I was spoiled with several plane trips in the month of April, which I always enjoy because it allows me some reading time. My recent trip to Boston and its subsequent layovers allowed me time to read ANA’s American Nurse Today and The American Nurse, and ONS’s Clinical Journal of Oncology Nursing (CJON). CJON had a great article, "Oncology Nurse Communication Barriers to Patient-Centered Care," by Drs. Wittenberg-Lyles, Goldsmith, and Ferrell.
I know communication is not really a hot topic. It's not quite as exciting as oncologic emergencies or new treatment modalities resulting from recent clinical trials, but every nurse could learn a great deal from this article. The authors interviewed several nurse managers who identified significant barriers to effective communication on their respective nursing units. Some of the barriers identified were lack of consistency in communication from healthcare staff, lack of time to piece together the plan of care, assumptions of physicians that RNs “should be able to do everything,” including speaking to patients about important issues such as end of life and issues with nurse-physician communication.
I began to reflect on my own communication problems in the various nursing positions I’ve had. One unit had patient education literature that helped with consistency; however, the assumption existed that you could teach the patient as long as you had the specific paper. Only recently was an ongoing education log implemented for each patient. And even then, if the log was not initiated, it often was not completed. And if it was completed, sometimes it was hard to find it. And as I filled it out, I always wondered, did anyone actually read this? The plan of care was typically communicated during morning rounds, which each nurse was strongly encouraged to attend. However, morning rounds always occurred during 8 am medications, morning routines, and other times when patient care was definitely the priority. Plus, how could you participate in rounds if you had not laid eyes on the patient or assessed them yet?
I also felt like I could relate to the physician-specific barriers. Some attending physicians who are extremely skilled and experienced assume that the nurse is comfortable talking to patients about big-picture things like the direction of care and advanced directives. Some residents are more uncomfortable than you, so they depend on your nurse-patient relationship to have these discussions. And of course, I saved the best for last—problems with nurse-physician communication. If we cannot communicate effectively with the physician, how can we expect our patients to know what is going on?
The article stated that nurses who participated in a communication skills training highly recommended such training to other nurses. I have never taken a designated communication course, but I am confident that we all need a little communication skills sharpening every once in a while. Improving our communication skills will benefit our work environments, our colleagues, and most of all, the patients.