Chapter 11: Professionalism
Anita Hedlund
Communication Related to Safe Patient Care
In relation to professionalism, clear communication is one of the most important aspects of being a professional. Most errors in healthcare can be attributed to a breakdown in communication. Inadequate or wrong information about something or someone can lead to severe mistakes that not only can cause harm to patients or workers, but could have legal and financial repercussions for the organization. Something as simple as properly labeling a container can be critical in protecting someone from a chemical burn.
According to Julia Riley (2023) “building positive coworker relationships, teamwork, and collaboration supports clear communication, which has a direct effect on patient safety” (p. 6).
When urgent or emergent care is being provided and there are many people in a room attending to a patient, it can be loud and chaotic but people need to hear and acknowledge what they are tasked with. For example, a provider may call out “give the patient 1 milligram of medication!” Someone on the team needs to make eye contact with the provider and say “I am getting the medication” so the whole team is aware of the request and the response, two people are not doing the same thing which would be inefficient, and the message is not lost.
Delegation is often used in healthcare. A nurse may ask the nursing assistant to check a patient’s blood pressure. The nursing assistant should then employ closed-loop communication and check back with the nurse to report either what the numbers were, or that they were unable to complete the task and why. This way the nurse is not left wondering how the patient is doing or if a concern needs to be addressed. Verifying what was asked of you, especially if anything is unclear, is so important.
When communicating with patients, family and visitors as well as other employees, be aware if they have deficits in hearing, vision, or English language skills. Find an appropriate communication method such as using a louder volume with your voice, large print written material, or a language interpreter. Keep everyone informed as to choices and next steps. “After the doctor sees you, you will go to the lab for a blood draw.” It helps reduce anxiety when people know what to expect. This builds trust with patients as they can see the healthcare workers are reliable and consistent in providing information.
It is also important to ask for help when you need it. Letting a supervisor know when a patient is not doing well, the clinic waiting room is backed up, a team member is out ill, or the amount of work is overwhelming and cannot be completed in the expected timeframe are all key to safe management of the workflow and meeting care needs.
When there is a serious event or error, it is important to have a debrief afterward. The team involved comes together to review a factual synopsis of events, what went well, and what could be improved if the scenario were to arise again in the future. Were there any safety concerns that needed to be addressed? Was there an error or problem with some system that needs fixing? This leads to improvement in quality of care. An example is a “Code Blue” (cardiac arrest). A whole team made up of different roles is set up to respond and each member has specific duties planned ahead of time. A physician is the team leader, a respiratory therapist will help with breathing, a pharmacist gives advice on medications and nurses administer them. Nursing assistants or technicians may be helping with chest compressions. A recorder creates a log of each event such as when medication was given, when a defibrillator was used, and so on. Even if everything went well and the patient is revived, it is best practice to review the event. How long did the team take to arrive? Were there any communication issues during the event? Did each person perform as expected? Do team members need support regarding emotions around the event or the intensity of it?
Dealing With and Resolving Conflict
The most challenging aspect of communication for most people is dealing with conflict. What if someone yells at you or corrects you in front of others and you are embarrassed? What if you and another team member disagree about how something should be handled? What should you do if you see another person behaving or speaking inappropriately?
The key is to speak up when things are not right, and to set clear expectations and boundaries. Remain calm. If someone else has heightened emotions, this may trigger an emotional response in you as well. Be mindful of your actions and the impact they may have, and take some deep breaths before responding. If you use an angry tone, raise your voice, or use body language like crossing your arms, this may feed into and escalate the other person’s unwanted behavior or words. Try to set feelings aside, focus on problem solving, and invite cooperation (Riley, 2023).
Being assertive (as opposed to passive or aggressive) can be challenging, but with practice can help you in both personal and professional communication. To be assertive means to consider your own needs and boundaries, to be confident that you deserve and have the right to ask for things or express your opinions without guilt or fear, and that you are also respectful and cause no harm to the other party. Riley (2023) defined assertive communication as “positive, caring, nonjudgmental, clear, and direct without threatening or attacking” (p. 6). Politely but firmly stating your position can help you. For example, your supervisor asks you to stay over your shift due to short staffing for the 4th time in a week. An assertive response would be “I am not sure you are aware but this would be the 4th time I stay over this week. I need to see my family and I am unable to help out this time.” This seems fair as you have already contributed quite a bit to unit staffing the past 3 times you stayed over. You are not unwilling to pitch in, but you need a break for self care. Also, exhausted employees are not able to provide the safest care.
A Note on Confrontation
Bower and Bower (2004), as cited in Riley, 2023, created a model for dealing with confrontation made up of the letters CARE:
(C) Clarify
Clarify what language or behavior is problematic? Be sure to specifically address the behavior, not the person.
Instead of the accusatory statement “you always forget to lock the office door,” which will put the other person on the defensive, try “when the door is left unlocked I worry that our computers and belongings may be stolen.”
(A) Articulate
Explain clearly what the consequence of the behavior or language is. How does it impact others or make them feel?
“When you take 15 minutes of our 1 hour meeting to talk only about your project, it makes me feel like you don’t value what the rest of the team has to say.”
(R) Request a Change
Give the person a respectful suggestion of how to improve the behavior.
In the example about the meeting, the request could be “we have 6 members on our team, what if we each got 5 minutes to bring up our questions and concerns, and the rest of the time could be for brainstorming as a group?”
(E) Encourage Change
Encourage change by explaining what the benefit of a new behavior or way of interacting will be, or what the negative effect of not changing would be.
“I think with the new plan for our meetings we could be efficient and make some real progress toward our goals and deadlines.”
Navigating Emotions
The other challenge in professional life is dealing with emotion. It is best to keep conversations as factual as possible. If you are upset about something, take some time to process the event or dialogue. If possible, go for a walk or at least take some deep breaths. Healthcare is stressful, be aware that another worker or patient may be hungry, fatigued, or not their best self in the moment. Be patient with your teammates. However, if there is repeated disruptive behavior, being assertive and advocating for yourself or a patient can be intimidating, but necessary. If you need to follow up with someone and let them know their behavior or words were unacceptable, suggest a place where you can talk in private. If the parties who need to resolve an issue have a high level of emotions that are interfering with communicating professionally, a third party such as a human resources representative may be needed as a mediator.
Skill Stitch: Communicating Professionally
Role play a scenario with both positive and negative outcomes.
Scenario: Eric is a new nurse and is working night shift. He is struggling with time management and at the end of the shift all he can think about is how behind he is and how much documentation he still needs to do, before he can get home to bed. Janet receives a report from Eric. Later, she complains to her coworker Tran that Eric always leaves his rooms a mess and it is so difficult to take over his patients as she has to clean up first. She is thinking of going to the manager about it.
Tran could take one of two options. The first is to contribute to the conversation with Janet, saying “yeah, Eric is an inconsiderate jerk. I guess he went to a bad nursing school. I hate having to train new people, they just don’t get it. Did you hear that the other new nurse Marta was flirting with Dr. Sams?”
Questions: Does Tran’s response do anything to help the team or workplace culture? How does gossiping at the desk reflect on Janet and Tran as professionals, especially if others overhear them? What could Tran do differently to encourage Janet to problem solve?
Instead of adding to the tension between Janet and Eric, Tran listens quietly, then points out to Janet that Eric is new and may be feeling pretty stressed. “Janet, have you thought about taking Eric aside privately and pointing out how the messy rooms affect you? I was taught that the best way to handle things is ‘send the mail to the right address’, in other words take it up with the person that is creating the problem. They may not even be aware it is an issue. It is not really fair to go over his head to the manager when you have not even talked to him about it.” Janet is surprised, but after thinking about this fair approach she agrees that she will catch Eric for a quick chat next time he works.
Create a script for Janet’s respectful and understanding conversation with Eric and how he might respond professionally.
Attributions
- Figure 11.3: image released under the Pexels License
- Figure 11.4: image released under the Pexels License
A communication process that involves the sender actively seeking feedback from the receiver to ensure accurate message transmission and comprehension.