How to improve your listening skills - American Nurse Today

Practice Matters —
How to improve your
listening skills
By Beth Boynton, MS, RN
AT ITS MOST BASIC, communication
involves a message between
a sender and a receiver. But
communication isn’t always a
simple matter. For healthcare
workers, it can be influenced by such variables as
power dynamics, clinical urgency, personalities, conflict,
time limitations, and fatigue.
As a nurse, consultant, and teacher with
expertise in communication and
conflict, I often find myself
wondering if we’re focusing
enough on the listening
part of communication
and workplace dynamics.
When I give
workshops and
courses on teambuilding
and leadership
for healthcare
professionals,
I usually ask,
“What’s the leading
root cause of
medical error?” The
answer—communication
failure—no longer
surprises anyone. That’s
good news; it means we’ve
become more aware that effective
communication is crucial to
delivering safe, high-quality care and
achieving job satisfaction.
More healthcare organizations and professional associations
are addressing concerns about effective communication.
Some use a structured communication model,
such as SBAR (Situation—Background—Assessment—
Recommendation), as a framework for healthcare
providers to communicate critical information about a
patient’s situation.
GRRRR: A formula for listening
Healthcare professionals can be more successful in developing
assertiveness skills if their work environment
values respectful listening. I developed the “GRRRR for
The “GRRRR for great
listening” model can make
you a better listener.
How
can I
help ?
great listening” model to provide
a structured approach to listening.
GRRRR may be especially effective
for those working in organizations
where disruptive behaviors,
toxic environments, and power struggles exist.
Unlike SBAR and other structured communication
techniques, GRRRR focuses more on how the message
is received than on how it’s delivered.
Staff nurses and leaders also
can use GRRRR to stimulate
discussion about listening
I
appreciate
your
call.
skills and develop their
own language for defining
the type of
culture they wish
to work in.
GRRRR can be
used regardless of
the participants’
relative rank and
status. But when
a power differential
exists, maintaining
structured
communication is
more crucial—especially
in environments where
poor conduct has been
tolerated.
Here’s what the GRRRR mnemonic
stands for:
Greeting. The listener or recipient of information
can set the tone for a professional dialogue
by opening with a kind “Hello” and using the other
party’s name. “Hi, Beth. This is Nursing Supervisor
Jones. How can I help?” This is a simple, respectful
way to begin what you anticipate might be a stressful
conversation.
Respectful listening. Let the other party finish
sentences without interruption. But do make occasional
acknowledgments, such as “Okay” or “Hmmmm.” Allowing
for brief pauses can ease anxiety and give the
other party a chance to think and transmit critical information.
If the communication takes place in person,
50 American Nurse Today Volume 4, Number 9 www.AmericanNurseToday.com

make eye contact, nod, and use other
receptive body language to promote
rapport—even in the middle of an
emergency. (See Seven tips for better
listening skills.)
Review. Summarize the information
the speaker has conveyed to indicate
you understood the message
correctly, and to give the speaker the
chance to correct any misunderstanding.
Called validating, this technique
allows you to clarify your concerns
and express additional thoughts without
being intimidating or humiliating.
A few seconds of validation can help
the speaker feel he or she has been
heard, respected, and ultimately understood.
However, this process can be challenging
because it requires listeners
to separate their perspective and response
from those of the speaker.
The ability to do this effectively can
be influenced by such variables as
time, stress, tradition, skill, training,
mood—and even the weather!
Doesn’t it seem prudent to establish
an organizational norm for effective
communication rather than try to
work around these variables?
Recommend or request more
information. Once the speaker is
finished conveying his or her report
and you’ve validated or clarified it,
you have enough information to
make recommendations or request
more information. Even if you disagree
with the speaker’s message, be
Seven tips for better listening skills
Follow the guidelines below to build your listening skills, assess your current
listening skills, and facilitate conversations with colleagues about effective
listening.
1. Maximize your openness to other perspectives. Realize that seeing other
viewpoints can add to your understanding—but keep in mind that you don’t
have to change your perspective.
2. Stay in the present. Use “centering” or another technique that helps you stay
calm and focused.
3. Keep your body language and vocal tone receptive. Roughly 80% to 90%
of communication is nonverbal. When nonverbal cues are aligned with the
speaker’s words and intent, they can build trust. When they’re not aligned,
mixed messages and broken trust may result. Keep in mind that body
language and vocal tone can be misunderstood. For example, folding your
arms across your chest may be interpreted as a sign of resistance when it may
actually be an effort to conserve heat, cover up a stain, or support a sore arm.
4. Demonstrate curiosity. Ask questions to seek better understanding. Clarify,
paraphrase, and reflect on what the speaker has said. Think of the situation as
an opportunity to learn.
5. Validate. Show the speaker you are listening and understand what she or he
is saying. Validating values the other person. Strive to make it a separate
phase of the communication.
6. Be aware of extenuating circumstances. For instance, the listener may be in
the middle of a clinical emergency, late for an important meeting, or feeling
ill. Or persons who shouldn’t be involved in or exposed to the exchange may
be nearby, making privacy and confidentiality impossible. If it’s not a good
time or place for the conversation to take place, let the other person know
and suggest an alternative. Work to minimize distractions and interruptions,
too. If these are unavoidable, acknowledge their impact on your ability to
listen.
7. Practice your listening skills. Accept that developing good listening skills is
an ongoing process, and that listening well is harder on some days than
others. Role-model good listening every chance you get. And give yourself
credit—listening well is hard work!
sure to maintain a collaborative approach and avoid
put-downs.
The following response is collaborative: “A chest
tube is a reasonable suggestion, and the objective information
you’ve provided is great. This patient has
some heart failure, too, and that could be part of the
problem. Let’s do a chest X-ray and ABGs stat. Take a
minute and get those tests ordered. Then let’s review
her med list.”
Compare that with this combative response: “You’re
wasting my time. Just get the chest X-ray and ABGs.”
Reward. Rewarding the speaker for the information
conveyed helps that person feel like a respected team
player. For example, after listening to the speaker, you
might say, “Thank you for your attention to this patient’s
needs” or “I appreciate your call.” Inviting further
discussion—for instance, “Call me if problems persist”—is
an empowering strategy that reduces reluctance
to call again in the future, thereby promoting a
collaborative problem-solving environment.
Addressing communication problems in healthcare
settings gives leaders opportunities to teach about and
build healthy work relationships by incorporating respectful
listening into communication training and
workplace policies. As they do this, they can help colleagues
steer clear of difficult dynamics and shift towards
collaboration.
✯
Beth Boynton is an organizational development consultant and author of the
book, Confident Voices: The Nurses’ Guide to Improving Communication & Creating
Positive Workplaces. She is an adjunct faculty member at New England College and
publishes the free e-newsletter Confident Voices for Nurses. A featured columnist
for ANA Maine Journal, Ms. Boynton has published numerous articles and offers
various workshops. She can be reached at bbbboynton@earthlink.net. For more
information, visit bethboynton.com.
www.AmericanNurseToday.com November/December 2009 American Nurse Today 51