BC Patient Safety & Quality Council

October 17, 2013 | Print This Article Twitter Facebook Email

Guest Insight: “Nursing Communication: One Size Doesn’t Fit All”

The following article is a guest Insight contributed by Clare Koning RN, MN Student. Contact us if you would like to submit an Insight.

Nursing Communication: One Size Doesn’t Fit All
A Short Review of Literature
Clare Koning RN, MN Student
August 2013

Collecting data for an observational study of shift report has given me a new perspective on what is involved in an activity that I myself have been performing for almost 13 years. The simple task of handing over responsibility, accountability, and continuity of care seems so basic and unscientific, yet a breakdown in communication during shift report claims to be the root cause of over 80% of sentinel events reported. Poorly structured communication processes create gaps for errors to occur in health care, with findings that more than one third of patient handover reports were flawed. Some even hypothesise that we have exceeded the capacity of the human mind and communication by creating the increasingly complex modern health care environment (Carroll, Williams, & Gallivan, 2013; Jukkala, et al. 2012; Kerr, 2002).

Although communication is widely recognised as a key element of effective work processes in a high reliability setting, the variations in communication, asymmetry in nursing roles during handover, and healthcare environment make it difficult to analyse and standardize (Carroll, Williams, & Gallivan, 2013).

We can make various assumptions about the importance of nursing communication. The effective communication of information during this exchange allows the oncoming nurse to skillfully hypothesise potential problems, plan continuum of care, and effectively care for his/her patients. Shift handover is a highly complex process that involves inclusion of context, non-verbal communication, social factors, knowledge and expertise. There is little consensus on what involves a good shift report or how to standardise handoffs to improve effectiveness, however, it can be assumed that without shift report communication, the oncoming nurses’ ability to plan and assess the status of his/her patient would be compromised (Carroll, Williams, & Gallican, 2013; Dowding, 2001; Kerr, 2002).

Shift report between nurses commonly involves two active parties, the receiver (oncoming nurse) and the sender (outgoing nurse) of information. These two roles have different expectations, participation, and communications styles. In addition to this, the knowledge and experience that the nurse affords influences what is seen as important and was found to result in a struggle to gain control during handover communication. Carroll, Williams, & Gallivan (2013) found that the receiving nurse values eye contact and the opportunity for questions, although these features are seen as interruptions and critique for the sending nurse. The sending nurse in contrast values an abbreviated handover to save time. Furthermore, years of experience influences communication, resulting in more experienced nurses giving shorter reports, and receiving nurses who are familiar with the patient asking more questions. These factors compound the difficulty in developing a single standardised tool to aid effective communication.

There are many suggested solutions to communication issues in nursing. Hill (2010) suggests that by incorporating elements of foresight, resilience, and intuition in shift report, nurses have the ability to address potential problems and anticipate changes when coming on shift. By encouraging questions in face-to-face communication, Hill (2010) reports that participating parties are able to seek clarity and better synthesize information about potential problems and progress. In addition, there are suggestions to use a minimum data set or a checklist, bedside report, face-to-face communication and additional training in communication (Hill, 2010; Kerr, 2002; Ortega, 2013)

Trying to improve communication, when it is a phenomenon with so many variables and highly reliant on context is no easy feat. However, in doing so we have the ability to increase safety and improve patient care. I believe it is the responsibility of each nurse, each leader, and every organisation to recognise the importance of effective communication, understand its limitations, and continually work on improving the spoken word. Let us learn from the past to improve on future communication, develop participatory productive relationships, value transparency and trust, and remember, “The single biggest problem in communication is the illusion that it has taken place” (Shaw, n.d).

What do you believe stands between you and effective communication? Send us your thoughts and we’ll post them below!



Carroll, J. S., Williams, M., & Gallivan, T. M. (2012). The ins and outs of change of shift
handoffs between nurses: A communication challenge. BMJ Quality & Safety, 21(7), 586.

Dowding, D. (2001). Examining the effects that manipulating information given in the change of shift report has on nurses’ care planning ability. Journal of Advanced Nursing, 33(6), 836-846. doi:10.1046/j.1365-2648.2001.01723.x

Hill, W. (2010). Cognitive human factors in ICU. Canadian Journal of Respiratory
Therapy, 46(4), 16.

Jukkala, A. M., James, D., Autrey, P., Azuero, A., & Miltner, R. (2012). Developing a
standardized tool to improve nurse communication during shift report. Journal of Nursing
Care Quality, 27(3), 240. doi:10.1097/NCQ.0b013e31824ebbd7

Kerr, M. P. (2002). A qualitative study of shift handover practice and function from a socio‐technical perspective. Journal of Advanced Nursing, 37(2), 125-134. doi:10.1046/j.1365-2648.2002.02066.x

Ortega, L., & Parsh, B. (2013). Improving change-of-shift report. Nursing, 43(2), 68.

Shaw, G. (n.d). Brainy Quotes. Retrieved from http://www.brainyquote.com

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