One of our colleagues, Gayle Burrow, commented last week that “Of the 5 Rights of Delegation the one that is most often missed is communication. Everyone gets busy during the shift and updating each other on the patients’ changes is left for the end of shift.” This is so true and the result often is an adverse event, compromised patient safety or decreased quality of care.
Detailed and timely communication between registered nurses and delegated personnel has been linked to improved patient outcomes and higher quality measures. Negative patient outcomes (i.e. medication errors, patient falls and failure to rescue) were linked to brief, non-specific or infrequent communication (Corazzini et al. 2013, Bittner & Gravlin 2009). In a review by the Joint Commission communication issues were the most common cause of deaths related to delays in treatment and the third highest root cause of all sentinel events (O’Keeffe & Saver 2013). Communication is the most influential of the five rights of delegation in shaping quality and patient safety outcomes (Anthony & Vidal 2010).
Characteristics of Information Communicated by Nurses
The type of information we communicate to other nurses and assistive personnel is complex and multifaceted. Some of this information is objective and discrete, like the results of recent blood work. It lends itself easily to written communication that can be easily retrieved from a chart or report. Other information is tacit or contextual and requires description or discussion; it is not so easily documented in a way that is meaningful to others. The value of a specific bit of information (a change in vital signs for example) decays over time. If information is not conveyed timely it may be too late to intervene proactively or it may be inaccurate because the patient’s condition has changed. When the meaning or importance of information can be interpreted in more than one way miscommunication can occur. For example, a nurse seeing patients during sick call says to an assistant, “Please get a blood sugar on this inmate.” The assistant, who does not know the patient’s condition the may interpret this request to mean right now or instead may schedule the inmate to return diabetic line which takes place in the next couple hours. Also each time information is handed off from one care provider to another some portion is lost, missing or forgotten. This can result in inadequate surveillance and failure to recognize a patient’s deteriorating condition (Anthony & Preuss 2002, Anthony & Vidal, 2010).
Standards of Professional Performance
The National Council of State Boards of Nursing (NCSBN) define the right communication as that which clearly and concisely describes the delegated task, how the task is to be done, the timing and nature of observations to be made (2005). According to the American Nurses Association (ANA), delegation communication should be respectful, timely and include a rationale that gives the task meaning. Good communicators demonstrate these behaviors:
- Assesses the effectiveness of their communication
- Actively works to improve communication skills
- Desires to improve interpersonal relationship
- Actions are consistent with words
- Clear about the role of self and others
- Candid, without partiality and unbiased (O’Keeffe & Saver 2013). These behaviors are included in the competencies for the standard on communication in the ANA’s Correctional Nursing: Scope and Standards of Professional Practice (2013).
Strategies, Tools and Techniques to Improve Communication
Various tools have been developed to support and improve communication in health care delivery. Among these are standardized communication formats such as SBAR and use of checklists which Lorry has written about on correctionalnurse.net. Use of these tools in combination with mindfulness have been shown to improve communication regarding patient care (O’Keeffe & Saver 2013). Mindful communication is characterized by authenticity, awareness, self-reflection and candidness. It involves more than just communicating the facts; it includes the rationale or how the facts pertain to the patient.When nursing personnel experience effective communication, the likelihood of sharing appropriate and timely information in the future increases (Anthony & Vidal 2010).
Clear, concise and complete communication is at the heart of delegation. The outcomes of improved communication are increased staff satisfaction and better clinical outcomes for patients. Some concrete communication suggestions are:
- Conscientiously appreciate that we need the help of others to deliver safe, high quality nursing care.
- Use kind words such as “please”, “thank you” and “good job”.
- Be approachable and make eye contact; be aware of your body language and facial expressions.
- Teach and don’t blame; give constructive feedback.
- Speak the truth but speak it gently.
- Identify checkpoints for communication that can occur throughout the shift.
- Listen without interruption.
- Allow time for the other to respond, ask questions or clarify (Ray & Overman 2014).
Do you have an example of an effort to improve communication among health care providers that contributed to better patient care outcomes? Let us know about the techniques or strategies you have used to improve communication when delegating care by responding in the comments section of this post.
For more on nursing delegation read Chapter 17 in the Essentials of Correctional Nursing. Order your copy directly from the publisher. Use promotional code AF1402 for $15 off and free shipping.
American Nurses Association. (2013) Correctional Nursing: Scope and Standards of Professional Practice. American Nurses Association. Silver Spring, Maryland: Nursingbooks.org.
Anthony, M.K. & Vidal, K. (2010) Mindful communication: a novel approach to improving delegation and increasing patient safety. Online Journal of Issues in Nursing. 15 (2) 2.
Anthony, M.K. & Preuss, G. (2002) Models of care: the influence of nurse communication on patient safety. Nursing Economic$. 20 (5): 209-215, 248.
Bittner, N.P. & Gravlin, G. (2009) Critical thinking, delegation, and missed care in nursing practice. Journal of Nursing Administration 39 (3): 142146.
Corazzini, K.N.; Anderson, R.A.; Mueller, C.; Hunt-McKinney, S.; Day, L.; Porter, K. (2013). Understanding RN and LPN Patterns of Practice in Nursing Homes. Journal of Nursing Regulation. 4(1); 14-18.
National Council of State Boards of Nursing. (2005). Working with others: a position paper. Accessed 2/11/2014 at https://www.ncsbn.org/Working_with_Others.pdf
O’Keeffe, M. & Saver, C. (2013) Communication, Collaboration, and You. American Nurses Association. Silver Spring, Maryland: Nursingbooks.org.
Ray, J.D. & Overman, A.S. (2014). Hard facts about soft skills. The American Journal of Nursing. 114 (2): 64-68.
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