Communication is the underpinning of healthcare and is a vital part of our job. More importantly, it is what threads humanity into healthcare. It is why robots can't replace humans. By nature, humans are designed for relationships, and communication is the core of relationships. Like any other nursing skill, good communication takes practice. You have to make a conscious effort to practice good communication every day. Unlike other skills in healthcare, many of us come with communication baggage. We have watched people communicate all our lives and have seen tons of communication styles. Siblings, parents, teachers, coworkers and friends help us create a communication style. Most of us form our communication style based on what we see, who we are interacting with, and what feels safe, not what is best practice.
While communication has always been an essential skill in healthcare, it is paramount in today's climate. Healthcare is facing a pandemic, structural racism, and healthcare disparities. Our success in all of these areas depends on our ability to communicate effectively. And as we face a nursing shortage that is not going away any time soon the World Health Organization projects will need 6 million new nurses by 2030 to maintain basic standards of care. Healthcare facilities worldwide are scrambling to figure out how they will bridge the massive gap in the next ten years. And while this is a scary projection, it leads many to think innovatively and outside the box. How can we spread our existing workforce more efficiently? What if we had an easy way to layer in flexible work where nurses and all healthcare providers can pick up extra shifts when and where it worked for them? How do we fill a gap without simply creating another gap? For this model to work, nurses have to perfect their communication skills. Communication is tricky even in the best of circumstances, but when you add the added complexity of being a flex-worker, it may seem impossible. Let's discuss what communication is, why it's essential, and as a flex worker, how do you float in and out of different facilities and interact with various coworkers while ensuring you are communicating effectively?
What is communication?
Communication, in its most simplified form, is information that we want others to know. We communicate for two reasons: to exchange information or learn and impression management (liking). Impression management is a fancy term for "getting others to like you." What's interesting about communication is that what we verbally say accounts for very little whether someone finds us credible or likable. Various studies have examined communication. One famous study from the 1960s identified that verbal communication accounts for only 7% of what someone believes. The bulk of our communication is based on our nonverbal behaviors. Most people we interact with are paying more attention to our tone, speech, cadence, and body language. Applying these facts in our current environment creates a complicated layer to communication. Today's mask requirements muffle our verbal and cover our non-verbal communication. As a flex worker, it is paramount to understand the influence your non-verbal communication plays.
Why is communication important?
The Institute for Healthcare Communication published a report that states the following:
Extensive research has shown that no matter how knowledgeable a clinician might be if she or he is not able to open good communication with the patient, he or she may be of no help.
I underlined clinician and patient because I think this statement applies across all titles and roles. You can fill in the blank with anything. So it doesn't matter how knowledgeable a nurse is; if they cannot open good communication with their peers, they may be of no help. What you know is essential, but your ability to establish rapport and build trust is more important.
As nurses, we communicate with patients to gather important information. Our ability to build trust and rapport with patients determines the type of information a patient provides. If they trust us, they will be honest. If they don't trust us, they will likely hold back information critical to their care plan.
Another essential reason nurses communicate is to educate and persuade. We need patients to understand their disease process. We are tasked with explaining information in a way that the patient understands. And if this isn't hard enough, we also have to establish rapport, so patients believe the information we are providing and are persuaded to implement the changes we educate them on. For example, when providing education to a patient with newly diagnosed DM2, they not only need to know what the disease is but, most importantly, they need to implement lifestyle changes.
Why is communication sometimes difficult for flex workers?
Two variables interfere with communication: high stress and high volumes of people. Whether you are the newbie or part of the original crew, communication in the healthcare setting is hard, and if healthcare professionals can't communicate effectively, lives are on the line. Dr. Gary Kaplan published an article in the Harvard Business Review, and he states:
When team members are open and honest with each other, without fear, it leads to mutual trust, collaboration, and sharing of best practices across disciplines. Patients are the ultimate beneficiaries.
When you are new to a team, and only there for a limited time, trust can be hard to establish. You are new, and you don't know your team, and your team doesn't know you. At times, this can cause flex workers to silo themselves during their shifts, which can be dangerous. Since trust is the foundation for good communication and time is not on your side, here are a few tips for building trust quickly.
Tip 1: Know Your Style
Remember, close to 93% of communication is non-verbal in nature. So whether someone finds you likable or credible depends on your non-verbal cues. Do you know your non-verbal style when you are nervous or going into a new situation? Most of us have 3 types of styles we lean toward when we are in uncomfortable or new positions, usually an overextension of a strength. We can be aggressive, passive, or passive-aggressive. Let's take a look at each of these styles.
Aggressive communicators come across as abrasive, hostile, and their response is often unpredictable. People may feel intimidated and even afraid to approach them. When you are aggressive, you want to be right at all costs, and you rarely think about the team's good. The strength of an aggressive communicator is they are decisive, quick thinkers, and can take charge. When you overextend those qualities, you move into the aggressive territory. What are the non-verbal queues of an aggressive communicator? Think about folding your arms when others are talking to you, using dominating body space like standing over someone while you are talking, or raising your voice. There are many ways our non-verbal can come across aggressively. People on the receiving end of the aggressive communicator are fearful, resentful, and afraid.
Passive non-verbal queues are a stark contrast to aggressive cues. Passive or submissive body language could be speaking too softly, avoiding eye contact. They avoid confrontation at all costs and are timid and afraid to ask questions. At first, passive people seem nice to work with because they sort of go with the flow and rarely ruffle feathers. In healthcare, we can't afford to not speak up when we are advocating for our patients. Many nurses fall into this category, especially when we are communicating with providers. People on the other side of passive or submissive communicators often feel frustrated, guilty, or exasperated.
Lastly, you have the passive-aggressive communicators. They complain about problems and would rather talk about people than solutions. Passive-aggressive communicators also start or participate in gossip. They avoid actual issues and instead talk about other people or even blame other people for problems. At the core, they are afraid to share what they really think. When someone does something that dissatisfies them, they choose to talk about them rather than confront the other person. The receiver feels confused. Maybe you just spoke to this person, and everything was fine, and you thought you had a great conversation, but then you hear from someone else they are displeased with you. Team members working with passive-aggressive communicators confused, resentful, angry, and hurt.
So the first step in building trust is to know your non-verbal communication style. Even if you don't like it, just be honest. We are all a work in progress. It is difficult to identify our own personal communication style, so I have found it helpful to ask a trusted friend or colleague. Other people know what it is like to be on the receiving end of you.
Tip 2: Ask Questions and Listen
When I was growing up, I was painfully shy. I would hide behind my parents, friends, trees, anything. I even used to cry when people looked at me. As I got older and my social awkwardness was no longer endearing, a mentor gave me great advice. She told me, "when you are nervous, just ask people questions about themselves. Everybody likes to talk about themselves." In the book, How to Win Friends and Influence People, Dale Carnegie encourages readers to ask questions that others will enjoy answering. To this day, I still keep this piece of advice in my back pocket and use it when I feel intimidated or unsure of myself. And don't just ask people questions about themselves; ask questions about processes and procedures. Don't assume you know everything; asking questions demonstrates that you are not only interested in individuals, but you are also interested in the organization as a whole. Another aspect of asking questions is to listen. I repeat: listen. Listen to understand, not to respond. Asking questions helps you build rapport with a new team, which is an excellent foundation for trust. Asking questions also prevents you from misinterpretation. Many times, we fill in the blanks with falsities, which prevents us from building trusting relationships. We make assumptions about the meaning behind what others say. Even if you are a temporary worker, take the time to ask questions. After all, your goal is the same as everyone else on the team: provide outstanding care to patients.
Tip 3: Be Assertive
The gold standard for communication is the assertive communication style. Assertive communicators are open, honest, and predictable. If you've ever been on the receiving end of an assertive communicator, you walk away feeling heard, respected, and most importantly, empowered. It can be challenging for flex workers to get to know your coworkers and superiors since you are not there on a day-to-day basis. On the opposite side, your coworkers and supervisors may not immediately trust you since they do not know you well. Informing them of your work style and experience may not be necessary for a full-time position, but letting them know you and your dedication can help build trust. Effective communication is essential in healthcare. The Joint Commission lists poor communication as one of the top 3 root causes of sentinel events in healthcare.
Assertive body language is welcoming, not intimidating. Often, women mistake assertiveness for aggression. Make eye contact, nod your head, repeat back what you heard. Be mindful of how you are feeling. Don't allow your feelings to dictate what you say or how you present yourself. Never say or do something that you think you may have to apologize for later.
One tool I have found extremely helpful in being an assertive communicator is SBAR. If you are a nurse, you are very familiar with this acronym and likely use it multiple times a shift. SBAR stands for Situation, Background, Assessment, and Recommendation. Numerous studies have shown that using SBAR improves patient care and improves communication among the healthcare team. When you use SBAR frequently, it becomes more natural and sounds less perfunctory. I use SBAR all the time outside of the healthcare setting. In fact, a coworker of mine made a comment that left me questioning whether I hurt her feelings. So instead of filling in the gaps with assumptions and falsities, I used SBAR. Without giving you too much detail, here is an overview of how that conversation went:
Situation: Hey, the other day, you joked that I did ______.
Background: I really care about you and would never want to do ______.
Assessment: When I look back at ______, I can see where you think I did that on purpose.
Recommendation: Can we talk about this to understand where each of us is coming from?
And you know what happened? We talked through it in less than 5 minutes and completely cleared the air. Not only did this clear the air, but it fortified a foundation of trust.
Good communication is a skill. It takes time, practice, and you will likely make mistakes along the way. None of us get communication right every time, and perfection is not the goal. The goal is to learn and evolve. Throw in the variable of being a flex-worker, and communication can be even more challenging. Healthcare needs flex-workers now more than ever. Due to the nursing shortage, we need more nurses willing to work at multiple locations and settings. Moving around is challenging and makes building rapport and trust stressful. Remember, we are all in this to help patients, so if you are a flex worker and want to work on your communication: know your style, ask questions, and be assertive. Doing this will likely make you the thought leader that leaves a team better than how you found it.