Charge Nurse Series Part 3 - How to Communicate Effectively

By Rose O. Sherman, EdD, RN, FAAN

“Seek first to understand, then to be understood.” Stephen Covey

Several years ago, I was involved in a series of 10 charge nurse workshops conducted by a large health system. As part of these workshops, we surveyed the 350 charge nurses who attended about their thoughts about their role challenges and qualities important to doing the job well. Not surprisingly, good communication abilities was ranked as the number one quality needed by these nurses working at the front-line of nursing leadership. Participants noted that communication is challenging in today’s environment with both the diversity in the workforce, and the culturally diverse patient populations served by their hospitals. Good communication was viewed as being critical to patient safety.

Good Communication Matters

Poor communication is the primary root cause of most sentinel events and medical errors. The charge nurse role has been compared to an air traffic controller, because you are at the center of communication flow on your unit. As a charge nurse, you are seen as the pivotal point person, or ‘go to’ person. You must master the art of assertive and persuasive communication, as well as develop negotiation and listening skills. Conversations may be initiated by staff, patients, families, physicians, hospital leadership, or by the charge nurse. Information is gathered and processed. Communication outcomes often result in changes in patient treatments plans, transfers to other levels of care, or in facilitating interdisciplinary communication with physicians or other departments.

Your success in charge nurse’s communication efforts is often reflected in staff, patient, and physician satisfaction scores. They are frequently the first stop for any complaint. Charge nurses must also be familiar with the unique communication issues, styles, and preferences related to gender, generation, and cultural dynamics. Additionally, charge nurses must overcome the many distractions which create barriers to communication that prevent them from advocating effectively on behalf of the patients and staff.

Useful Tools

It can be extremely difficult to effectively communicate in complex healthcare environments where many team members are working with the patient. Fortunately, there are good tools available to help you communicate more effectively, and even more important to make certain the the communication is understood. Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based communication model that has been developed for use in clinical practice with funding from the Agency for Healthcare Research and Quality. Tools in the model include the Two-Challenge Rule, Call-Outs, and Check-Backs.

Two-Challenge Rule requires the communicator to voice their concern at least twice to receive acknowledgment by the receiver. This rule may be invoked when a member of the healthcare team suggests or performs an intervention that deviates from the standard of care. The charge nurse would assertively voice their concern at least two times and if the team member who is being challenged does not acknowledge this concern, the charge nurse would then take a stronger action or utilize the hospital chain of command as needed.

Call-Outs are a strategy that the charge nurse can use to inform all team members of crucial information during emergencies to assist team members in anticipating what comes next. For instance, during a stroke alert, the results of the patient’s NIH scale and the need to transport the patient as rapidly as possible for a CT scan may be communicated out loud to the rest of the team.

Check-Back’s require the sender of the communication to verify the information that is being received by the other team member, or to use closed-loop communication. For example, the charge nurse is often responsible for verifying that telephone order read backs are performed according to policy.

Some communication takes place during times of escalating stress, such as in a rapid response event. Here effective and efficient communication is crucial for successful patient outcomes. As charge nurse, you can model and demonstrate evidenced based practice by utilizing recognized communication tools such as SBAR (Situation-Background-Assessment-Recommendation).

If the team is communicating well, then responses to patient needs will be quicker and deaths due to ‘failure to rescue’ will be avoided. Charge nurse handoffs to one another are also critically important so that continuity of care is maintained for the patient. Jean Flynn and her colleagues at New York Presbyterian Hospital/Weill Cornell Medical Center developed a very useful charge nurse handoff report guide published in 2010 by the American Journal of Nursing. Charge Nurse Hand off Report

Staff nurses must be able to trust in the charge nurses ability to assist them to respond to a sudden change in a patient’s condition. Skilled communication at the unit level is viewed as one measure to balance a culture of safety with the workforce challenges that exist in the current healthcare environment. When there are communication difficulties at the unit level, it can lead to the development of conflict between one or more team members.

The next blog in the charge nurse series focuses on managing conflict. Your comments are important so please share your ideas about communication.

Read to Lead

Agency for Healthcare Research and Quality. (b). TeamSTEPPS. Team STEPPS Website

Flynn, J.P., Prufeta, P. & Minghillo-Lipari, L. (2010). An evidence-based approach to taking charge. American Journal of Nursing, (9) 110, 58-63.

Sherman, R.O. & Eggenberger, T. (2009). Taking Charge: What Every Charge Nurse Needs to Know Nurses First, 2(4), 6-10.