Silence Kills – Being a Skilled Communicator Matters

In 2005, the American Association of Colleges of Nursing (AACN) wrote that “Relationship issues are real obstacles to the development of work environments in which patients and their families can receive safe, even excellent, care. Inattention to work relationships creates obstacles that may become the root cause of medical errors, hospital acquired infections and other complications, patient readmission, and nurse turnover.”

Stories - Quote Bubble

Skilled communication is at the very foundation a healthy work environment, something that is important in achieving the best patient outcomes and retaining staff. And while we cannot control how others communicate to us, we can control our communication to others. As a result, we are able to redirect the tone and conversation to a higher level and contribute to a better overall work environment.

Furthermore, skilled communication is important, because, as the AACN wrote in 2005, it “supports the ethical obligation to seek resolution that preserves a nurse’s professional integrity while ensuring a patient’s safety and best interests.”

Can skilled communication be learned?

Yes! First, let’s looks at the behaviors demonstrated by skilled communicators.

Skilled communicators:

  • Seek solutions and desirable outcomes
  • Protect relationships among colleagues
  • Invite and hear all relevant perspectives
  • Ensure their words and actions match and hold others accountable for doing the same
“As you notice skilled communicators, you will see that they call upon good will and mutual respect to build consensus and arrive at a common understanding.”

As you notice skilled communicators, you will see that they call upon good will and mutual respect to build consensus and arrive at a common understanding.

These behaviors bring about positive changes in personal and professional environments. Improved teamwork, patient safety, and job satisfaction improves with effective communication.

What does it take to be a skilled communicator?

There are two things that are important to being a skilled communicator.

1. Courage. Without courage, we would prefer to withdraw.  It is often easier to stay silent than to speak up.  We all need courage at times to speak up for ourselves, for our peers and for our patients.  In a nationwide study conducted by Vital Smarts™ in partnership with the AACN, findings suggest that only a small percentage of people speak up when witnessing colleagues cutting corners, breaking rules, demonstrating disruptive behavior, making mistakes, or demonstrating serious incompetence (Maxfield, Grenny, McMillian, Patterson, and Switzler, 2005).  Staying silent is dangerous to patient safety.

2. Trust. Communication is most effective when a high level of trust exists. When we have high trust we communicate openly and share more ideas.  We exercise more creativity and take more risks when we have a trusting relationship (Reina, Reina, & Rushton, 2007).

Three Types of Trust

  • Competence Trust is the trust of capability.  Competence trust acknowledges the skills and abilities of teammates.  Competence trust encourages teammates to make decisions, involves others and helps teammates learn new skills (Reina, Reina, & Rushton, 2007).
  • Communication Trust is the trust of disclosure.  Communication trust is fostered when we share information, tell the truth, admit mistakes, give and receive constructive feedback, maintain confidentiality and speak with good purpose (Reina, Reina, & Rushton, 2007).
  • Contractual Trust is the trust of character.  When we exhibit contractual trust we manage expectations, establish boundaries, delegate appropriately, encourage mutually serving intentions, keep agreements and demonstrate consistency (Reina, Reina, & Rushton, 2007).

When trust is broken, communication breaks down. But we can get it back and I’ll explore that topic in my next article on communication recovery, which is needed when trust is broken and we need to earn back trust to improve our interpersonal relationships.  Earning and keeping trust is essential in skilled communication, teamwork, and healthy work environments.


Article References:

American Association of Critical-Care Nurses. (2012). AACN Standards for Establishing and sustaining healthy work environments: A journey to excellence. Retrieved from

Maxfield, D., Grenny, J., McMillan, R., Patterson, K., & Swiztler, A. (2005). The Seven Crucial Conversations for Healthcare, Silence Kills. VitalSmarts, L.C.

Reina, M.L., Reina, D.S., & Rusthon, C.H. (2007). Trust: The foundation of team collaboration and healthy work environments, 18(2): 103-108.


, , , , , , , , ,

Skip to toolbar