Nurse Communication: Importance, Failures, and Improvements

Introduction

Communication is one of the most important aspects of nursing, as the case study of the student and the instructor illustrates. 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 passing before this information was relayed to another nurse is highly unacceptable, considering how much emphasis is placed on preventing medical errors (Cimiotti, Aiken, Sloane, & Wu, 2012). It is therefore imperative that student nurses appreciate the ramifications of communication failures — 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 of both the health care organization and the patient.

Importance of Nurse-to-Nurse Communication

Nurse-to-nurse communication is essential to ensuring that preventable medical errors do not occur. When communication is habitual and guided, the risk of pertinent information falling through the cracks is reduced, and errors that can harm patients become less likely.

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. 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 reviewing the data reports filed by the student the following week — whether any action had been taken on behalf of the patient at all. The abnormal reading signals a red flag to the instructor and should have signaled a red flag to the student nurse as well, yet no additional information is attached regarding what the student nurse did in response. There is no communication, and the instructor is left in the dark regarding the status of the patient.

Investigating the matter will now require the instructor to spend time away from other duties in order to unearth more information about the patient and to understand why the nurse recorded no further actions. As the case suggests, there are too many unknowns — and in health care, this is not acceptable practice. When patients' lives are in the balance and the integrity of health care providers is at stake, communication failures take on supreme importance. The instructor must now determine whether something prevented the nurse from reporting the reading, whether the nurse lacked proper training, whether the error was caused by fatigue, whether the patient's health has been impaired, and whether any action was taken at all. A number of questions and alarms have now been raised that could have been prevented had proper communication processes been followed.

Negative Implications of Failure to Communicate

The negative implications of a failure to communicate are first and 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, patient safety can be jeopardized. If patient safety is jeopardized, the health care provider is likewise placed at risk — particularly if the patient's health suffers — and legal repercussions may follow. Medical malpractice lawsuits are burdensome and can be devastating for health care providers. When nurse-to-nurse communication is all that is needed to prevent an error or emergency from occurring, special attention must be given to ensuring that communication takes place.

Communication failures can also undermine trust and transparency among nurses. If a nurse develops a reputation for failing to share important information with colleagues, that nurse will quickly be viewed as a liability — someone with whom others do not want to work. The situation can escalate to the point of scheduling conflicts and a drop in overall employee morale.

Most critically, however, the patient's health is at risk. This is the most serious negative implication of a nurse's failure to communicate. In the case study, a low 87% oxygen saturation reading could be especially problematic depending on the patient's existing condition. The patient may require supplemental oxygen, may have a more serious underlying issue that has not yet been diagnosed, or may need special attention. None of these needs can be addressed if the nurse does not communicate the abnormal reading.

A lack of documentation can also lead to errors in providing medical care. It may be that the student nurse simply failed to document action that was taken to address the abnormal reading — perhaps the student did communicate with a senior nurse but did not record the response steps. This is still a serious problem, because without documented evidence, any subsequent care provider must approach the patient essentially uninformed about what has already been done. Documenting every step is crucial for supplying other nurses and physicians with an accurate picture of the patient's care. Without that accurate picture, a provider may recommend an action that affects the patient adversely. This is why thorough documentation is indispensable.

Conclusion

Nurse-to-nurse communication is vital for patient safety and for proper health care practices in health care facilities. Breakdowns in communication or failures to document action steps can reduce the effectiveness of caregivers and place the patient at risk. For the patient's safety and for the good of the health care organization, communication must be treated as a top priority.

Addressing communication issues can range from offering routine practice sessions to identifying the underlying causes of communication failures, such as nursing fatigue. If the failure is simply a matter of insufficient practice, the student nurse in the case study can be corrected through training. If it is a matter of failing to document steps taken, that too can be corrected. If, however, the failure stems from nursing fatigue caused by a long shift or another source of burnout, the issue requires deeper exploration. In such cases, the health care organization must work to sustain a positive workplace culture that promotes communication through practice, technology, and routine — ensuring that all patients receive the quality of care they have the right to expect.

References

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