Effective interpersonal communication (IPC) between nurses and the healthcare consumer is one of the most important elements for improving satisfaction, compliance, and health outcomes. Effective IPC is necessary to perform an assessment and to make an accurate diagnosis that is based on a full disclosure of information by the healthcare consumer, thus leading to an appropriate plan of care that the consumer can agree to. The nurse must ensure that the healthcare consumer understands his or her medical condition, as well as the rationale behind a treatment regimen.

Communication is a complex feedback loop that requires a sender, a message, and a receiver. The mode through which the message is sent and received can be verbal, nonverbal, spoken, or written. A key principle of effective communication is that the only true communication is what the other person perceives you to have said, written, or intended.

There are three communication styles. Passive communication is described as having the goal of avoiding conflict at all cost. The actual behavior is one of (1) ignoring one’s own rights, being inhibited, not speaking up, or avoiding eye contact; (2) having a soft, weak, wavering voice; or (3) being vague, rambling,
and apologetic. This style is not very effective because passive communicators do not meet their own needs, the unit does not benefit from their wisdom and contributions, and they often suffer from physical, mental, and emotional illnesses related to “keeping it all bottled up inside.”

Aggressive communication is characterized as competitive, controlling, manipulative, dominating, bossy, loud, demanding, sarcastic, and blaming. The aggressive communicator’s goal is to win regardless of the cost to others. This style is not effective because everyone loses in the long run. The senders may get what they want for a short time, but that satisfaction generally does not last. Others do not respect, follow, or comply with the sender’s wishes for very long, if at all.

Assertive communication is described as adult communication with the goal of win-win. It is open, honest communication that results in respect of self and others. Characteristics consist of expressing oneself without violating the rights of others; remaining calm, confident, and relaxed; taking responsibility for one’s own behavior; seeing and making choices; and being open to negotiation. This communication style is hard and needs to be learned through continued study and practice. People who routinely communicate in an assertive manner generally experience successful relationships in their marriages, workplaces, and professional and personal relationships.

When stress is added, perceptions get tangled. In general, the communication feedback loop works well when there is no stress. It is up to the sender and the receiver to communicate in such a way as to minimize the stress and to maximize the chance that the true intention is what is perceived and acted upon. This approach becomes especially challenging in today’s fast-paced, emailing, texting, and technology-driven world.

Communication is a hot topic in health care today. The American Association of Colleges of Nursing (IPEC, 2011) identifies skilled communication as a core competency for interprofessional collaborative practice as follows: Communicate with patients, families, communities, and other health professionals in a responsive and responsible manner that supports a team approach to the maintenance of health and the treatment of disease. The Joint Commission suggests that ineffective communication is a top contributor to sentinel events. Intimidating and disruptive behaviors can foster medical errors; contribute to poor patient satisfaction and to preventable adverse outcomes; increase the cost of care; and cause qualified clinicians, administrators, and managers to seek new positions in more professional environments. The safety and quality of patient care depend
on teamwork, communication, and a collaborative work environment (The Joint Commission, 2008).

Studies have indicated that more than 60% of medication errors were caused by mistakes in interpersonal communication (Maxfield, Grenney, McMillan, Patterson, & Switzer, 2005). Each year, hundreds of thousands of patients are harmed during their treatments because of fundamental problems in the collective behavior of the caring professionals who care for them (Kohn, Corrigan, Donaldson, 2000). Eastbaugh (2004, p. 36) reports, “The most common cause of malpractice suits is failed communicating with patients and their families.”

In 2005, the American Association of Critical-Care Nurses (AACN) and VitalSmarts® conducted a nationwide study, Silence Kills (Maxfield et al., 2005), that suggested that people in health care frequently failed to have crucial conversations, which would likely add to unacceptable error rates. This study recommends that improvement in those crucial conversations will contribute to significant reductions in errors, improvement in quality of care, reduction in nursing turnover, and marked improvement in productivity. However, fewer than 1 in 10 fully discussed their concerns with the other person. And most do not believe they have the responsibility to bring their concerns to the attention of the other person. About half of the respondents say the concerns have lasted for more than a year. A significant number reported that there have been serious injurious consequences of the concerning behavior (Maxfield et al., 2005).

In the follow-up study, Silent Treatment (Maxfield, Grenny, Lavandero, & Groah, 2010), 58% of the nurses reported that they had been in situations where they felt unsafe to speak up about the problems or where they were unable to get others to listen. The nurses cited that their lack of ability to speak up, belief that it was not their job, and low confidence that speaking up would do any good were the three primary obstacles to direct communication. Other obstacles included time and fear of retaliation. The three main “undiscussables” were dangerous shortcuts, incompetence, and disrespect.

A discussion of communication is not complete without including today’s new communication networks. Social networks and the Internet provide great opportunities for exchange and dissemination of knowledge among nurses. Online social networking can enhance collegial communication among nurses and can provide opportunities for continued professional education. At the same time, the social networks have great potential for violating patient confidentiality, damaging the public trust in healthcare providers,
and damaging a nurse’s professional and personal future. ANA’s Principles for Social Networking and the Nurse (ANA, 2011a) offers essential principles for all nurses to follow: