InfoLAW: Communication

Good communication is essential to good health care. In most Canadian lawsuits against doctors and hospitals, there was a breakdown in communication with the patient.¹ In a British Columbia case, for example, the Court found that the nurse’s failure to ask more questions of a person seeking telephone advice was negligent, saying, “Her fault lies in failing to pursue the matter further.”²

What is the nurse’s role in communication?

The nurse is often the central communication link between the patient and other members of the health care team. Fulfilling this role is pivotal to ensuring the patient receives safe care. In nursing practice, dialogue, written documentation, electronic and telephone communications and video presentations are commonly used forms of communication.

What are three essential channels of nursing communication?

1) Nurse / Patient communication – this is essential for the well-being of the patient. Research studies show effective patient-physician communication can improve a patient’s health as quantifiably as many drugs.³ It has influenced emotional health, symptom resolution, function, pain control, and physiologic measures such as blood pressure level or blood sugar level.⁴

For good communication it is important to:

• Speak directly with the patient or the substitute decision-maker. Focus on the patient.
• Maintain eye contact while communicating unless it is inappropriate for cultural or religious reasons. Non-verbal body language, facial expressions and tone of voice are important to facilitate good rapport and generate trust.
• Take time to listen to the patient and to hear what she is telling you. Do not interrupt to make your own point.
• Treat the patient’s concerns seriously and with respect
• Address the patient’s concerns in a manner the patient can understand. Avoid medical jargon. Seek feedback to determine comprehension.
• If you are unable to answer the patient’s questions, find someone who can; clearly identify nursing treatment, procedures and expected outcomes to the patient so the patient is aware of what is happening.
• Avoid asking questions which suggest the answer.
• Ensure the patient is literate and speaks the language used in the document before disseminating written material. Written instructions should be clear, concise and should include a contact number for assistance.

Be aware that a patient decides whom to sue; a caring manner is your best protection.

2) Nurse / Team communication – this must flow smoothly to ensure a safe, healthy working environment for staff and patients. Delays in communication, failure to communicate and miscommunication amongst team members have all been avoidable causes of injury to patients.

It is important to:

• Communicate patient information to colleagues in a timely manner
• Respect colleagues. Listen attentively and do not interrupt
• Share relevant knowledge and information
• Follow policies and procedures for communication and documentation
• Ensure there is a process for communicating concerns to management. If the problem is not resolved, continue to address the issue until an appropriate resolution is reached

Professional nursing standards hold there is a duty to communicate.⁵ Nurses have faced professional misconduct disciplinary actions pertaining to client communications as well as to inappropriate communication with other staff regarding a client.⁶ In a negligence lawsuit, the nursing team leader was found negligent for her lack of supervision of a new nurse and for her poor communication to the doctors in the team, at the expense of the patient.⁷

3) Nurse / Physician communication – this has been an issue in lawsuits where it was alleged that the nurse did not pass on information to the physician in a timely manner or at all. The courts have also held that physicians must be able to depend on the information given to them by a nurse.⁸

It is important to:

• Question an order if there is a concern about a medication, such as dosage or allergies.
• Obtain clarification of unclear orders. Never guess at an order.
• Communicate concerns, lab reports, test results to physicians in a timely manner and document that you have done so, as well as the response.
• Seek clarification of unclear facsimile transmissions by telephone.
• Notify the physician if the patient is unclear about or has questions concerning a proposed medical treatment or surgery.

Documentation is one of the most effective forms of communication used by health professionals. In the event of a lawsuit, it may also be the only evidence that a communication took place. You should follow nursing standards as well as the employer’s policies when documenting health care.⁹

In summary, always keep in mind that good communication is the key to safe care.

CNPS beneficiaries can contact CNPS at 1-800-267-3390 to speak with a member of CNPS legal counsel. All calls are confidential.

1. Ellen I. Picard and Gerald B. Robertson, Legal Liability of Doctors and Hospitals in Canada, 3rd ed. (Toronto: Carswell, 1996), p. 433.
2. Poole Estate v. Mills Memorial Hospital, [1994] B.C.J. No. 635 at para. 17 (S.C.) (QL).
3. John M. Travaline, Robert Ruchinskas and Gilbert E. D’Alonzo, Jr., “Patient-Physician Communication: Why and How,” JAOA 105, 1 (January 2005): 13-18.
4. M. A. Stewart, “Effective physician-patient communication and health outcomes: a review,” CMAJ 152, 9 (May 1995): 1423-33.
5. See, for example, College & Association of Registered Nurses of Alberta, Nursing Practice Standards, March 2003, ss. 4.2, 4.4.
6. College of Nurses of Ontario, “Summarized Discipline Decision re unnamed member re Inappropriate Care, Treatment and Communication,” The Standard 30, 3 (September 2005): 38.
7. Granger (Litigation Guardian of) v. Ottawa General Hospital, [1996] O.J. No. 2129 (Gen. Div.) (QL).
8. Ibid.
9. infoLAW, Quality Documentation (Vol. 1, No. 1, May 1992, reprinted Spring 1996).

N.B. In this document, the feminine pronoun includes the masculine and vice versa.

Vol. 15, No. 3, May 2006

THIS PUBLICATION IS FOR INFORMATION PURPOSES ONLY. NOTHING IN THIS PUBLICATION SHOULD BE CONSTRUED AS LEGAL ADVICE FROM ANY LAWYER, CONTRIBUTOR OR THE CNPS. READERS SHOULD CONSULT LEGAL COUNSEL FOR SPECIFIC ADVICE.