Effective Nurse Leadership and Patient Care: The Role of Communication

Leadership in Nursing

• Traditionally, leadership was associated with a dominant personality, especially in clinical healthcare roles.
• Effective leadership involves inspiring teamwork and collaboration rather than just giving orders, empowering staff and increasing confidence, leading to safer, person-centered care.
• The COVID-19 pandemic highlighted challenges in healthcare, including staff shortages and burnout, while also raising public awareness of the importance of nursing.
• Digital innovations like instant messaging and video calls have enabled nurses to develop confidence in new care avenues, such as remote consultations.
• Nurse managers face the decision of demanding change versus using leadership to boost morale and communication skills for optimal patient care.

Key Components of Effective Leadership

*Acts as a visionary: Assesses how patient circumstances can be improved, weighing the ‘pros and cons’ of care plans.
*Takes individual accountability.
*Has a positive mindset.
*Confronts suboptimal standards.
*Acknowledges optimal care.
*Inspires others (Gopee and Galloway 2017).

Safe and Effective Care

• Safe and effective care is a basic principle of nursing practice.
• Nurse managers should encourage trusting therapeutic relationships with patients by ensuring staff understand the Nursing and Midwifery Council (NMC 2018) Code, which prioritizes the patient’s needs.
• Care should be evidence-based, supporting staff well-being to enhance their workplace performance.

Leadership Styles

• Leadership is vital at all levels in nursing (Fernandez 2017, Gopee and Galloway 2017).
• Definitions vary, with some leaders using a transactional (top-down, authoritarian) style and others preferring a transformational (collaborative, shared influence) style (Saleh et al 2018, van Diggele et al 2020).
• The fundamental aim of leadership is ‘an influencing process aimed at goal achievement’ (Stogdill 1950).
• Effective nurse managers lead by example, assessing their performance and encouraging reflective practice in their staff (Fowler 2016).
• Effective leadership qualities are not limited by pay grade or job role, but focus on traits that can be developed (Gopee and Galloway 2017).

Communication Skills

• Optimal communication skills are crucial for nurse managers to impart healthcare values and goals (Fernandez 2017).
• Communication is essential for effective nursing care and nurse competency, impacting all aspects of practice (Price-Dowd 2018, Kim and Sim 2020).
• Ineffective communication is a significant cause of patient harm (World Health Organization 2009, Afriyie 2020).
• Communication involves verbal and non-verbal modes (Fowler et al 2021) and is a two-way exchange of information (Choi et al 2018).
• Nurse managers can use the ‘seven Cs’ to structure conversations and interactions for clear communication.

The Seven C's

1. Clear
2. Concise
3. Concrete
4. Correct
5. Coherent
6. Complete
7. Courteous (Ellis and Abbott 2017)

*Following the seven C’s helps maintain consistent care standards. For example, clarifying patient allocations at the start of a shift avoids confusion (Baillie 2017).

Practical Methods to Promote Communication

• Role-play scenarios: Nurse managers can simulate clinical scenarios to practice communication styles and discuss challenges (Dorri et al 2019).
• Team training: Involve multidisciplinary team members like clinical psychologists in team meetings to discuss communication styles (Chen et al 2021).
• Rehearse arguments and recommendations: Help nurses prepare for interactions, such as communicating with a patient refusing medication (Armstrong 2018).

Non-Verbal Communication

• Most communication is non-verbal, encompassing any system that doesn't involve speaking or writing (Hall et al 2019).
• Mastering non-verbal communication helps understand patient needs for safe and effective care (Price-Dowd 2018).
• Non-verbal cues reveal feelings, attitudes, and emotions, offering deeper understanding (Hall et al 2019).
• Understanding non-verbal cues helps nurses advocate for patient needs and promote person-centered care (Kim and Sim 2020).

Forms of Non-Verbal Communication

• Facial expressions, such as smiling or grimacing.

• Sighing.

• Gestures such as dismissive waves of the hand.

• Body language such as crossed arms (Afriyie 2020).

• Non-verbal communication links with emotional intelligence, helping nurse managers understand ‘real’ meanings (Jambawo 2018) and motivate positive behaviors (Carragher and Gormley 2017, Walls 2019).

• Education in non-verbal cues through seminars, handouts, and rehearsal (role play) breaks down barriers between nurse managers and staff (del Vecchio et al 2022).

Written Communication

• Often overlooked in nurse leadership, but crucial for communicating observations and patient status (Kagan 2023).
• Examples include nursing notes, discharge forms, and medication charts (Afriyie 2020).
• The NMC (2018) Code emphasizes effective communication in documentation, but lacks specific guidance, leading to inconsistencies.
• Ambiguous documentation can result in litigation (Smith and Parkhouse 2018).
• Nurse managers should promote clear, specific language and avoid jargon (Smith and Parkhouse 2018) to reduce misinterpretation and enhance patient outcomes (Russell-Roberts 2020).
• Audits, consultation, and lists of ambiguous abbreviations can improve documentation (Table 1).

Examples of written communication used in clinical practice

• Nursing notes
• Discharge forms
• Admission forms
• Medicine prescription charts, such as Kardex or EPMA (electronic prescribing and medicines administration) (Afriyie 2020)

Examples of common ambiguous abbreviations that should be avoided in nursing documentation

(Davis 2020)

Academic Writing

• Academic writing is a form of written communication where nurses educate and inspire others (Wood 2017).
• Nurses should lead in expanding the profession’s evidence base to influence best practice (Moffat 2018).
• The NMC (2018) Code states nurses must share skills and knowledge to benefit patients and colleagues.
• Written work should combine evidence-based practice with clinical experience (Fowler 2021).
• Publishing encourages other nurses and ensures patient care is based on best practice (Sfantou et al 2017).
• Academic writing can inspire a ‘thirst for knowledge’ and encourage consideration of nurse leadership (Wood 2017).

Communication Challenges

• Staff may struggle with assertive communication when witnessing poor care, hindering patient advocacy.
• Newly registered nurses may find assertive communication challenging (Darawad et al 2020), leading to job dissatisfaction and burnout (Hazelwood et al 2019).
• Lack of confidence and hierarchical structures can discourage initiative (Bickhoff et al 2017, Royal College of Physicians 2018, Dunn 2019, Darawad et al 2020).
• Negative attitudes from healthcare managers can influence nurses' communication in unsafe practice cases (Mansour and Mattukoyya 2018, Darawad et al 2020, Mansour et al 2020).
• Nurse managers should provide autonomy and support for effective communication (Law and Chan 2015, Darawad et al 2020), being available for discussions to address concerns (Choi et al 2018).

Education

• Interdisciplinary education between nurses and doctors can challenge hierarchical mentalities (Fagan et al 2016, Dunn 2019, Gopee 2020).
• Practice-based interdisciplinary education, such as role play and clinical simulation, can help nurses overcome communication anxieties.
• Tools like CUS (‘concerned’, ‘uncomfortable’, ‘safety issue’) empower staff to point out clinical issues without challenging authority (Royal College of Physicians 2018).
• Adopting the CUS tool promotes safer, more effective care, protecting patients and staff (Gangaram et al 2017).

Conclusion

• Communication skills are vital for effective nurse leadership.
• Nurse managers can assist staff through role play and clinical simulation.
• Optimal communication skills role-model appropriate behavior, boosting confidence.
• Understanding verbal, non-verbal, and written communication enables effective advocacy and dissemination of best practice.