Skillful communication.

This includes listening

to others, encouraging exchange of information,
and providing feedback:
1. Listening to others. Listening is separate from
talking with other people: listening emphasizes
that communication involves both giving and
receiving information. The only way to find
out people’s individual wants and needs is to
watch what they do and to listen to what they
say. It is amazing how often leaders fail simply
because they did not listen to what other
people were trying to tell them.
2. Encouraging exchange of information. Many
misunderstandings and mistakes occur because
people fail to share enough information with
each other. The leader’s role is to make sure
that the channels of communication remain
open and that people use them.
3. Providing feedback. Everyone needs some information about the
effectiveness of his or her
performance. Frequent feedback, both positive
and negative, is needed so people can continually improve their
performance. Some nurse
leaders find it difficult to give negative feedback
because they fear that they will upset the other
person. How else can the person know where
improvement is needed? Negative feedback can
be given in a manner that is neither hurtful nor
resented by the individual receiving it. In fact,
it is often appreciated. Other nurse leaders,
however, fail to give positive feedback, assuming that coworkers will
know when they are
doing a good job. This is also a mistake because
everyone appreciates positive feedback. In fact,
for some people, it is the most important
reward they get from their jobs.

■ Communicating a vision for the future. The

effective leader has a vision for the future.
Communicating this vision to the group and
involving everyone in working toward that
vision create the inspiration that keeps people
going when things become difficult. Even better,
involving people in creating the vision is not
only more satisfying for employees but also has
the potential for the most creative and innovative outcomes (Kerfott,
2000). It is this vision
that helps make work meaningful.

■ Developing oneself and others. Learning does

not end on leaving school. In fact, experienced
nurses say that school is just the beginning, that

chapter 1 | Leadership and Followership 11

school only prepares you to continue learning
throughout your career. As new and better ways
to care for clients are discovered, it is your
responsibility as a professional to critically
analyze these new approaches and decide
whether they would be better for your clients
than current approaches to care. Effective leaders not only continue to
learn but also encourage others to do the same. Sometimes, leaders
function as teachers. At other times, their role
is primarily to encourage and guide others
to seek more knowledge. Observant, reflective,
analytical practitioners know that learning
takes place every day if people are open to

Communication
People often assume that communication is
simply giving information to another person.
Communication involves the spoken word as well
as the nonverbal message, the emotional state of
people involved, and the cultural background that
affects their interpretation of the message
(Fontaine & Fletcher, 2002). Superficial listening
often results in misinterpretation of the message.
An individual’s attitude also influences what is
heard and how the message is interpreted

Principles for Effective

Communication
To communicate effectively with others, consider
the following principles (Table 6-1).
1. Be sure that the message is understood. Ask for
feedback from the receiver to clarify any confusion. Bring focus to the
interaction. Repeating key
words or phrases as questions or using open-ended
questions can accomplish this. For example: “You
have been telling me that Susan is not providing
safe care to her patients. Can you tell me specifically what you have
identified as unsafe care?”

2. Use direct and exact language. In both written

and spoken messages, use language that is easily
understood by all involved.
3. Encourage feedback. This is the best way to
help people understand each other and work
together better. Remember, though, that feedback may not be
complimentary. This is discussed later in the chapter.
4. Acknowledge the contributions of others.
Everyone wants to feel that he or she has worth.
5. Use the most direct channel of communication available. The greater
the number of individuals involved in filtering a message, the less
likely the message will be received correctly.
Just as in an old children’s game, messages
sent through a number of senders become
more and more distorted. Information that is
controversial or distressing should definitely
be delivered in person so that the receiver can
ask questions or receive further clarification. A
memo delivered “To all nursing staff ” in
which cutbacks in staffing are announced
would deliver a message very different from
that in a meeting in which staff are allowed
Barriers to Effective
Communication in the Workplace
People are often unwilling or unable to accept
responsibility or to perform a specific task because
they do not fully understand what is expected of
them. Professional nurses are required to communicate patient
information to other members of the
nursing team. Although this may sound easy, there
are many potential barriers to communication.
These barriers may be physical, psychological,
semantic, or even gender-related.
Physical Barriers
Physical barriers to communication include extraneous noise, too much
activity in the area where the
communication is taking place, and physical separation of the people
trying to engage in verbal
interaction.
Psychological Barriers
Psychological “noise,” such as increased anxiety, may
interfere with the ability to pay attention to the
other speaker. Social values, emotions, judgments,

and cultural influences also impede communication.

Previous life experiences and preconceived ideas
about other cultures also influence how people
communicate.
Semantic Barriers
Semantic refers to the meaning of words.
Sometimes, no matter how great the effort, the
message just does not get across. For example, words
such as neat, cool, and bad, may convey meanings
other than those intended. Many individuals have
learned English as a second language and therefore
understand only the literal meaning of certain
words. For example, to many people, cool means
interesting, unique, or clever (e.g., “This is a cool
way to find the vein.”). To someone for whom the
word cool refers only to temperature (e.g., “It is cool
outside.”), the preceding statement would make
very little sense.
Gender Barriers
Men and women develop dissimilar communication
skills and are inclined to communicate differently.
Often, they give different meanings to conveyed
information or feelings. This may be related to
psychosocial development. Boys learn to use communication as a way
to negotiate and to develop independence, whereas girls use
communication to confirm, minimize disparities, and create or
strengthen
closeness (Blais, Hayes, Kozier, & Erb, 2002)

Joint Statement: The Role of the Nurse Leader in Care Coordination

and Transition Management
across the Health Care Continuum
As health care’s rapid pace of change continues, it is imperative that
new models of care incorporate a broad
understanding of care coordination and transition management across
the continuum. Nurses are well
positioned to coordinate and deliver these services to patients.
Care coordination and transition management roles are needed to
support achievement of the Triple Aim:
improving quality of care to individuals, improving the health of
communities and simultaneously reducing
costs. Comprehensive strategies are needed to assure patients and
families experience seamless care
provided by interprofessional care teams across health care settings.
Strong leadership is needed to
strategically drive innovation and inspire transformative change in a
complex health care environment. The role
of the nurse leader is to advocate the value of nursing in care
coordination and transition management.
The American Organization of Nurse Executives and the American
Academy of Ambulatory Care Nursing
collaborated to outline how nurse leaders in inpatient and post-
acute/outpatient settings should approach their
roles to enhance development of care coordination and transition
management across the continuum of care.
Nurse leaders can activate interprofessional collaboration through
adoption and engagement in the following
strategies. These six principles provide a basis for establishing an
informed and collaborative care coordination
process that includes all staff, key stakeholders and nurse leaders
across the continuum of care.
1. Know how care is coordinated in your setting.
 Know your population. What are their needs, requirements and
resources?
 Identify, track and simulate the patient’s journey through the health
care system.
 Know and understand your current patient transition infrastructure
and how the team of
interprofessional leaders communicates.
2. Know who is providing care.
 Conduct an organizational assessment of individuals, specifically
nurses, providing care
coordination and transition management activities. What are their
roles, competencies, preparation
and training?
 Develop role definitions, including key job responsibilities, for each
member of the interprofessional
care team across the continuum of care that are evidenced-based and
organization appropriate.
3. Establish relationships with multiple entities and individuals who
can work together to improve
care coordination and transition management systems.
 Identify leaders across the continuum involved in or impacted by care
coordination activities and
create a shared vision.
July 2015 Page 2
 Convene an internal interprofessional stakeholder group of team
members involved with care
coordination across the continuum of care. Invite external
stakeholders to join the group based on
the needs of your particular hospital and post-acute care/outpatient
settings.
 Invite all stakeholders to provide input on aligning communication
and collaboration between
current resources to improve care coordination and transition
management.
4. Know the value of technology, its impact on workflow and the roles
of care coordination team
members.
 Assess the current state of technology as it impacts care coordination
and patient transitions of
care.
 Strategize and optimize potential technology, workflow and role
development to support seamless
care coordination for the future. Identify the gaps between the current
and desired future state.
 Work with information technology staff on data analytics to capture
outcomes and identify high risk
patients in need of care coordination and transition management.
5. Engage the patient and family.
 Determine how patients and families want to be involved in
coordination of their care. Utilize patient
engagement strategies to assess and activate patient and family
involvement in care.
 Ensure all staff members are competent in engaging the patient and
family in care coordination.
 Engage the patient and family in developing and understanding the
plan of care (i.e. who will deliver
the care, when and what is their role in the care process).
 Provide the patient and family with a point of contact (a specific
person or 24-hour support line) to
address needs.
 Develop workflows to include patients and families on advisory
boards, in survey development and
review of survey results, and shared decision-making for overall care
coordination process
improvement.
6. Engage all team members in care coordination.
 Select a nurse leader and a physician leader (e.g. CNO and CMO or
chief of staff) to co-lead care
coordination efforts.
 Identify physician partners to co-lead care coordination and
transition management strategies and
to influence staff physicians.
 Educate leaders and staff about the value of care coordination and
how it can achieve the health
care system’s goals of improving the patient experience, increase
patient engagement in selfmanagement and improve population
health.
July 2015 Page 3
About the American Organization of Nurse Executives (AONE)
AONE is the national professional organization for nurses who design,
facilitate and manage care. With more
than 9,000 members, AONE is the leading voice of nursing leadership in
health care. Since 1967, the
organization has provided leadership, professional development,
advocacy and research to advance nursing
practice and patient care, promote nursing leadership excellence and
shape public policy for health care.
AONE is a subsidiary of the American Hospital Association. For
additional information, visit the AONE website.
About American Academy of Ambulat
Essential Communication Skills for Nurse Administrators

The ability to communicate effectively is an essential skill for nurse

leaders. Good communication skills are associated with better patient
outcomes and higher employee satisfaction.

Communication Skills Essential for Successful Nurse Leadership

The development and nurturing of communication skills is a core part
of effective nursing leadership. Strong communication skills enable you
to interact more effectively with both colleagues and patients. In fact,
a 2014 study published by the National Institute of Health determined
that good communication is essential for achieving successful health
care outcomes. Skills such as public speaking, writing, presenting and
listening are important for a successful leader and help win trust from
patients, colleagues and staff.

Oral and Written Communication Skills for Nurse Leaders

As a nurse administrator, you are constantly interacting with patients,
colleagues and staff. You may have to deliver negative messages such
as staffing changes or more positive news like praise for great
performance. The nature of the message, the audience and result you
hope to achieve all influence whether it is best to communicate the
information orally or in writing.

Regardless of what you are communicating, written communication

should be clear, grammatically correct and incorporate terminology
your audience will understand.

When speaking, you should:

Enunciate clearly and speak slowly.

Avoid slang and jargon (unless appropriate for the audience).
Respond to others using mirroring language.
Be mindful of your facial expression and body language.
Whether writing or speaking, it is important to keep these tips in mind
to help you better manage nurses and patients alike.

Other Tips for Communicating with Staff

One-on-one (1:1) interactions are important in developing
interpersonal relationships. The best style of communication to adopt
in a 1:1 interaction is clear and direct. Say what you mean. For
example, “You seemed distressed earlier today.” The advantage to 1:1
interaction is that you can address sensitive issues inappropriate for a
group meeting.

1:1 meetings with staff are also an ideal time to discuss negative
feedback or when asking for honest information about issues of
concern to staff members. Most 1:1 interactions should be
confidential, however, a letter or email follow-up including others may
be appropriate if the situation warrants.
1:1 interactions with peers are useful for comparing information
among departments, improving relationships and addressing issues
that affect multiple teams. In peer-to-peer interactions, phone calls
and emails are useful but face-to-face meetings may be the most
effective way of addressing more complex issues.
Overall, 1:1 interactions are helpful in building relationships and
demonstrating respect for your staff members’ and coworkers’ privacy.

Equally important: Be receptive to staff input, both of the positive and

negative variety. Simple ways to demonstrate being receptive include:

Listen, nod and smile encouragingly, especially if employees seem

nervous or uncomfortable.
Avoid making promises; instead, reassure the employee that their
concerns are important and will be taken seriously.
Write down complaints and concerns; this demonstrates that you
intend to follow-up.
Listening Skills Needed to Be a Nurse Administrator
While it is important to be able to speak to colleagues and patients in a
straightforward manner, it is equally important, especially when
dealing with patients, to be a good listener. With that in mind, master
active listening skills and pass them on to your staff. Adopting
receptive body language conveys to patients that you are sincere and
willing to help. Reinforce this by practicing the following when others
speak:

Lean forward and nod your head.

Keep a relaxed posture; do not fold your arms.
Maintain eye contact.

Also, make sure your staff pays attention to a patient’s pitch and tone.
They may say, “Everything is fine,” or, “I understand,” but a dreary
pitch, a worried expression or folded arms and hunched shoulders
could indicate otherwise. It’s possible they may not understand what
was said or they have additional concerns that they are afraid to
address. It is your job to win their trust through body language, tone
and choice of words.

Employing good communication skills with patients can result in the

following outcomes:

More expedient recovery rates

Increased reports of feeling safe
Higher satisfaction with the quality of care
More likely to follow treatment plans
Developing your communication skills is key in preparing you to
manage fellow nurses and provide exceptional patient care. The ability
to listen and communicate effectively in both speech and writing tends
to make others think of you as trustworthy and enhances your ability
to motivate and lead. More importantly, good communication skills
lead to more positive patient outcomes, higher employee satisfaction
and better overall health care.