When talk’s not cheap: Conversations and networking for career success

By Kathleen D. Pagana | 07/01/2015
The ability of nurses to connect with colleagues, clients, and coworkers is essential for success. This chapter from The Nurse’s Etiquette Advantage, Second Edition provides great tips to make you more confident and professional both at work and in social situations.
Cover of The Nurse’s Etiquette Advantage
Do you:
  • Know how to start a conversation during a networking opportunity?
  • Need to improve your listening skills?
  • Wonder if a certain topic is safe to bring up?
  • Know the proper placement of a name tag?
  • Know how to gracefully exit a conversation when it is time to move on?
These are concerns that most people have in networking situations. Unfortunately, with today’s emphasis on electronic communication, we have neglected some of our interpersonal skills. This has weakened our confidence and skill in face-to-face communication. As an example, think of going to a gym. Note the number of people with earphones. They do not even say “hello” to others.
The ability of nurses to connect with colleagues, clients, and coworkers is essential for success. Read on for some tips designed to make you more confident and professional both at work and in social situations.
Conversational topics
What topics are safe for conversation?
When you are making new acquaintances within a professional setting, avoid controversial topics. See Table 2.1 for a list of safe and taboo conversational topics.

Table 2.1: Conversational Topics

Safe Unsafe
Weather Politics
Sports Religion
Traffic Salary or cost of items
Travel Jokes of questionable taste
Movies and books Medical problems
Current events Gossip
Education Personal misfortunes
New developments in science Controversial issues
Is it OK to talk about children?
Yes—to some extent. If people ask about your children, answer briefly. Feel free to ask about their children. Be careful to avoid monopolizing the conversation by talking about all the great things your children are doing. Be sensitive to the fact that some people may not be able to have children. People without children may also be bored hearing about your children.
What are some attributes of a good conversationalist?
In addition to being polite and truly caring about others, a good conversationalist does the following:
  • Shows interest in others
  • Keeps abreast of major news items
  • Makes good eye contact when speaking
  • Pays attention to body language
  • Doesn’t pre-judge others
  • Avoids correcting a person’s grammar in public
  • Accepts compliments gracefully
  • Knows how to pay a compliment
  • Addresses everyone in the group
  • Does not monopolize the conversation
  • Knows how to make a shy person feel included
  • Knows how to ask questions without prying
  • Steps in to fill an embarrassing void in the conversation

Your listeners won’t care how much you know until they know how much you care.


The art of small talk
Is small talk really important?
Yes. Small talk is an easy way to start conversations until you find a common area of interest or until business begins. It is used to break the ice and to make people feel comfortable. Small talk is a gateway to new relationships and is also important for maintaining established relationships. There is nothing small about small talk (Pagana, K. D., 2009b)!

Faux pas
Marlene was interviewing for a faculty position. As part of her tour around the campus, she was guided by Janet through the library. Marlene made no comments and did not ask any questions throughout the tour. Her responses to Janet’s questions were all one-word replies. When the dean met with Marlene, the 45-minute scheduled interview was completed in 15 minutes. Her awkwardness was readily observable. She was uncomfortable and made the interviews uncomfortable. All of Marlene’s evaluations were negative, and she was not offered the position.

One always speaks badly when one has nothing to say.


Do you have any tips for breaking the ice with small talk?
Yes. To aid your conversation, use the acronym OAR:
  • Observe. Make an observation. For example, “It looks like there are 500 people here.”
  • Ask. Ask questions. For example, “Is this your first time in San Diego? ”
  • Reveal. Reveal something about yourself. For example, “This is my fifth time attending the Sigma Theta Tau convention.”

Practice this technique. You can do this anytime and anywhere. For example, you can be standing in the cafeteria line with a colleague, waiting for a meeting to begin, or chatting with the grocery store clerk at checkout (Pagana, K. D., 2013a).

How important is networking for career development?
Networking is about forming relationships. It is essential for career development because these relationships can benefit you, the other person, your careers, and your lives. These relationships connect you with new colleagues, new opportunities, new information, and different professional practice settings. Think of networking as part of your career, not an add-on if you have time (Pachter, 2013).
Don’t make the mistake of thinking that networking occurs only in a professional setting. It can happen anywhere—on the train, at an art class, in the gym. You might be chatting with someone who knows a key person who can help you obtain your next position.
Networking is also facilitated by social media, such as LinkedIn. See Chapter 7, “Avoiding Blunders with Social Media,” for more details.

Good Idea!
Eloise flew to Chicago to interview for her dream job. While eating lunch, she was chatting with the waiter about her reason for coming to Chicago. To her surprise, the waiter’s father was the person she was scheduled to interview with the next morning! She learned a lot of key information that made her interview a great success.

What are some ways to expand my network?
There are several ways to expand your network. Here are a few tips (Pagana, K. D., 2013a):

  • Join professional organizations.
  • Attend professional meetings.
  • Use social media, such as LinkedIn.
  • Join a health club or gym.
  • Serve on committees and boards.
  • Volunteer in your community

Good Idea!
Kim was a new employee in a large company. She joined the company soccer team and met many new friends. She volunteered to help coordinate the holiday party. During the party, she was the master of ceremonies and introduced all the company officers at the party. This was certainly a great way to network and meet all levels of people in a new position.

How can I prepare for a networking session at a conference?

Networking is a powerful way to make new contacts and form new professional and personal relationships. Prepare by being well-read. Read newspapers, magazines, and key journals related to your conference or specialty. Find out who is going to be there and plan to meet at least several new people. Also research people online. This is a great way to find out what they have done and any common interests.

I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.

–Maya Angelou

Faux Pas
Donna, the executive director of a nursing association, was the closing presenter at the annual state conference. She spent the day in her hotel room working on her presentation and checking her email. Unfortunately, she missed hearing and meeting the other invited speakers. The conference-planning team wanted to invite one of the speakers to present at the national convention. Unfortunately, Donna was unable to provide any feedback because she had missed the chance to network with the other speakers and attendees.

What is the key to “working the room” at a business or social event?

The key is to demonstrate respect, courtesy, and consideration for the feelings of others as you stay alert for networking opportunities. Good manners are good for business, and bad manners may mean no business. To paraphrase the great Maya Angelou, we may forget what people say to us, but we remember how they made us feel.

Working the room does not entail flitting from person to person, handing out your business cards, and pumping hands with as many people as possible in a short period of time. If you don’t care about people, they will easily sense your insincerity.

TIP: If you can spot someone “working a room,” that person is doing it wrong.

How do I work the room?
The easiest person to approach is a single person standing alone. That person will appreciate your walking up and introducing yourself.

If you see couples, take note if they are in an open or closed stance. If they are in an open stance (standing side by side), feel free to approach and introduce yourself. If they are in a closed stance (standing face to face), this implies they are having a private conversation. Don’t approach them.

With groups of three, note the open or closed standing positions. Approach a group with the open stance. If you observe a large group of four or more people standing in a circle, that group is closed.

There are basically six ways that people assemble at a networking event:

  • Standing alone
  • The open two
  • The open three
  • The closed two
  • The closed three
  • Larger groups standing in a circle

The first three types of groups will generally be welcoming. Avoid the latter three unless you know someone in the group (Kintish, 2006).

What should I say as I approach a person or group that I do not know?
Smile and say, “Hello, may I join you?” Then introduce yourself and use small talk to get acquainted.
What do I do if I hear myself talking too much?
You do not want to monopolize the conversation. You can demonstrate your interest in others by letting them speak. Remember the old adage that you were given two ears and one mouth for a reason. You want to listen more than you speak. Here are two acronyms to keep you on track (Kintish, 2006).
  • WAIT: Why Am I Talking?
  • STALL: Stop Talking And Listen and Learn 
Table 2.2: Common Networking Mistakes and How to Avoid Them

Networking Mistakes

Tips to Avoid Mistakes
Skipping the networking reception at a conference Arrive early to mingle with other guests or the speaker.
Approaching the event with a negative attitude Approach the event with enthusiasm.
Focusing on your personal agenda Try to be a resource for others.
Forgetting your business cards Always carry your business cards with you.
Not writing down pertinent information Jot down notes on the back of a business card.
Connecting only with your friends Expand your network by making new contacts.
Not following up afterward Schedule time afterward for follow-up.
Drinking too much Drink responsibly.
What is the best way to handle a compliment?
Smile and graciously say, “Thank you.” You could add to this by saying, “Thank you. I appreciate that.” Here are some helpful hints for giving or receiving a compliment (Mitchell, 2004):
  • Discounting a compliment makes you look unprofessional.
  • Don’t feel compelled to return the compliment.
  • Do not ask where someone bought his or her outfit or how much it cost.
  • Do not brag about your designer labels.
  • Make sure you are sincere when complimenting someone.

TIP: Even when you are a guest at an event, act like a host. When you think like a host, you act in a different way. You will be more confident, purposeful, and certain.

Are there cultural considerations for networking?
Yes. There are many cultural considerations, such as personal space, eye contact, topics of conversation, handshaking, and use of the business card. If you know who will be at a networking session, you should learn in advance about cultural preferences and sensitivities. For example, Chileans stand very close when talking. Chinese people may keep their eyes slightly averted as a sign of respect. See Chapter 12, “Going Global,” for more guidelines on global etiquette.
How can I disengage gracefully from a conversation?
This is important when networking, because your goal is to meet several people, not to spend the entire time talking with one person. Here are some tips:
  • Excuse yourself and say you are going to the restroom.
  • Excuse yourself and say you have to make a phone call.
  • Excuse yourself and say you need to touch base with a colleague.
  • Say, “It was great speaking to you. I’ll let you have some time to speak to others.”
  • Say, “It was nice meeting you. I hope to see you later.”
  • Say, “Well, Theresa, it has been nice talking with you. Will you excuse me? I see my roommate over there, and I promised I’d catch up with her.”
  • Introduce the person to someone else and then excuse yourself as you move away.
  • Keep your phone on vibrate at professional gatherings. If it should ring, apologize and move away to talk.
Generational differences in communication
Where do I start with generational issues in communication?
A good starting point is to understand that differences exist between people of different generations. These create both challenges and opportunities. Business is all about building relationships. This can be harder when people come from other generations. To begin, identify what generation you belong to, as well as what generation others belong to. Use the following guide (Post, 2014):
  • Veterans: Born before 1945
  • Baby Boomers: Born between 1945 and the mid-1960s
  • Generation Xers: Born between the mid-1960s and 1980
  • Millennials: Born between 1980 and 1995
How do I deal with different styles of communication?
Know where people are coming from with their communication style. For example, veterans entered the workforce talking to one another in person; baby boomers communicated by phone; gen Xers use email; and millennials favor texting. Awareness and respect are the keys to working together. This awareness is especially important for nurses, who work with colleagues and clients from different generations.
Veterans may prefer face-to-face interactions. Boomers may prefer face-to-face, telephone, or email. The younger generations prefer electronic communication (Saver, 2011). However, don’t assume that all members of the same generation are the same. There are many individual differences.
How do I determine how my colleagues prefer to communicate?

Ask. Alternatively, follow their lead if they initiate the communication. For example, if they sent you an email, respond by email. If they left a phone message, use the phone.

Does multitasking affect communication?
This is an important example of generational differences. The younger generation has grown up texting and doing several things at a time. To the older generation, this behavior seems distracted, disorganized, and often disrespectful. Think about this. Also, don’t forget the importance of eye contact when communicating face-to-face.

How can mentoring help with networking and career development?
A mentor can be invaluable, helping connect you to people and opportunities. Listed here are some of the benefits of having a mentor (Vance, 2011): 
  • Building your confidence
  • Increasing your productivity
  • Preparing you for leadership roles and other opportunities
  • Developing your potential
  • Increasing your career satisfaction
When is the right time to look for a mentor?
When you establish your career goals, you will know what you are looking for in a mentor. Target a person with similar personal and professional aspirations.
How long does the mentoring relationship last?
Many of us think of a long-term relationship of mentoring over years or even decades. But according to Vance (2011), mentoring can also include one-minute or instant mentoring.
As a new graduate, I once asked an experienced nurse for help locating something in the supply closet. She not only located the object for me, but went through the entire closet and told me how everything there was used for patients. That one-minute mentorship was invaluable! We can all be one-minute mentors for many people.
Our hospital has an optional mentoring program for new graduates. Should I join?
Absolutely. The first year at work is challenging for new graduates. Having a mentor can help you learn about the hospital from an insider. The mentor can help you deal with challenges and position you to meet your professional goals. Be sure to express your appreciation to your mentor.
TIP: Open, honest communication is the foundation of a healthy mentoring relationship.
Are there mentoring problems that protégés should try to avoid?
Yes. Problems with the mentoring relationship can occur. Here are some to try to avoid (Vance, 2011):
  • Unrealistic expectations: This can cause feelings of disappointment and betrayal.
  • Power and control issues: Power should always be used to enhance the potential of the protégé rather than for manipulation or self-aggrandizement.
  • Excessive competitiveness: This can weaken trust and mutual sharing.
  • Dependence: After receiving input, guidance, and encouragement, the protégé should make his or her own decisions.
Name tags
What is the proper placement for a name tag?
The name tag should be placed on the right side of your chest so it can be easily seen when shaking hands. When you shake hands, your right shoulder is thrust forward and your left shoulder moves out of the eye line of the other person.
If you are wearing a name tag on a lanyard, adjust the length of the string so it is positioned at the upper part of your chest. It is awkward having to move your eyes from a person’s face down his or her body to the navel area to see the name tag. Also, check often to make sure your name is facing out, not flipped over.
What credentials should a nurse in a healthcare provider role wear on a name badge?
At a minimum, a registered nurse should have RN on a name badge. Patients have a right to know who is taking care of them. If you list other letters, it is your responsibility to educate others about the meaning of your credentials.
Communicating with a person with a disability
Do you have any suggestions for communicating with a person who has a disability?
Focus on the person and not on the disability. Here are some guidelines to avoid offending someone with a disability (Brody, 2005; Mitchell, 2004): 
  • Avoid using the words victim, cripple, and invalid. Disability is preferred over handicap.
  • Ask if people need help with something before moving to help them. Don’t assume a disabled person cannot do something like open a door when in a wheelchair.
  • Be prepared to shake hands with a person who has a physical disability. Note which hand the person extends for the handshake and respond in kind.
  • Identify yourself as you approach a person who has a visual impairment. Don’t raise your voice. If the person has a guide dog, don’t pet the dog without asking permission. If the person is blind, make your presence known by speaking and introducing yourself. When initiating a handshake, say something like, “May I shake your hand?” If the blind person initiates a handshake and you cannot shake hands, explain why you can’t. For example, say, “I’d like to shake your hand, but I am carrying several packages.” Say goodbye so the person knows when you are leaving.
  • If you are speaking with someone who has a hearing impairment, stand where you can be seen. Stay within his or her line of vision so the person can see your lips. Reduce background noise. Speak directly to the person, even if he or she has an interpreter present. Add facial expressions. Listen patiently.
  • Position yourself at eye level when speaking to someone in a wheelchair. Never assume a person in a wheelchair cannot see, hear, or speak. Don’t move a wheelchair out of reach of the person who uses it. Push a wheelchair only if the person wants your help.
How can I ensure successful interactions with deaf and hard-of-hearing patients?
To ensure successful interactions with deaf and hard-of-hearing (HOH) patients, HOH patient and educator A. Kay Tyberg recommends the following (personal communication, 2007):
  • Deafness is an invisible disability. Do not be embarrassed when patients tell you they are deaf or hard-of-hearing (HOH).
  • Speak face to face to the patient.
  • Deaf and HOH patients can do only one thing at a time. So, for example, if weighing the patient on a scale, do not ask other medical-related questions.
  • Not every deaf or HOH patient is a skilled lip reader.
  • It is inappropriate and rude to use the term deaf and dumb.
  • Healthcare personnel should wear their name tag in the upper chest area so patients can immediately identify their name and credentials.
  • Post a sign above the patient’s bed indicating that the patient is deaf or severely HOH.
  • If the patient is hospitalized, nurses need to communicate to all shifts that the patient is deaf or HOH.
  • If the patient rings the call bell, do not respond over the intercom.
  • While in the hospital, see if closed caption television is available.
Can I ask family members of a deaf person to serve as interpreters to save expenses?
According to the Americans with Disabilities Act, it is illegal for hospital personnel to ask family members to serve as interpreters to curtail expenses. A sign language interpreter should be provided upon the person’s request (Tyberg, personal communication, 2007).
What is the best way to get the attention of a deaf person?
Physical touch is the normal way of getting the attention of a deaf or HOH patient. Tap the person on the hand, arm, or shoulder to get his or her attention.
Nurse-to-nurse collaboration
What are some tips for nurse-to-nurse communication?
​Civility is the key word for nurse-to-nurse communication and interaction. Civility is demonstrated in a clinical setting by nurses being courteous and polite with each other. Their conduct should consistently show respect for others, make others feel valued, and contribute to effective communication and team building.
Incivility can be described as rude or disruptive behavior that often results in distress (psychological or physiological) for the person targeted. Incivility can progress through a wide range of behaviors, from eye rolling all the way to physical violence (Clark, 2013). Uncivil behavior has a negative impact on nursing job satisfaction and turnover as well as patient safety and outcomes (Lower, 2007). Table 2.3 lists examples of incivility in the workplace.
Table 2.3: Examples of Incivility in the Workplace
Verbal Abuse Negative Behavior Physical Behavior
Making demeaning comments Humiliating a colleague Throwing charts
Using condescending language Scapegoating Assaulting someone
Making impossible demands Withholding information Punching a wall
Expressing impatience with questions Undermining staff morale Outbursts of rage
Insulting a colleague in front of a patient Acting with a cultural bias Slamming doors
Telling ethnic jokes Spreading rumors Banging into others

(Lower, 2007)

Is incivility a new problem in healthcare?
No. It has been around for some time. However, now the healthcare community is making more of an effort to stop it. Here are the three examples of how:

  • The Joint Commission has listed incivility and bullying as a sentinel event in 2009.
  • State boards of nursing have sanctioned some nursing programs for this problem.
  • It would be unlikely for a hospital or medical center to attain or sustain Magnet status if this type of behavior exists.
What are some of the costs of incivility in healthcare?
There are many. Some of the most important are listed here (Clark, 2013):
  • Increased stress
  • Damaged relationships
  • Lowering of self-esteem and morale
  • Feelings of vulnerability
  • Staff disengagement
  • Staff turnover
  • Lower productivity
  • Decreased safety in the workplace
  • Unsafe or compromised patient care
What behaviors promote a positive work environment?
Here are some ideas to promote a positive work environment:
Greet colleagues with a smile and a “hello” when you arrive at work.
  • Offer to help others.
  • Thank people for helping you.
  • Use polite language and good manners.
  • Compliment others when appropriate.
  • Avoid listening to gossip.
  • Don’t be a complainer.
  • Respond to phone calls, emails, or other forms of correspondence in a timely fashion.
  • Don’t interrupt conversations to respond to phone calls, emails, or text messages unless they are urgent. If you must interrupt, ask permission and apologize for the interruption.
  • Participate in department events.
  • Say “goodbye” to your co-workers when you leave the work setting.
How can I initiate tough conversations dealing with things like tardiness, poor hygiene, bullying, and lack of teamwork?
Before confronting someone with a difficult topic, ask yourself three questions:
  • What’s the problem?
  • How do I feel about it?
  • What do I want to be different?

Now you are ready to use the STOP strategy to guide you through difficult conversations. Plan, prepare, and practice this conversation before confronting the person. Here are the components (Pagana, K. D., 2014):

  • State the situation or problem.
  • Tell the person what you want.
  • Offer an opportunity for a response.
  • Provide closure (review, summarize, or thanks).
What is an example of the STOP strategy?
Here is an example for dealing with a staff member who is tardy:
  • S: “Monday and Tuesday, you arrived 20 minutes late for work.”
  • T: “I want you to be here at 6:45 a.m.”
  • O: “Can we agree to this?”
  • P: “Thanks. This will help us work together better.”
Nurse-to-physician collaboration
How can nurses better communicate and collaborate with physicians?
The key to better communication with physicians is to remember that you are an important member of the healthcare team. Research on Magnet hospitals shows that improved collaboration between nurses and doctors leads to better patient outcomes (Pagana, K. D., 2012b). Here are some tips:
  • When you see a physician on the nursing unit whom you do not know, introduce yourself and say, “I am the registered nurse taking care of _____.”
  • Tell the patient that the physician is on the unit. This will give the patient an opportunity to be ready and in position for an examination before the doctor enters the room. The patient will also have time to think of concerns and questions.
  • Inform other nurses taking care of the physician’s patients that the doctor is on the unit. This will give them time to organize their questions and concerns.
  • Make rounds with the physician and discuss pertinent care issues and needed orders. If you cannot make rounds, have issues documented on a communication sheet.
  • If the physician is covering for another physician, provide an update of the patient’s hospital course. For example, say, “Mrs. Balon was admitted 3 days ago for syncope. She had a pacemaker inserted 2 days ago and is hoping to be discharged today.”
  • Check the orders before the physician leaves the unit and clarify as needed.
  • If the physician was called to the unit to handle an urgent situation, have the physical assessment findings and updated vital signs available along with the pertinent lab values. Put the patient in a position to be examined. Discuss the concerns that led to the urgent call to the unit.
  • If texting a physician regarding a patient, do not use any patient-identifying information. Text a request to talk about a patient and ask the physician to call you.
Why are some nurses reluctant to speak to physicians about patient concerns?
Nurses and physicians are taught to communicate in different styles. Physicians tend to be concise and get to the point quickly. Because nurses are taught not to make diagnoses, they tend to be insecure about presenting their findings and paint a broad picture of the situation when communicating with physicians. Often, physicians become impatient with a lengthy and possibly rambling message (Tocco & DeFontes, 2014).
Are there are guidelines to facilitate effective communication with physicians?
Yes. There are several. I will give two examples. One is the SBAR technique, which is widely used in healthcare (Pagana, K. D., 2012b). SBAR stands for the following:
  • Situation: What is the reason for your concern?
  • Background: Why was the patient admitted? What procedures or surgery was performed?
  • Assessment: What are the vital signs, lab results, and clinical findings?
  • Recommendation: What would you like the physician to do or order?

For example, suppose you want to recommend an anxiolytic for your patient. Here’s how you can use the SBAR technique to convey your recommendation to the physician:

  • Situation: “Mrs. Collins is complaining of severe anxiety.”
  • Background: “She is 1 day post-op from a lumbar laminectomy.”
  • Assessment: “She is alert and oriented and her vital signs are stable. She has no numbness or tingling in her extremities.”
  • Recommendation: “She said she takes lorazepam 2 mg orally at home when she is anxious. Would you like to order this or something else for her?”

Another technique is the check-back tool for ensuring clear communication and teamwork. This is a concept promoted by TeamSTEPPS and CREW resources. This tool employs closed-loop communication to ensure that information conveyed by the sender is understood by the receiver as intended. Here is an example:

  • Doctor: “Give me 25 mg of diphenhydramine IV push.”
  • Nurse: “25 mg of diphenhydramine IV push.”
  • Doctor: “That’s correct.”
What can I do to collaborate better when patient safety is at stake?
Patient safety concerns may require the CUS technique. This is a mutually agreed upon critical language derived from the airlines. For critical language to be effective, all team members must understand it and accept it in a culture that immediately addresses patient-safety concerns. CUS is an acronym for the following:
  • I’m Concerned: For example, you might say, “Dr. Jenkins, I am concerned about Mrs. Knight. The baby’s heart rate is in the low 60s.”
  • I’m Uncomfortable: Here, you could say, “I’m uncomfortable with these late decelerations.”
  • This is unSafe. Finally, you could say, “I don’t think it is safe to continue labor.”

How can I demonstrate professionalism in a phone call with a physician?
This is a key area for preventing communication breakdown and acting as a patient advocate. Here are some suggestions:

  • Be sure you are contacting the right physician: The orthopedic surgeon will not want to be called about an abnormal heart rate.
  • Contact the physician by his or her preferred method: Many physicians use cell phones and do not want to be called on their home phone.
  • Offer specific instructions to unit clerks: If you are asking a unit clerk to initiate the call, be very specific with your instructions. For example, say, “Please call Dr. Guisseppi at his office and say that I would like to speak to him about the blood sugar on Mike Browning.”
  • Be available for quick access when the call is returned: Make sure the unit clerk can quickly locate you.
  • Have pertinent information at your fingertips: For example, be ready with the latest set of vital signs, intake and output, assessment data, current intravenous solutions, recent lab reports, medication list, allergy information, and patient chart.
  • Be succinct: Use the SBAR technique mentioned earlier in the chapter.
  • Be ready to take orders: Have an order form available and ready to use for phone orders if the physician cannot enter the order electronically.
The patient experience
How does communication with patients affect the patient experience?
This is a timely question with healthcare reimbursement. Value-based purchasing is now used to determine the effectiveness of patient care and to determine payment for services. Basically, this is “pay for performance” based on quality of care. The patient experience is one of the four determinants of reimbursement along with outcomes, efficiency, and clinical process of care.
TIP: Open communication improves the quality and safety of patient care.
Communication is one of the key components used to evaluate the patient experience.

Patient survey questionnaires such as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) address core questions about the patient’s hospital experience. Examples include questions about communication with nurses, communication with doctors, communication about medications, and discharge information A key component of the patient experience involves listening to patients.
How can I improve my listening skills?
Listening is one of the most generous and gracious human behaviors (Krames, 2002). Never underestimate the power of good listening. A good listener can make the patient feel like the most important person in the world.
Table 2.4: Tips for Good Listening
Things to Do

Make good eye contact.
Things to Avoid

Finishing sentences for others
Ignore distractions. Daydreaming
Smile and nod your head. Interrupting
Ask questions. Changing the subject
Lean forward. Looking at your watch or mobile device
Face the person with your body. Distracting body language (looking around the room)

Good Idea!
After falling and fracturing his patella, Brian was admitted to the hospital for a patella repair. He started physical therapy (PT) the morning after surgery. After returning from PT, he was upset and told his nurse several reasons why he was unhappy with his treatment by the PT department. The nurse contacted the supervisor of PT and explained his concerns. The supervisor came to the unit to discuss the problems. He was treated by a different therapist in the afternoon and was pleased with the quick response to his concerns. This situation demonstrates the nurse’s role as an advocate for patients in vulnerable positions.

What is the best way to respond when a patient thanks you for something?
Smile and say, “My pleasure” or “You’re welcome.” Don’t use the phrase, “No problem.” This minimizes the expense, education, and experience it took you to become a professional nurse.
How can networking and conversational tips be applied in clinical settings?
There is a book called Don’t Sweat the Small Stuff. The advice to not sweat the small stuff does not apply in networking and clinical settings, however. Sweat the small stuff! Small things make a big difference, especially to a client in a healthcare setting. Some guidelines are listed here:
  • Address all patients as Mr., Mrs., or Ms. Use a first name or nickname only if the patient gives you permission. Avoid all use of familiarities such as “honey” or “sweetie.”
  • Greet new patients with the following: “Welcome to _____. My name is [first and last name], and I am the registered nurse who will be coordinating your care until [time].”
  • Review the plan of care and treatment goals for the day. Tell the patient the times of any scheduled activities, such as physical therapy. Write this information on a white board, if one is available. Ask for patient input. Don’t write anything that would violate HIPAA privacy rules.
  • When leaving a patient’s room, ask, “Is there anything else you need? I have the time.” Make sure the call bell, phone, water, TV, and tissues are within the patient’s reach.

Many healthcare facilities are adopting policies and scripting to ensure more positive interactions with patients. See the following sidebar for examples.

Tips for professional patient encounters

  • Knock on the door, speak softly, and wait for the patient’s permission to enter the room.
  • Wash your hands.
  • Identify the patient.
  • Make eye contact and smile.
  • Introduce yourself.
  • Provide an explanation of what you are going to do.
  • Be gentle in handling the patient.
  • Ensure maximum privacy (pull the curtains and close the door).
  • Wipe down the needed equipment (such as blood-pressure cuff).
  • Do not act rushed even if you are.
  • Ask the patient:
    • How can I help you today?
    • Is there anything I can get you before I leave?
    • Do you have any questions?

Used with permission by Ohio Valley General Hospital, McKees Rocks, Pennsylvania

Advice from a clinical specialty area
Because of frequent contact with dialysis clients, nurses may reach a comfort level and disregard the professional boundary lines. Even when nurses are completely at ease with patients, they need to remember that the workplace is not their home. They should maintain a degree of formality and consider the workplace a place of respect. As an example, a colleague recounted a complaint made by her mother, who had recently begun dialysis. The staff in the dialysis unit did not call the mother by her name, but used terms such as “sweetie” and “honey.” The patient found this belittling and demeaning. She was an individual with a name. This lax attitude annoyed her and made her uneasy. (Headley, 2007)

Frequently asked questions

What should I do if I am talking with a colleague and someone I do not know joins us?

Introduce yourself. Your colleague may not make introductions because he or she has forgotten your name or the other person’s name.

What should I do if someone keeps asking me questions and never says anything about himself or herself?

Say, “Enough about me. Tell me about you.”

How can I avoid getting drawn into a political or gossipy conversation?

You can say something like, “I’ve got to go. I have found that politics (or gossip) doesn’t mix well in the work environment.”

If a colleague or potential client is unavailable when I call on the phone, how can I find out a good time to call again?

In a polite manner, ask the receptionist, “When do you recommend I try calling back? ”

What should I do if I am having trouble understanding someone who is speaking English as a second language?

Ask the person to repeat what he or she said more slowly. Tell the person you are having a hard time understanding and need his or her help. Put the blame on yourself, not on the speaker. Another option is to call interpreter services to assist.

If I am speaking to someone at a reception, and a friend is waving to me across the room, what should I do?

You can wave and nod, but then return your full attention and focus on the person you are speaking with.

What should I do if I am greeting and meeting people and I need to sneeze?

Have a handkerchief or tissue in your left hand. That way, your right hand will be clean for handshakes.

After I’ve met someone at a networking session, how can I keep the connection alive?

Make an effort to stay connected. For example, send notes or emails. Try to connect within a week or two so the person will remember you. Call on the phone to say “hello” or to meet for a meal. Acknowledge any awards or honors with a congratulatory note. If you see an article that might interest the person, send it with a brief note.


The essence of networking is the building of new relationships.

Respect is a key component of effective intergenerational communication.

Plan a two- or three-sentence response for the inevitable question, “What do you do?” Tailor this to the situation or event.

There is nothing small about small talk.

Try being a one-minute mentor.

If your name tag is hanging on a lanyard, make sure it is turned so it can be read.

Use the term disability instead of handicap.

Incivility among healthcare professionals can lead to compromised patient care.

Use the SBAR technique to facilitate communication with physicians.

The patient experience is a determinant of healthcare reimbursement.

When calling someone’s office, always treat the secretary or receptionist with respect and courtesy.

Make the first move when meeting new people.

When someone tells you that you are a great conversationalist, it is often a compliment to your listening skills. 

Kathleen D. Pagana, PhD, RN, an emeritus professor at Lycoming College in Williamsport, Pennsylvania, is president of Pagana Keynotes & Presentations. She is the author of more than 85 articles and 28 books. Her most popular books have sold more than a million copies and have been translated into French, Chinese, Korean, Greek, Polish, Spanish, and Portuguese.

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