Communication Skills For Nurses: Building Trust Without Losing Time

You are moving fast, you have a list, and somewhere in the rush, the people in front of you can start to look like tasks. It happens under pressure, and it happens to good nurses. 

We have spent more than 20 years training student nurses and nurses in the field, and we want to clearly state an evidence-based fact: communication is a primary clinical component of nursing.

Nursing care is accomplished through communication. Self-awareness about your own communication and expectations of others is where communication training begins. Rapport and listening are lifelong labors that we all can improve upon, and through these communicative acts, trust is built with patients and their families.

What follows are a few communication competencies that professional nursing expects of you, and the actions you can take to improve nursing care at the bedside.¹

Recognize the whole person

A nurse walks into an exam room for a medication consult and finds the patient, an older adult, nervously flipping through a folder of papers. This patient describes their need to have a prescription reissued from the provider, and so the goal of the meeting is clear: assess the prescription, possibly revise it. But the first thing that needs to happen is not task-based but relationship-based.

Acknowledging the anxious and busy state of the patient recognizes the whole person, the person who lives outside of the clinic setting. This is a small but significant act of perspective-taking. Acknowledging that this patient is managing a lot today invites their whole person's perspective into the room.

Relationship-centered care comes down to three moves:

• Attend to the whole person, not just the task-based patient needs 

• Acknowledge what you observe and hear from the patient

• Maintain a supportive atmosphere by staying open and receptive to the patient’s experience

Differences and dilemmas

A difference of choice or opinion is not the same thing as an ethical dilemma. Think about your favorite ice cream. If the person next to you prefers a different flavor, that is a difference, and it carries no dilemma. Not even close.

Patients have preferences and beliefs about their own health, and you have the duty and the honor of making a way for them to choose their own path of care, even when it is not the path you would choose. Supporting that choice through ongoing communication is competent nursing.

An ethical dilemma unfolds when every action available to you seems to violate a duty you hold. What if a patient with diabetes refuses insulin? Now you are holding the patient's right to autonomously decide against your duty to protect their well-being, and there is no clear next step.

These situations are steeped in stress and anxiety, and they cultivate moral distress for nurses. The core ethical principles of nursing, autonomy, beneficence, justice, and non-maleficence, can get pulled in different directions at the same time.

A code of ethics for communication will give you structure amid an ethical dilemma:

• Invest in understanding the other person.

• Show attention and presence.

• Avoid interrupting.

• Ask for help when you need it.

• Focus on the issue at the center of the dilemma.

• Recognize feelings.

Difficult conversations for nurses and patients/families 

Conversations are difficult for nurses because the topic might be emotionally charged or involve a life-changing health situation. If a patient or family member is angry or shuts down the conversation, this can be very stressful for a nurse. When that happens, rather than saying to yourself, "This patient/family member is difficult," ask, “What is difficult for this patient/family member?”

Commonly, patients and families experience uncertainty, fear, exhaustion, grief, and anxiety. Often, they need information and time to be resilient, and in moments of life-changing news, no one is at their best.

We share two communication tips to carry you through the difficult communication moments:

1. Share medical information as you are able, so the patient and family have what they need to make decisions.

2. Express goodwill and presence so they know you are in it with them.

Picture a young man in the clinic with a painless, round chancre near his mouth and swollen lymph nodes in his neck. He tests positive for syphilis; you recommend testing for HIV, and he starts crying and shaking. He needs accurate information to decide what comes next, and he needs to know his nurse is present with him and wants the best outcome for him.

Nurses often tell us they want to feel more prepared for precisely these conversations—the ones that come right after life-changing news.

Communication and Telehealth

If you had the choice between making a phone call and sending a text, plenty of us would pick the text every time. Many of you are digital natives. The comfort of digital or video interaction is greater than face-to-face interaction for many people. But the opposite is also true—so many of us find greater ease with face-to-face interaction.

Nursing and other healthcare disciplines are shifting more and more into digital modalities for care delivery: Video visits, secure messaging, tele-monitoring, and plain text are common. Without self-awareness and preparation, many of these modalities can strip out the tone and expression we rely on to be understood.

Whatever the platform, digital empathy should be the focus, bringing compassion, respect, kindness, and thoughtfulness into interactions that a screen or text may otherwise flatten.

A short acronym, TECH, keeps it practical:

• Tone. Slow down, enunciate, and let your voice carry emphasis, especially when the other person cannot see you.

• Eyes. Move your gaze between the screen, the patient, and your records instead of locking onto the chart or a form to populate as you interview the patient.

• Context. Show up on camera as you would in the office: well-lit, private, and free of clutter behind you.

• Hand. Offer your “hand” virtually when you cannot offer it in person; something as ordinary as "thanks for trusting me" or “let’s get you feeling better” expresses goodwill and relationship.

The TECH acronym emphasizes a connection that has to be purposeful in virtual care platforms. Nurses have the most contact with patients, which means they are often the ones who innovate ways in which these technologies can cultivate person-centered care.

Health literacy is created together

Picture a pet owner in an emergency vet visit, their dog suddenly refusing food, the owner panicking and barely able to take in a word the vet says, let alone decide on treatment. At this moment, it doesn’t matter that the pet owner holds a PhD in biological science. When people are frightened and information is new, retaining it or deciding among options is especially challenging and has little to do with educational background or demographics. 

Health literacy is not something a patient simply has or lacks. It depends on the communication of everyone in the interaction, and meaning gets built together.

Using plain language is how you can support health literacy with patients and families. Plain language does not omit or “dumb down” information. Rather, plain language offers a responsive approach to connecting with others about health information and management.

Here are some pro tips for using plain language at work: 

• Explain your technical terms.

• Give the main point first, then the details.

• Make room for silence.

• Speak in an active voice (active: "when you take the first dose" vs. passive: "when the first dose is taken"). 

• Use the patient's name.

• Keep sentences short.

• Repeat main points.

Cultural knowledge is a big part of health literacy. The healthcare world has its own culture. And a patient entering that world is immediately in an unfamiliar place with lots of unfamiliar information.

Speaking of culture, you will never master another person's culture, and quality care rather than mastery should be your goal when it comes to all people in your care. The priority is to know that culture shapes what any patient believes, fears, and chooses, and part of your work is learning about a patient’s beliefs and choices.

Self-care for nurses

The nursing profession loses many nurses in their first five years to burnout and exhaustion. Caring for yourself must be a priority.

Communication and self-awareness are powerful ways to take care of yourself and your work as a nurse. Your own communication is where emotional intelligence starts, and it consists of three parts:

• Self-awareness: knowing your own emotions and how they impact others.

• Social skills: reading and responding to what other people are experiencing.

• Self-regulation: holding your composure and staying solution-focused when a situation heats up.

Three practices that will help you care for your own heart and mind in the profession rely on your communication with others: 

• Show and tell. Show up for yourself, and tell safe others how you actually feel.

• Turn to the team. Prioritize, share the load, and lean on colleagues when stress and fatigue build.

• Read the room. Notice the emotional temperature and adjust.

If you find yourself isolating, avoiding certain spaces at work, or fixating on what you got wrong, that is the moment to turn to trusted colleagues and friends and share how you feel. 

More resources for you

Communication Essentials for Nursing includes core basics for nurse-patient communication as well as corresponding and easy-to-glance-at infographics.

Check out our brief modules for working with other colleagues through conflict: 

• Professional Communication: Constructive Conflict With Coworkers

• Professional Communication: Strategies for Working With Difficult Coworkers

• Professional Communication: Ethical Communication and a Culture of Safety

For hospice and family caregiver interactions:

• Essential Tools for Talking With Family Caregivers

• Deep Listening: Reflexive Skills for Working With Families

• Care Plans: Helping Family Understand Decline in a Patient

• Strategies for Navigating Conflict With Family

• Optimizing Communication to Reduce Family Grief

And for dementia care communication with patients and families:

• Caregiver Communication: Orienting Family to Dementia Caregiving

• Caregiver Communication: Talking About Dementia With Patients and Families

• Caregiver Communication: Starting the Conversation About Hospice and Dementia

Whatever your care context, communication is likely the most significant part of the work you will do with colleagues, patients, and families. It is a teachable skill that can improve, and it begins with your own self-awareness.  

References

1. American Association of Colleges of Nursing. The Essentials: Core Competencies for Professional Nursing Education, Competency 2.2.