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Title: Why Are Nurses Not Listening?
Author: Mary Atkinson RN, MSN
Address: Administrator, Equinox Home Care LLC
12 Farm House Lane
Shelton, Ct. 06484
(203) 556-3113
Date Posted: April 17, 2011
About the Author
I have been a Registered Nurse for 18 years with 14
years as a Hospice nurse. I received my BSN from
Fairfield University and am currently attending
University of Hartford and will receive my Masters in
Nursing in May 2011 with an interest in Public Health
Nursing.
Introduction
Why are nurses not listening?
Listening is one of the fundamental values of caring. People don’t realize how therapeutic sharing time with another human being can be. In this day in age nurses do not have the required listening skills to meet the expectations and needs of their patients. Listening is a valuable skill under-utilized by all nurses because of lack of knowledge, lack of time, work place expectations of the nurses, and staffing issues within the work environment.
There are six kinds of listening: discriminative: comprehensive: critical: appreciative: therapeutic and relational (Bentley, 1998, p. 57). Discriminative listening requires the listener pay attention to who the listener is and tries to discern how the speaker is saying the words and what the tone of the conversation is. The next kind of listening is comprehensive listening, which requires that the listener understands most of what the speaker is saying. Critical listening requires the listener either accepts what is being said or reject what is being told. This type of listening would be valuable for the nurse to utilize as a skill when the patient is not following a plan of care and the nurse needs to figure out why.
Appreciative listening is of value when trying to utilize coping skills or music therapy to provide some stress relief. Therapeutic listening is an active listening and the most valuable of all the styles for the nurse to learn. A therapeutic listener uses empathy as a listening tool that is valuable in the care of the patient. The final style of listening is the relational listening, which is what is referred to as “small talk”, used most frequently when you just meet another person and are getting to know each other. This style is usually the first style of listening that is used and leads into the other styles. Along with these different styles are listening techniques that also should be included when therapeutic listening skills are being taught to improve the quality of the listening skill (Bryant, 2009).
Nursing schools teach the student therapeutic communication in their foundations coursework. Therapeutic communication is good when trying to find out why a patient is noncompliant with medications or when teaching a new diabetic about their disease. While being taught the value of therapeutic communication, the student is also taught about keeping boundaries and not crossing the “line” and becoming too involved with their patient. The student usually interprets this as keep all conversation light and geared to the problem at hand. Many nurses recognize this hole in their skills and attribute it to inadequate preparation in their nursing education. (Kluge, Glick, & Engleman, 2007, p. 188) The student does not learn empathy or the healing side of active listening. Students who have been questioned about their confidence in listening and therapeutic communication have indicated that their biggest worry is not knowing the right language to use. (Corless, Michel, Nicholas, & Jameson, 2009, p. 369). Those skills are learned through experience as the nurse gains more confidence in the role as a nurse and these skills are learned in the work environment.
As the nurse gains more competence in her skills and more confidence in her knowledge as a nurse she finds her role as a nurse is beginning to change. She finds herself involved in the day to day fast pace of the job, swamped with acute patient problems, schedules and paperwork. Effective listening is put on hold as she tends to be focused on the task at hand and unable to spend the five to ten extra minutes it would need to listen to the patient and their concerns.
Any communication the nurse has with the patient is usually about a procedure or a new medication or discharge planning. During these interactions, the focus is on what the nurse needs to tell a patient so that the teaching can be documented. The time to sit back and listen to what the patient’s needs are has passed. This is unfortunate because research has shown that effective listening could enhance the patients’ satisfaction and improve patient outcomes. (Chant et al 2002 as cited in Shepherd, Braham, & Elston, 2009, p. 8). Many years ago nurses could listen to patients while providing them a morning bath or evening care, but now these tasks are delegated to other staff members.
Staffing issues also play a role in the time constrictions nurses have. Trying to fill gaps in the daily absences so that all patients have safe care makes it harder for nurses to take time to sit with their patients and listen. Because of this, nurses have to rely on the nurses aides to provide the extra TLC that the patients used to be able to expect from their nurse. This has also led to frustration on the part of the nurses trying not only to provide the physical care needed for their patient but to also provide all the needed instructions for discharge and the needed information the patient can take with them to avoid another hospitalization. Many times the nurse realizes that misinformation or problems with not following the plan of care could have been avoided with more time spent communicating with the patient (Neuwirth, 1999).
As the role of the nurse continues to change and the work environment becomes busier, it is crucial that the nurse be given the tools needed to face these challenges. The knowledge of good listening skills could prove to be an invaluable tool for the nurse as she faces these hectic days. This knowledge would allow the nurse to multitask a lot better as she becomes better at listening as she goes about her daily tasks (Hein, 1973).
Armed with the needed skills for listening many positive events could take place. The nurse would be able to give the patient the needed attention in such a way as to be therapeutic. The patient would feel validated by this interaction thus the satisfaction of the patient would be increased. The nurse would not need to count on another discipline to provide this skill and there would be no wrong information exchanged, thereby decreasing the stress the health care team members and the patient. Educating nurses with this set of skills would take some in-service hours on the part of the nurse but the benefits of effective communication skills would be invaluable. It would also be beneficial if these communication skills were taught in the nursing school before the nurse started to practice. This would allow time for the skills to be sharpened and built into the nurse’s daily tasks without thought.
Conclusion
Listening skills would have a positive effect not only on patient satisfaction, but could also increase the nurse’s sense of satisfaction as the nurse-patient relationship becomes a stronger part of the daily routine and not a task to evade.
References
Bentley, S. C. (1998). Listening better. Nursing Homes, 47, 56-60.
Bryant, L. (2009). The Art of Active Listening. Practice Nurse, 37(6) .
Corless, I B., Michel, T H., Nicholas, M., & Jameson, D. (2009). Educating Health Professions Students about the issues involved in communicating effectively: A novel approach. Journal of Nursing Education, 48(7), 367-374. .
Hein, E. (1973). Listening. Nursing, 75, 93-102. .
Kluge, M.A., Glick, L. K., & Engleman, L. L. (2007).
Teaching nursing and allied health care students how to
“communicate care” to older adults (Doctoral
dissertation, Beth-El College of Nursing and Health
Sciences, University of Colorado, 2007). Dissertations
Abstracts International, 33, 187-207.
Neuwirth, Z. (1999). The difficult patient--myth or reality? Hospital Medicine, 35(4) .
Shepherd, T., Braham, J., & Elston, C. (2009). Listening and Interpersonal Skills Review (Doctoral dissertation, University of Leeds, 2009). Dissertations Abstracts International, 1-15.
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