While interviewing for my current role as a nurse in intensive care I was asked questions such as ‘What are the most important qualities of good teamwork?’, ‘How do you handle conflict?’ and ‘How do you manage workplace stress?’. I found my answers to these questions tended to revolve around one particular skill, which was good communication.
I can hold my hands up and say that communicating effectively has been one of the most difficult things for me to learn as a newly qualified nurse. As a student nurse, even in your final year of study, you always have a direct element of support. As a student you have your responsibilities, but there is always a qualified nurse who is ultimately responsible for the patients. It is the transition from working with direct support to working autonomously and having to ‘fight your own battles’ that has been a big challenge. Not to mention the fact that I am naturally quite a quiet and introverted person, so adapting to make my voice heard when needed wasn't easy. It's so important to feel confident enough to speak up and be an advocate for your patient, especially in work areas such as intensive care, where my patients are often sedated and unable to communicate for themselves.
I think my communication skills have improved significantly since completing my supernumerary period. Even my phone voice isn't as clunky as it used to be! Although, for some reason, phone calls are still anxiety-inducing at the best of times. It just goes to show that you aren't able to fully develop some skills until you qualify, and that's okay.
Working in intensive care, I frequently encounter people with delirium, which creates considerable communication barriers. This has been tough to navigate, but I am learning ways to communicate effectively with people who have delirium, including offering lots of reassurance that whatever frightening hallucinations they are seeing are not real and they are safe and that we are looking after them. Reorienting patients to time and place in critical care, whether or not they have delirium, seems to really help and has a calming effect.
I also communicate with intubated people during sedation breaks, which involves reading body language and using communication aids such as picture cards and whiteboards with pens. These are situations I am gaining more confidence with as I encounter them quite often. ‘Can you squeeze my hand!?’ is a phrase that echoes around the unit a lot.
Recently, I looked after a patient who could only communicate with eye movements as they couldn't move the rest of their body, and we were still trying to gain a better understanding of what each eye movement meant for them. This presented a totally new challenge, because the highest priority to me as a nurse is to make sure that my patients' needs are being met. Luckily, I was able to observe a session with the speech and language therapy team early in the shift so I was able to learn from that. I also found speaking with the patient's relatives to be particularly valuable. It reaffirmed the importance of not only having good open communication with other members of the multidisciplinary team and their specialised skillset, but also with the patient's family and loved ones, as they are the people that know the patient the best, and they have often been with them for every step of their recovery.
Sometimes, no matter how hard I try, I cannot understand what a patient is trying to say to me, and that is one of the most frustrating feelings in the job. Adding in facemasks has further complicated these situations as I think it's really important for patients to be able to see your facial expressions to provide reassurance, understanding and to build trust. It also gives them the option to lip-read if they have hearing problems, aphasia, or language barriers.
I am yet to be in the position where I have to communicate bad news to a patient or their loved ones, so this will be another step to overcome in the future.
Knowing when to escalate an aspect of patient care to the medical staff and being confident enough to do so is another aspect of communication that I have been working on. It's not easy to step into an office full of junior doctors and consultants and express your concerns, especially when you're a newbie. The mentality I have developed is that it's always better to face potential embarrassment than to not highlight something that may become a bigger issue. It's a really rewarding feeling when your judgement is correct and makes a positive difference.
I think that at this stage of my newly qualified career I am developing a lot of communication skills that will in turn allow me to build on my leadership skills. Hopefully, dealing with the challenging situations I have described will start to come more naturally in the future. For now, though, I will enjoy the little communication wins, such as leading a team to hoist a patient from bed to chair, or reassuring a delirious patient, or even just picking up the ward phone without becoming tachycardic.