Author: Simiao Li, MD (EM Resident Physician, PGY-3, NUEM) // Edited by: Michael Macias, MD (EM Resident Physician, PGY-4, NUEM) // Expert Commentary: Elizabeth Even, MSN, RN, CEN
Citation: [Peer-Reviewed, Web Publication] Li S, Macias M (2016, October 4). Nursing Communication 101 [NUEM Blog. Expert Commentary By Even E]. Retrieved from http://www.nuemblog.com/blog/nursing-communication/
Tips For Improving Nursing Communication
Ah, July. The time of year when the sun is shining, the grass is growing, and... new interns are facing their much-anticipated jobs with both excitement and trepidation. Typically, they will find themselves in a new hospital, in a new role. Interns in the field of emergency medicine also face a particular challenge - in addition to learning a wave of new medical knowledge, they are also thrust into an environment where they must care for undifferentiated and critically ill patients amongst (what seems like) an ever changing sea of new faces - attendings, consultants, nurses, emergency department (ED) technicians. The list goes on.
Why is it important to be a good communicator in the ED?
Setting science aside, one facet of the art of becoming an emergency physician involves learning to communicate optimally with ED staff. You will work alongside them for multiple years, sharing laughs as well as poignant moments, getting to know each other in the process. Furthermore, when ED residents are good communicators, they foster trust within the ED team and also build efficiency, both vital aspects to delivering sound patient care. On the other hand, the ED is a high risk environment and communication lapses can directly lead to negative health outcomes. On average, residents spend 16% of their time directly interacting with patients; nurses, far more. Nurses are often the first to note some transient hypoxia, an errant blood pressure reading or a changing clinical picture. These issues will more frequently be brought to your attention when you are able to foster trust and open communication with your nursing staff.
There is no textbook on how to be an effective MD with respect to communication with colleagues (at least, there wasn’t at my med school). So, in this learning curve that is equally as steep as learning real world medical practice, here are some tips and tricks to becoming an effective communicator.
Introduce yourself. No need to individually and formally make the rounds to twelve different nurses when you first come on shift. BUT - do make a point of saying hello, and introduce yourself when you are caring for your first patient with a nurse. More importantly, do your best to remember that name, and use it. The next time a critically ill patient rolls in, it is much easier to ask for a hand, ask for a medication, ask for equipment when you know the name of the person who is helping you.
Ask a nurse for his or her assessment. They frequently see the patient first and triage them long before you have a chance to meet them. A face to face interaction will give you far more information on a telemetry call or a family member’s corollary than a triage note ever will. Then, just as you would any handoff from any other colleague, take the information they provide into account but do not treat it as lore in an environment with an ever changing picture.
Learn from nurses. How do you start an IV without dripping blood all over the place? What color blood draw tube do you use for a lactate? How long does a patient need to be drinking barium before they can get that CT scan? I would have been clueless to the above without a nurse’s guidance, and it would have taken me much longer to figure out on my own. Your nurses will be your best asset in learning the ropes in your new and unfamiliar territory.
Share your learning. Medical school and nursing school are two very different animals and I assume the latter did not involve reciting the citric acid cycle (a task which I would hope you will never have to do again). However, as you grow in your new role you will be able to share useful and vital information related to patient care. Why do you send a d-dimer on some patients and scan others? What is the significance of a new left bundle branch block? When a care plan has context and is not solely disjointed information, it is easier for nursing to be on board, to communicate with patients, and to facilitate safe patient care.
Good communication with nursing staff is not rocket science but it does take deliberate practice and effort on the part of the physician. In a busy and chaotic place such as the emergency department, this communication will be a key to optimizing patient care. We are all on a team together and it is our duty as a leader to build trust with our nursing colleagues and create an open communication line to learn from one another.
Expert Commentary
Communication. We learn to do it at such a young age. We continue to use it absolutely every single day of our lives and it is impossible to get through life without it. When you enter any workplace or team situation, without a doubt, the biggest satisfier to anyone asked is “excellent communication” and the biggest dis-satisfier is “lack of- or poor communication.” How can something so simple be so difficult?
All we do in emergency medicine is- Talk. All. Day. Everyday. We talk to our patients, we call lab to see where our blood results are, we talk to paramedics on the telemetry radio, we talk to each other about who is getting food and can they grab you something because you are going to pass out and cannot stand to eat yet another hospital-supplied turkey sandwich. Just as anyone who has ever been in a relationship with another human being of any kind will tell you- it is tricky. It is all about WHAT you say, HOW you say it, WHEN you say it, WHO you say it to and HOW MANY TIMES you repeat yourself. On the flip side, there is the mystery of the message received which has a great chance of being very different than the intended message, so what is a doctor to do? First and foremost, open your mouth and actually TALK TO THE NURSES FACE!! A note in the computer or the hope that they are all mind readers will not suffice. You need to build professional rapport and trust.
Start with the basics. “Hello. How are you? I am Liz, I am one of the new emergency medicine interns.”
You want the nurses to know that you are their project ASAP. We won’t put a ton of effort into a rotating resident- what is the point? But if you are ours, you better believe that we have opinions about what you are doing and how you are doing it. Asking for simple feedback or advice is almost never unwelcomed unless you pick the time we are about to push the shock button during an unstable cardioversion.
A greeting goes a long way- every day. Don’t be that guy who is so socially awkward that he can only talk in "medicalese" or get right to what you need done. On the flip side, we are busy, so get to the point! A simple “Hey Liz, how are you? How was your weekend?” will suffice. You have then done some work to strengthen a human bond to one of your 4 year co-workers. Do that every day and you are off to a great start.
There are worse things that being nice. You know who nurses hate? Pompous, arrogant interns who think they know everything. They love to see them crash and burn as long as it doesn’t affect the care of their patients. You know who they try to help? Nice people who are really making a solid effort. Be the nice person who is making the solid effort. How do you do that? Well, we have the greeting thing down pat, you could also throw in some kindergarten manners of please and thank you and now we are really getting somewhere! “Could you please give that patient in room #13 40mg of IV Lasix- I am putting the order in now” or “thanks for letting me know about that guys blood pressure- I had no idea he was starting to go south in there.”
Don’t suffer on the inside. But for God’s sake, don’t suffer on the outside either. There WILL be a time in your intern year and probably every other year in your residency that you are drowning. You have so many things to do and everything is taking longer than you thought it would and 40 different people are asking you to do 60 different things and a level 1 trauma just rolled in. UGH!!! Let your nurses know this in a calm, succinct way- “Liz, I am drowning right now and I don’t think I can get that guy’s paperwork together anytime soon.” That sets our expectations and you better believe we have other ways to get things done than to ask our interns- no offense. Otherwise we are going to be waiting around wondering why on God’s green earth it takes you 90 minutes to write up a non-complicated hand lacerations discharge instructions who is chomping at the bit to get out of our department.
On the flip side, as the mother of 2 small boys, let me be the first to tell you that nobody likes a whiner. We are all busy and we don’t want to hear all your groaning about how you are busier than anyone else. That is what your significant others, pets and the local pub are for after work. Get it together, take a deep breath, put one foot in front of the other and let us know how we can help. We don’t bite, I promise.
Welcome. Do your share, be nice and don’t be above the bedpan. We are all in the trenches together which is way better than being alone.
Elizabeth Even, MSN, RN, CEN
Manager; Emergency Department
Northwestern Memorial Hospital
Further Readings
- Abourbih D, Armstrong S, Nixon K, Ackery AD. Communication between nurses and physicians: strategies to surviving in the emergency department trenches. Emergency Medicine Australasia. 2015 27(80-82).
- Creswick N, Westbrook JI, Braithwaite J. Understanding Communication Networks in the Emergency Department. BMC Health Services Research. 2009 9:247.
- Garmel GM 2013. Conflict Resolution in Emergency Medicine In JG Adams (Ed.), Emergency Medicine Clinical Essentials (pp2171-2185). Philadelphia, Pennsylvania: Saunders.
- Pun JK, Mattheissen CM, Murray KA, Slade D. Factors affecting communication in emergency departments: doctors and nurses’ perceptions of communication in a trilingual ED in Hong Kong. Int J Emerg Med. 2015 8(1)48.
- Spencer R, Logan P, Coiera E. Supporting Communication in the emergency department. University of New South Wales, Sydney, Australia; 2002.