Running head: Successful Communication

Successful Communication within the Hospital

Lydia G. Kelley
University of Kentucky

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Abstract

A nurse has a position that consists of varying power positions on a daily basis in a
hospital. When communicating with doctors, nurses are in a clear subordinate position and must
adjust their communication styles to accommodate that. When nurses talk to other nurses they
are have the same power, which requires a different communication style. When caring for
patients, a nurse is in a more controlling position and has to use a more powerful type of
communication to make sure the patient feels comfortable in his or her surroundings. Adjusting
to all of these communication differences make a nurses job successful.

Keywords: success, communication, nurses

Successful Communication

Successful Communication within the Hospital

There are a total of 2,724,570 registered nurses in the United States today. Each has been
exposed to a hospital setting and has used different kinds of communication to make them
successful in their jobs. A nurses ability to communicate with doctors, other nurses, and patients
is a critical part of a nurses career. In each of these situations, a nurse takes on a different power
position and must adjust accordingly, and it is vital for a nurse to make these adjustments in
order to communicate effectively. Poor communication can increase the risk for medical errors.
These errors could cause severe injury or even patient death. Medical errors, especially those
caused by poor communication, are a common problem in health care organizations.
Anyone who has been to a doctors office or a hospital knows
that the doctor has a more superior job than the nurses. Doctors are the
superiors and nurses are the subordinates, even if the nurses do not
directly report to the doctors. Doctors are responsible for diagnosing
the patient and prescribing the correct medication, causing a hierarchy
because the position of the doctor is greater to the patient. Therefore,
this hierarchy of power affects the way nurses must communicate with
doctors. In addition, there is often a power struggle for the
nurses. The stereotypical doctor and nurse are a male and a

I. Male doctor thinking he is better

than a female nurse.

female, which can occasionally be an issue. I read an article online called, Nurse/Physician
relationships improving or not? that states that when female nurses are working with male
physicians the male physicians feel like they have all the power, and the nurses opinion does not
matter. However, male nurses have reported that physicians treat them more respectfully and

Successful Communication

with greater power. This direct quote from the article indicates that occasionally male
physicians believe they have more power over female nurses. While quality between men and
women are getting better, there is still a long way to go, especially in medical settings. A nurse
must work within this environment and still communicate all vital patient information to the
doctor. It is sometimes necessary for a nurse to simply ignore feelings of inferiority and realize
that the information is important for patient care. In the picture on the side is a doctor saying,
How could I be wrong? Im a doctor. He is saying this to a female nurse, which indicates the
point that male doctors sometimes have the power go straight to their head.
Putting their power differences aside, nurses and doctors have to work together to make
sure the patient is getting the best care possible and having a good experience at the hospital.
Having a low context communication relationship is often a good method to overcome the power
difference. Having a low context culture means that the doctors use very specific words with
every conversation they have about a patient with the nurse. Even though the doctor has more
authority than the nurse, he or she depends on information that only the nurse can provide and
therefore must listen to and respect what he or she says. This can be seen anytime a person goes
to the doctor and sees the doctor and nurse working together. Usually, the nurse will start off the
appointment by taking the weight, height, asking about the symptoms the patient is having and
running simple tests. In the meantime, the nurse is plugging all this data into a computer for the
doctor to look at. The nurse has to make sure that they put every detail into the computer so the
doctor can correctly diagnose and prescribe the correct dosage of medications to the patient. If
this was not the case and nurses did not get every detail they have to the doctor, then the patient
can be misdiagnosed. That would defeat the entire purpose of the main goal that doctors and
nurses work towards. All in all, while the doctors might be in a superior position of power, they

Successful Communication

still depend on nurses in order to provide the best care for the patient. It is often the nurses
responsibility to deliver this information in a clear concise manner. However, nurses always
need to keep in mind that the doctor does have the final say and does have more medical
knowledge.
Therefore, there is a delicate balance between whose information is more important and
how that information is communicated. To maintain their common goal nurse and doctors have
to have a collectivist culture. A collectivist culture is when the employees of the hospital put
away their differences and individual goals in order to reach one shared goal, making sure the
patient receives the best care possible. The challenge, then, is to make the most of all
interactions in order to utilize the best knowledge and abilities of all health team members and
produce positive patient outcomes. This quote was taken from an article online called The
Online Journal of the Issues of Nursing. The quote explains how a collectivist culture
overcomes feelings of inferiority or superiority. It is key for doctors and nurses to remember that
patient care is their only goal and to accomplish that they must communicate within an
atmosphere where there is a difference in power.
Another key component is communication between nurses. Nurses are people who have
dedicated their life to helping other people. Unlike the communication between doctors and
nurses, when nurses communicate with each other they often have the same authority and are on
the same power level. They have to deal with the same issues and need to know how to
communicate with their peers correctly, as they have the same job and the same amount of
power. One key communication between nurses happens when the nurse is handing off a patient
at the end of shift to another nurse. In this situation the nurse that is leaving has taken care of the
patient all day can be tired and eager to leave, but he/she still has to be concise and give every

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detail of the patient to the next nurse. The nurse leaving should make sure that the nurse taking
over feels 100 percent comfortable with taking care of the patient. In the book I read called, The
Making of a Nurse, by Tilda Shalof the main character Tilda worked for 30 years in the ICU
treating for patients. After every shift Tilda had to give every detail possible to the nurse coming
in. One time when Tilda was coming in to work the nurse before her told Tilda to give the patient
insulin but was not specific enough. When Tilda took over she accidently gave the patient too
much insulin too fast and the patient almost died. The communication in this situation is crucial
in order to make sure the patient is getting the best care possible. There is no hierarchy of power
in these situations, so both people have equal standing in the conversation. Again, patient care
must be the main priority so that the communication between these equals remains effective.
There have been at least 615 wrong-site surgeries reported to the Joint Commission
between 1995 and 2007. That not so small number was taken from an article written by Susan
V. White in a book called Patient Safety and Quality: An Evidence-Based Handbook for
Nurses. Obviously this is unacceptable, and simple communication could have prevented these
surgeries. Hospitals work very diligently to lower that number and make sure everyone has a
nice stay in the hospital without any mistakes made by staff. The number of errors could be
lowered if nurses took more time and effort to discuss details with the other nurse taking over.
Whether a nurse is leaving a shift or a patient is being transferred there is absolutely no
assuming. A nurse cannot assume that the other nurse knows a detail. Since neither nurse has
more power than the other, it is critical that communication remains concise and fact based. It
must include time for questions and both nurses should avoid editorial conversations or gossip.
Peer to peer communication can sometimes tend to be argumentative, as no one technically has
the final say. Therefore, those conversations must be avoided in shift change communications.

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Another instance when nurses communicate to other nurses is when they are switching a
patient to another unit. In this case, the nurses have different jobs but once again have equal
power. Over the summer I shadowed a nurse that worked in the delivery department and I
watched her transfer the moms that just gave birth from the room that she gave birth into the
recovery room. The nurse that I shadowed had the job of helping the doctor getting the baby out
safely. She weighed the newborn and made sure the baby was healthy. She also cared for the
mother and was there to fulfill any needs. Once everything calmed down the patient was moved
to a different part of the hospital where she would recover. When I followed everyone upstairs
there was a new room with nurse ready for the patient. The nurses had a detailed conversation
about the patient to make sure she was getting the best care. Again, this is peer-to-peer
communication, and while the nurse handing over the patient has more information, he or she
must remember that they are talking to a peer and should avoid trying to seem superior. It is
important to leave time for questions and to keep the communication open and equal. Every
little detail has to be shared because there is a great deal of room for mistakes with these
transfers.
In addition to switching shifts or patients, nurses do
not just communicate with other medical professionals. They
also communicate with patients. In these situations, the nurse
takes on a more powerful role. Because of medical
knowledge, the nurse is in a power position when
communicating with a patient. In an article I read it is
proven that patients like it better and feel more comfortable

ii. A nurse taking great care of her

patient

when their nurse introduces them to the new nurse that is taking over. This makes the patient

Successful Communication

feel that the nurses are in control of the situation and the care will be seamless. The nurses that
work within the delivery department in the hospital communicate with the patients in different
ways during their stay at the hospital. When the patient first gets to the hospital they are in labor
and in a tremendous amount of pain. The nurses job is to make sure that the patient feels
comfortable and remains calm during the whole process. The nurse does this by taking firm
control of the situation and letting the patient feel that everything will be taken care of. In these
situations, the nurse takes on an authority role while communicating with the patient. A patient
can feel overwhelmed or upset during their stay at the hospital and it is the nurses job to take
control in order to comfort and be there for the patient.
Doing research for this paper lead me to article called 3 Steps to Better Nurse-Patient
Communication. The three steps that are listed are, confirm feelings and thoughts, clarify
information, and collaborate to evaluate healing. If one of these steps is missing the nurse is not
doing their job the best that they can do. The first step, confirm, can be achieved by asking a
question such as, How are you feeling today or You seemed concerned about ___. Without
this step the nurse can seem like they do not care about the patient and not as willing to help the
patient. The next step, clarify, is used by the nurse to explain what is happening, why they are
receiving the treatment, and why they are sick. The last step, collaborate, is used by nurses when
they ask, What concerns do you have when youve left our care? or How can we do better.
This step indicates to the patient that the nurse is always willing to change to make sure the
patient is getting the best care. In all of these steps, the nurse is taking a lead and initiating the
communication. Unlike communication with doctors or other nurses, the nurse is in a position of
power when talking with a patient.

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In total, open and accurate communication is vital in healthcare situations. A nurse has a
unique position of being in varying power positions on a daily basis. When communicating with
doctors, they are in a clear subordinate position and must adjust their communication styles to
accommodate this. When speaking with other nurses, they are on equal ground with their peers
and therefore must use a variety of different communication styles. Finally, when caring for
patients, a nurse is in a position of power and must use that power to take control and make the
patient feel comforted and cared for.

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References
Drew Altman (2014). The Henry J Kaiser Family Foundation. Retrieved from
http://kff.org/other/state-indicator/total-registered-nurses/
Fast, Hershberger, Lopez-Cox, Nalbone, Navey-Davis, Sellnow &Verderber. (2014).
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Linda L Lindeke (2014). The Online Journals of Issues in Nursing.
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/
OJIN/TableofContents/Volume102005/No1Jan05/tpc26_416011.html
Margery Pabst (2013). 3 Steps to Better Nurse-Patient Communication
http://www.nursetogether.com/3-steps-to-better-nurse-patient-communicati
Theodora Sirota (2007). Nurse/Physican Relationships Improving or Not.
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Tilda Shalof (2007). Retrieved from The Making of a Nurse
T. London (2014). American Nursing Assosiation.
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Susan V. White (2007). Handoffs: Implications for Nurses.
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