hauk, C., Y. (2004). Influence of work environment on emotional health in the healthcare setting. Occupational Medicine. 54, 207-212. Retrieved on May 14, 2006 from ProQuest Database.

Colan, L., J. (2005). Power exchange: How to boost accountability and performance in today’s workforce. Corner Stone Leadership Institute. Dallas, TX.

Grover, S. Shaping effective communication skills and therapeutic relationships at work: The foundation of collaboration. AAOHN Journal. Thorofare: Apr. 2005. Vol. 53, Iss.4; pg. 177, 6 pgs. Retrieved from ProQuest Database.

Marshall, T. (2003). Pump up your people. Retrieved on May 20, 2006 at:

http://www.tessmarshall.com/programs/workplacemorale.htm

Studer, Q. (2003). Hardwiring excellence: Purpose, worthwhile work, making a difference. Firestarter Publishing, Gulf Breeze, Florida.