Clinical performance metrics and evaluation

Nurse Communication

Communication is one of the most important aspects of nursing, as the case study of the student and the instructor indicates. The student nurse failed to communicate to the instructor the patient's abnormal oxygen saturation reading -- a reading that could have had very serious consequences for the patient. An entire week going by before this information is relayed to another nurse is highly unacceptable, considering how much emphasis is placed upon preventing medical errors from occurring (Cimiotti, Aiken, Sloane, Wu, 2012). Thus, it is imperative that student nurses appreciate the ramifications of failures in communication -- ramifications that could be potentially fatal for patients and, by extension, legally adverse for the health care facility. Stressing the crucial importance of nurse to nurse communication is vital to the well-being both of the health care organization and the well-being of the patient.

Importance of Nurse to Nurse Communication

The importance of nurse to nurse communication is essential to ensuring that preventive medical errors do not occur. Nurse to nurse communication reduces the risk of pertinent information falling through the cracks, and when communication is habitual and guided, preventable medical errors that can cause harm to patients are less likely to occur.

In the case of the student nurse who failed to alert the clinical instructor of the patient's low oxygen saturation reading, a significant error was made on the student's part. Not only did the student fail to report the abnormal reading to the supervisor immediately, but there was also no documented evidence of any follow-up action. In other words, the instructor had no way of knowing (by looking at the data reports filed by the student the following week) whether any action was taken at all on behalf of the patient. The abnormal reading is there signaling a red flag to the instructor -- and should have signaled a red flag for the student nurse -- but no other information is attached regarding what the student nurse did about the reading. There is no communication -- and the instructor is now in the dark regarding the status of the patient. To investigate the matter will now take time out of the instructor's schedule, disrupting the duties he or she must perform so as to unearth more information about the patient as well as about the nurse and why he/she recorded no other actions.

As the case suggests, there is too much confusion and too many unknowns -- and in health care, this is not a good practice. When patients' lives are in the balance and the integrity of the health care providers on the line as a result, communication issues take on supreme importance. The instructor must now ask whether something happened to the nurse that obstructed the nurse from reporting the abnormal reading, whether the nurse is lacking in formation or whether this error was caused by fatigue, whether the patient's health has been impaired, whether any action at all was taken (if so, why it was not recorded), and so on. In short, a number of questions and alarms are now raised that could have been prevented had proper communication processes been followed and nurse to nurse communication been effectively achieved.

Negative Implications of Failure to Communicate

The negative implications of failure to communicate are first foremost related to patient safety. Patients have the right to expect reasonable quality care from health care providers and if vital information or readings are not transmitted or communicated correctly, the patient's safety can be jeopardized. If the patient's safety is jeopardized, the health care provider is likewise jeopardized, especially if the patient's health suffers: legal repercussions may follow. Medical malpractice lawsuits are quite burdensome and can be devastating for health care providers -- and if nurse to nurse communication is all that is need to prevent an error or emergency from occurring, special attention should be given to ensuring that communication is provided.

Failures to communicate can also undermine trust and transparency among nurses. If a nurse receives a bad reputation for failing to communicate to other nurses important information, that nurse will very quickly be viewed as a risk asset, one with whom other nurses will not want to work. The situation could escalate to the point where scheduling conflicts occur and employee morale drops.

Most importantly, however, is the fact that the patient's health is at risk. This is the biggest negative implication of a nurse's failure to communicate. With the patient in the case study, a low 87% oxygen saturation reading could be especially problematic depending on what is already known about the patient. The patient may require oxygen, may have a more serious issue going on that has heretofore been undiagnosed, may need special attention, etc. The point is that none of this is being addressed if the nurse does not communicate an abnormal reading.

Lack of documentation could also lead to errors in providing medical care. In the case study, it may be that the student nurse simply failed to document action that was taken to address the abnormal reading. It could have happened that the student did communicate to a senior nurse the abnormal reading but that the response steps were not documented. This is still a problem, however, because now there is no evidence in the report of these steps. Any care provider at this point must approach the patient seemingly in the dark about what has been done for the patient. Documenting the steps is crucial for supplying other nurses and doctors an accurate picture of what has been done for the patient. Without that accurate picture, the care provider may recommend some action that could affect the patient adversely. This is why it is crucial to have everything documented.

How to Improve Communication Issues

One way to improve communication issues is to begin at a workplace culture level. This means that the culture in the workplace should be very supportive of communication between nurses. A supportive culture could be one in which nurses are actively encouraged to begin or end all communications with a set of questions that will reduce the risk of information falling between the cracks. This culture could also be facilitated by reducing risks of nurse burnout/fatigue, which can be caused by numerous variables and which can contribute to preventable medical errors (Cimiotti, Aiken, Sloane, Wu, 2012). By addressing the issue of nursing fatigue/burnout, the risk of communication breakdowns occurring could also be reduced (Kachalia, 2013). Because proper communication processes are less likely to be adhered to if nurses are fatigued or burned out during a shift, it is imperative that the workplace culture take steps to address these preventive care issues (Dall'Ora, Griffiths, Ball, 2016). Thus, a functional step that could be taken would be to place a limit on nursing working shift hours at 8, as research has indicated that more medical care errors occur in extended working hour shifts, when nurses are more likely to feel fatigued (Dall'Ora, Griffiths, Ball, Simon, Aiken, 2015). This could very easily be the case with the student in the case study, who neglected to tell the clinical instructor about the patient's abnormally low oxygen saturation reading. Understanding the factors behind the failure of communication is essential, and research indicates that fatigue is a common cause of medical errors.