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Effective Communication: Get the Nursing Team on the Right Track

Effective Communication: Get the Nursing Team on the Right Track

Establishing strong, open communication in the nursing department has always been a challenge, says Suzy Harvey, RN-BC, RAC-CT, director of clinical specialty services for Foster Senior Living in Springfield, MO. “In just the daily hubbub of a nursing home, the director of nursing services (DNS) deals with resident care issues, family calls, and the crisis of the day. Now with the COVID-19 public health emergency, there are extra layers of stress and confusion that can make maintaining open communication even more difficult.”

Implementing the following process steps can help the DNS boost open communication in the nursing department:

Set clear expectations for staff

Good communication practice hinges on establishing expectations, says Harvey. “Staff need to know what is expected of them in all aspects of their position—from what time they need to be at work, to what duties they must perform on the clock, to what time they can leave their shift. You can’t effectively evaluate staff performance if you haven’t communicated your expectations.”

“These expectations should include what needs to be communicated, how it should be communicated, who it should be communicated to, and the time frame in which the communication should occur,” says Shelly Maffia, MSN, MBA, RN, NHA, QCP, CHC, director of regulatory services for Proactive Medical Review and Consulting in Evansville, IN. “For example, following a fall, do staff need to immediately notify the DNS? Or what is the process that they need to follow? Often, staff don’t communicate information when they need to because they didn’t know that it was expected of them.”

Expectations can come in any form, notes Harvey. “You can include them in staff orientations, the employee handbook, memos, or even competencies that staff have to complete. Whatever communication method you choose, you should make sure that staff understand your expectations and that you have signed verification that they understand. That can be their own signature or the signature of their supervisor confirming that the information was passed on to staff. Then, you have a mechanism to hold staff accountable for the expectations that you have communicated, whether it’s during annual review or a disciplinary action.”

Be visibly present

The DNS should have an open door policy to promote effective communication, says Maffia. “Staff need to know that they can come to you and communicate issues, and if you notice staff who aren’t reaching out, you may want to reach out to them individually to develop that open communication with them.”

However, an open door is just the first step toward being visible, says Harvey. “You have to be present as well. It is important for the staff to see you as more than a figurehead who shows up at a meeting and says, ‘Do this; do that.’ Staff need to see you out on the floor.”

One common, impactful way to be seen on the floor is to make rounds every day, says Harvey. “Rounds are a perfect time to connect with staff. You should listen to them no matter what they have to tell you. They may want to talk about a work-related issue, or they may want to talk about a personal issue. For example, if a staff member is a single mother with no support, you may be the only person they can talk to, and letting them vent for a few minutes can make a huge difference for that staff member.”

When on the floor, the DNS should make a point to engage staff, and residents as well, says Harvey. “At a minimum, you want to acknowledge them with a smile and a greeting. Doing rounds isn’t the place for multitasking. You don’t want to walk around with your head down looking at your phone or a piece of paper. If you don’t recognize staff as you are walking around, you immediately close off that pathway to communication.”

During rounds, the DNS should carry a pad and pen to take notes—both good and bad—based on conversations with staff, suggests Harvey. “Jotting down a quick note can help you remember what staff tell you about work-related issues, and it shows them that you are taking what they say seriously. While you also could take notes on your phone or another electronic device, you need to make your purpose clear so they don’t think your attention is divided. For example, you could say, ‘I’m going to make a note right now so I remember this and can address it,’ and then immediately put your phone away again.”

The DNS should be sure to stagger those rounds as well, says Harvey. “You want to hit various shifts throughout the week so that all of your staff can see you, not just one shift.”

Another option is for the DNS to participate in some change-of-shift reports, suggests Maffia. “Like with rounding, these reports are a key time that managers can communicate with staff.”

Establish strong meeting processes

Meetings obviously are a primary source of communication, so having strong clinical meeting processes in place is critical, says Maffia. “With the pandemic, a number of facilities have gotten away from having some of the clinical meeting processes that they used to have. However, it is just as important—if not more important than ever—to continue having those meetings. You may need to hold some of them via conference call, Zoom, or another virtual technology, but clinical meetings ensure that all staff know what is happening with each resident and that follow-up is occurring.”

For example, Maffia identifies two key clinical meetings:

  • Daily morning clinical triage meeting for nursing leaders. “Unit managers, or whoever is the designated leader on each unit, should meet with nursing staff every morning to discuss critical issues (e.g., review the 24-hour report),” suggests Maffia. “Then, those unit managers can bring forward identified issues and communicate them to the DNS, the assistant DNS, and other nursing leaders at each morning’s clinical triage meeting to ensure there is appropriate follow-up.”
  • Daily clinical meeting for the interdisciplinary team. “In addition to having a nursing triage meeting in the morning, you should have a clinical meeting for the entire interdisciplinary team at some point in the day,” says Maffia. “The whole team needs to be aware of pertinent clinical issues, work to validate care plan updates, and make sure any needed follow-up is done by the relevant disciplines.”

There should be clear ground rules for each meeting to ensure they stay on task and make efficient use of staff time, says Maffia. “Everyone who attends a meeting should have a set role. For example, someone should be designated to do any necessary updates to the chart. Someone else should be designated to use a follow-up tool to document what follow-up needs to occur. That follow-up tool is very important for the DNS. It allows you to have accountability. Someone can be assigned to go back and validate that what was discussed was in fact appropriately followed up on and not missed.”

In addition, there should be clear expectations of what items need to be discussed in each meeting, says Maffia. “For example, going back to the triage meeting, you may decide that every meeting should include a review of the accident and incident reports from the previous day, the 24-hour reports, any new admissions, and any alerts from your software system.”

Note: For more tips on how to plan and conduct meetings effectively, check out AADNS’s Guide to a Successful Meeting tool.

Always follow up on work-related issues

When staff alert the DNS to an issue involving resident care or another staff member, the DNS should initiate an investigation, if needed, and follow through on that issue, says Harvey. “Your staff should see that you are paying attention—that’s when taking notes can come in handy—and that you will investigate and handle it. You want to take it off their plate so it becomes a nonissue for them.”

In addition, the DNS should express gratitude that the staff member came forward, says Harvey. “Be encouraging and supportive while they express their concerns, and then make sure that they know you are grateful that they felt they could open up to you. That will help you continue to make that connection with your staff.”

Note: Learn more about the leadership skills that can help the DNS promote strong communication in “Five Ways to Be a DON Who SNF Staff Want to Follow” on the AAPACN blog here.

Avoid ‘dragon’ mode communication

The DNS should be transparent with communication, says Harvey. “The most important rule is: Don’t hoard news. Unless it involves sensitive knowledge about a team member or a resident, you don’t want to hold back information from your staff. As part of the nursing team, your staff deserve to know what is happening in their workplace so that they can act on it and provide the best care possible for residents.”

The DNS also needs to find the best method or combination of methods to disseminate information, says Harvey. “You have to communicate essential information to all of your staff. You may be able to use e-mail blasts or text messages. However, some facilities—and even some staff members—may not have the technological capability for electronic messaging. You may need to use old-fashioned techniques, such as posting eye-level flyers at the time clock or in break rooms, nurse’s stations, or even restrooms.”

In addition, the DNS should take advantage of in-person opportunities to communicate information, says Harvey. “For example, the weekly or biweekly COVID-19 tests are a great time to catch staff to share information. You can even do some one-on-one in-services for staff education or return demonstrations.”

Use exit interviews to identify communication concerns

When staff give notice or quit unexpectedly, the DNS should always complete an exit interview, suggests Harvey. “You want to try to find out about their experiences in your facility and their reasons for leaving. Exiting staff often are more open, and they may provide some valuable feedback that you can use to identify issues, such as orientation process problems or insufficient support of staff, to improve open communication with your other staff—and ultimately result in better care for your residents.”

Practice a ‘just’ culture

Penalizing staff for process or system issues can put a freeze on open communication, says Maffia. “Looking at problems from a process perspective helps you earn the trust of your team members, especially new team members. Rather than immediately putting blame on an individual, you should do a root-cause analysis to determine if there was a break in your process: Did you not clearly identify expectations? Was your orientation training ineffective? The root-cause analysis may show that a staff member made a human error or engaged in risky behavior, but you should take that opportunity to look at your process to figure out how you can improve it to keep the problem from reoccurring.”

Note: TeamSTEPPS 2.0 for Long-Term Care, an evidence-based teamwork training curriculum from the AHRQ, has a Communication module and a Leading Teams module that offer resources for improving communication.

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