Essentials of Nursing Leadership and Management, 5th Edition

chapter 6 | Getting People to Work Together 75

2.Use direct and exact language. In both written
and spoken messages, use language that is easily
understood by all involved.
3.Encourage feedback. This is the best way to
help people understand each other and work
together better. Remember, though, that feed-
back may not be complimentary. This is dis-
cussed later in the chapter.
4.Acknowledge the contributions of others.
Everyone wants to feel that he or she has worth.
5.Use the most direct channel of communica-
tion available. The greater the number of indi-
viduals involved in filtering a message, the less
likely the message will be received correctly.
Just as in an old children’s game, messages
sent through a number of senders become
more and more distorted. Information that is
controversial or distressing should definitely
be delivered in person so that the receiver can
ask questions or receive further clarification. A
memo delivered “To all nursing staff ” in
which cutbacks in staffing are announced
would deliver a message very different from
that in a meeting in which staff are allowed to
talk and ask questions.

Assertiveness in Communication

Assertive behaviors allow people to stand up for
themselves and their rights without violating the
rights of others. Several authors have stated that
nurses lack assertiveness, claiming that nurses would
rather be silent than voice opinions that may result
in confrontation (Tappen, 2001). Assertiveness is
different from aggressiveness. People use aggressive
behaviors to force their wishes or ideas on others. In
assertive communication, an individual’s position

is stated clearly and firmly, using “I” statements.

For example:

The nurse manager noticed that Steve’s charting has

been of lower quality than expected during the past

few weeks. She approached Steve and said,

“JCAHO surveyors are coming in several months.

I have been reviewing records and noticed that on

several of your charts some pertinent information is

missing. I have scheduled time today and tomorrow

from 1:00 to 2:00 in the afternoon for us to review

the charts. This allows you time to make the neces-

sary corrections and return the charts to me.”

By using “I” statements, the nurse manager is con-

fronting the issue without being accusatory. Assertive

communication always requires congruence between

verbal and nonverbal messages. Had she shaken her

finger close to Steve’s face or used a loud voice, the

nurse manager might think she was being assertive

when in fact her manner would have been aggressive.

There is a misconception that people who com-

municate assertively always get what they want.

Being assertive involves both rights and responsi-

bilities. Assertive communicators have the right to

speak up, but they must also be prepared to listen to

the response.

Barriers to Effective

Communication in the Workplace

People are often unwilling or unable to accept

responsibility or to perform a specific task because

they do not fully understand what is expected of

them. Professional nurses are required to commu-

nicate patient information to other members of the

nursing team. Although this may sound easy, there

are many potential barriers to communication.

These barriers may be physical, psychological,

semantic, or even gender-related.

Physical Barriers

Physical barriers to communication include extra-

neous noise, too much activity in the area where the

communication is taking place, and physical sepa-

ration of the people trying to engage in verbal

interaction.

Psychological Barriers

Psychological “noise,” such as increased anxiety, may

interfere with the ability to pay attention to the

other speaker. Social values, emotions, judgments,

table 6-1

Principles for Effective Communication

Principle One Aim for clarity and focus.

Principle Two Use direct and exact language.

Principle Three Encourage feedback.

Principle Four Acknowledge the contributions of

others.

Principle Five Use the most direct channels of

communication available.

Tappen, R.M. (2001). Nursing Leadership and Management: Concepts

and Practice(4th ed.). Philadelphia: FA Davis, with permission.