35NURSING ECONOMIC$/January-February 2013/Vol. 31/No. 1

MAGNET® JOURNEY FOCUSESon nurse staffing andworkforce developmentthat demonstrates the

structures and processes thatserve to give a “voice” to nursesas part of shared decision mak-ing. A key component in under-standing how nurses give voice totheir work is thinking about hownurses actually describe theirwork to others. What is the style

and substance of how nurses’ communication facili-tates or deters the listener(s) in seeking more informa-tion and/or elaboration about their individual work orthe work of the profession? As the Magnet visitbecame a reality, the nursing vice presidents of thethree acute care hospitals involved voiced concernsregarding how the nurses may not be prepared for the

visit. They believed the nursing staff were not com-fortable talking to reviewers about the details and sub-stance of their work. The CNO listened, gatheredinformation, and facilitated the development of anaction plan to foster better communication to detailthe impact and value of nursing in the organization.

A dynamic collegial partnership was forged withthe senior vice president for marketing and communi-cations at Main Line Health, Bryn Mawr, PA. Shefocused on how to present nursing work and out-comes to a wide variety of audiences. Her experiencein communications, coupled with a long-standingassociation with a nationally recognized expert in thisfield, helped prepare the nurse workforce. Althoughthe focus and impetus at the time was preparing thenursing staff for the upcoming Magnet visit, the les-sons learned through this experience may be appliedto nurses in any setting. It can be part of the overalldevelopment of the workforce, independent of anevent such as a Magnet visit. The aim of this article isto describe how a “communications makeover”through an intense day of education and coachingtransformed the nursing staff into effective communi-cators.

The nursing workforce must be able to communi-cate with confidence and ease their contributions andvalue to patients, co-workers, and the community atlarge. When thinking about nurses’ communication,collaboration, credibility, compassion, and coordina-tion have been identified as skill sets that exemplifynurse professionalism to members of health teams(Apker, Propp, Ford, & Hofmesiter, 2006). And withmore emphasis on communication as it relates tooverall quality and cost, the role that nurses play ispivotal (Agarwal, Sands, & Schneider, 2010).

A daylong, intensive communication training withselected Main Line Health staff provided an opportuni-ty for nurses to gain tips, techniques, and skills in howto communicate effectively in the workplace. Nursesneed specific tools to convey their mission and beinfluencers. They must be encouraged to discuss theirrole, the value of their work, and the difference itmakes to patients, families, and the community.

Giving Voice to Communicating Values, Beliefs, andContributions

Although nurses were rated top of all profession-als for honesty and ethics for the 11th year (Jones,2011), there is generally not a clear understandingamong the public and even among many health pro-

Communicating Nursing’s Excellence and Value: On the Way to Magnet®

NANCY M. VALENTINE, PhD, MPH, RN, FAAN, FNAP, isPrincipal, Valentine Group Health, Philadelphia, PA; NurseResearcher, Lankenau Institute for Medical Research,Wynnewood, PA; and Adjunct Associate Professor, University ofPennsylvania School of Nursing, Philadelphia, PA.

ACKNOWLEDGMENT: The author wishes to thank SarahPeterson, former SVP for Marketing and Communications, for herguidance in program organization, and Merrie Spaeth, SpaethCommunications, Inc., for her consultation, training, and staffassistance in the preparation of this article.

Nancy M. Valentine

EXECUTIVE SUMMARYEffective communication is essential as nurses conveytheir critical impact in care delivery.

As part of Magnet readiness, the Main Line HealthSystem engaged a nationally recognized expert to devel-op a communications strategy for staff nurses and front-line managers.

This initiative was driven by the chief nursing officer andthe nursing leadership team.

The goal was to refine communication skills of the nurs-ing staff to tell their story of the Magnet work achievedas well as to better prepare staff to clearly articulate theessential elements of their work in all settings.

The result was clinical nurses who were able to articu-late their unique value in a changing health care worldclearly.

Nancy M. ValentineImpacts & Innovations

NURSING ECONOMIC$/January-February 2013/Vol. 31/No. 136

fessionals and health care administrators as to thepivotal role nurses play in delivering superior care.Often nurses are referred to as the “glue” that holdshealth care together because they are physically pres-ent 24/7. With “glue” being a nebulous description,much of the expert knowledge, science, and skill thatnurses utilize every day often gets lost in translation.Nurses are often viewed as simply “present” doingthe work, but defining that work is not communicat-ed with clarity and purpose. Why? One often hearsnurses say with a cheerful smile, “I am just doing myjob,” “This is what is expected, it is nothing special,”or “I am just a nurse.” With such humble statementsthat connote a neutral self-image, it is no wonderthere is confusion as to what role nurses play andhow they are viewed by others.

There is work to be done to strengthen how nurs-ing’s contributions are communicated within theworkplace and beyond. However, in the pragmaticworld of the daily workplace, there is little time todiscuss such issues, unless it is made a priority. Typ -ically, the chief nursing officer (CNO) and a team ofnurse administrators expend a lot of energy buildinga large workforce with the hope of shaping a positiveteam with the outcome of excellent patient care. Tocreate an organizational architecture that allows nurs-es to articulate how the organization is structured forsuccess and how they as professionals bring value tothe organization, nurses must have in place a full-fledged communication strategy. This strategy cancontribute to giving nurses the ability to communi-cate their contributions to a wide spectrum of stake-holders, with confidence and ease.

Developing a Communication Strategy and UsingSkills to Share the Message

Workforce development is a priority for all organ-izations. For the purposes of this article, Magnet expe-rience and how it was a catalyst for developing a com-munication strategy for the nursing staff is described.The American Nursing Credentialing Center (ANCC)trademarked the phrase Journey to MagnetExcellenceTM, which is a perfect description for whatis both an exhilarating and onerous process. The CNOrealized communication can be a barrier if there is nota dedicated strategy in place. She believed communi-cation should be approached as any other process,with a clear model, a definition understood by all,and a shared vocabulary.

A critical step in sharing the nurses’ dedication toproviding quality care is an agreement on a definitionof effective communication and how to incorporate itacross the organization. The CNO employed a strate-gic communications consulting firm to provide guid-ance and training. Communication could help ournurses tell their story with both information and con-fidence. The result would be a workforce of confi-dent, articulate, staff-driven stories that brought years

of work to fruition through the outcome of redesigna-tion of Magnet status. The definition of effective com-munication is being able to influence what the targetaudience hears, believes, and remembers and enliststhem to carry your message. This is a simple, butdynamic way of thinking.

Words MatterThe power of words must not be underestimated;

in fact, words are the most powerful memory drivers.Individual words are the starting point for all mes-sages and by following a few simple rules, messagescan be memorable. A common phenomenon is to pickup and repeat each other’s words. Words fall into twobasic categories, “good words” and “bad words.”They are simplistically named to make it easy toremember the distinction (see Table 1).

“Good words” are the words you want your audi-ence to repeat and remember. “Bad words” are thewords you never want to repeat. Jargon is a subset of“bad words” because if your target audience does notunderstand a word, they stop listening and don’tremember the message. The Centers for DiseaseControl and Prevention note “nearly nine out of 10adults have difficulty following routine medicaladvice, largely because it’s often incomprehensible toaverage people” (Landro, 2010, p.1). While ANCCMagnet reviewers are extremely knowledgeable ofmedical terms, they need to know that you can speakin the language meaningful to patients and their fam-ilies. Avoid jargon or give the definition if you mustuse it to make your point. Acronyms fall into this cat-egory as well; avoid confusion and increase under-standing, spell them out.

Words have serious consequences. Organizationsqualifying for Magnet designation need to show avery sophisticated understanding of internal andexternal audiences, as well as how to educate andmotivate them beginning with “good words.”

Good words evolve into main messages, whichare titled “headlines.” By definition, “headlines” areshort, memorable, and the most powerful headlinesmake a claim. Nurses are extremely knowledgeable,but they also tend to be extremely humble or self-effacing and fact oriented. This can work against theMagnet designation process because it is particularly

Table 1.Good-Bad Words and Jargon

Good Words Bad Words (Jargon)

Accountable Accident Anuric

Caring Death BMP

Professional Fault CBC

Highly trained Neglect PERRLA

37NURSING ECONOMIC$/January-February 2013/Vol. 31/No. 1

the nurses at the bedside who need to stand out.Preparation begins with developing several “head-lines” and using them liberally. For example, Table 2reflects a headline rooted in three distinct “goodwords.”

Headlines never stand alone. While the best head-lines make a claim, they also create an expectation tothe listener that the speaker will validate or “prove”the claim. These are called “proof points,” as they val-idate the headline (see Table 3). Table 4 reflects anexample of the basic Headline + Proof structure.

Proof points do not have a restriction on length;in fact, storytelling is encouraged. The most motivat-ing proofs are stories, and quotes from other people(patients, co-workers, physicians). Stories are motiva-tional by nature and nurses have a wealth of them toshare. They can be named or unnamed to maintain

confidentiality of the patient and the rules governingprivacy.

Nurses can harness the power of words, and honenewfound skills by developing headlines and incor-porating storytelling. It’s important to dedicate time topractice using headlines and storytelling for itrequires changing behavior.

Answer vs. ResponseNurses are highly knowledgeable and by nature

fact oriented. They answer exactly what is beingasked and do not elaborate. While it is true a questionis a request for information, it should also be viewedas an opportunity to satisfy the questioner and thenmove on to the headlines and stories developed tofurther illustrate key points. However, questionershave certain expectations. They do want an answer,but the word “answer” has an impact on one’s behav-ior. People tend to accept, and limit themselves to theparameters and topic of the question, rather than ask-ing, “Who’s my audience? What do I want them tohear and remember?” The goal is to be both informa-tive and proactive, and if this is incorporated into theapproach it will be motivational as well.

Use a framing question, where a “yes” or “no”response is expected. Table 5 reflects a comparison ofthe “right” and “wrong” way to respond to this typeof question. The “wrong” response is a lost opportu-nity. A successful exchange is when you “acknowl-edge” the question with a short, truthful response andthen deliver your headline and proof point.

The real power of the “acknowledgment phrase”TM

comes into play when a negative question is posed.Most people fall into the trap of repeating negativewords (see Table 6). Table 7 reflects a successfulexchange.

Communication Skills TrainingApproximately 75 nurses were selected to partic-

ipate in the communication skill training program.The participants, even those in front-line manage-ment roles, were uncomfortable being asked direct

Table 2.Headline

“Our hospital prides itself on giving us numerous opportu-nities for professional development.”

Table 3.Proof Points

Informational Proof Motivational Proof

FactsStatistics

AnecdotesExamplesQuotes

Headline“Our hospital prides itself on giving us numerous opportu-nities for professional development.”

Proof“I received an advanced degree and tuition reimbursementwhile working full time at [hospital name].”

Table 4.Headling + Proof Structure

Table 5.Wrong and Right Responses

Question Response

“Does your hospital provide tuition reimbursement?” Yes

Wrong Response

Question Acknowledgment Headline+Proof

“Does your hospital provide tuitionreimbursement?”

“Absolutely” “Our hospital prides itself on giving us numerous opportuni-ties for professional development. In fact, I received anadvanced degree and tuition reimbursement while workingfull time at [hospital name].”

Right Response

NURSING ECONOMIC$/January-February 2013/Vol. 31/No. 138

questions. A few were near tears and others said theysimply couldn’t be counted on to deliver their posi-tive messages. They knew how much was at stake,which only added to their anxiety. This misplacedhumility and nervousness must be substituted withpride and confidence. By sharing proven techniquesand giving nurses time to digest and practice theirnewly learned communication skills. The same nerv-ous participants transformed in just a few short hours.Anxiety quickly turned to pride when they could seethemselves and their peers coached in how to tell acompelling story that was a true reflection of theirdaily work. Gaining a level of comfort with the tech-niques, being critiqued, and then seeing the results,was very rewarding to all of the participants.

Videotaping staff nurses and letting them see the“before” and “after” of their presentations and Q&Asessions proved to be a powerful tool. They were ableto see themselves as knowledgeable, compellingspeakers. These videos were so effective we postedmany of these interviews on the nursing web page aspart of the CNO blog, Nancy’s Corner, so these exem-plars could be viewed by nurses and other staff acrossall five hospitals. In the end, there were no betterspokespersons than the staff nurses themselves.

Building the individual communication skills ofthe nurses helped the organization achieve Magnetredesignation. Once the nurses were able to utilizethe checklist of skills to acknowledge questions andproactively provide headlines and stories, the ANCCMagnet appraisers heard, believed, and rememberedthe positive image.

In summation, the lessons learned from imple-menting a solid communication strategy were: • Make Effective Communication an Organi -

zational Value. Invest in developing employees’communication skills: a multi-tiered plan, begin-ning with nurse administrators and continuingthroughout the entire organization.

• Imbed a Communication Plan as a Key Elementin the Strategic Plan. Have a solid definition andmodel of effective communication and identifyresources to have staff developed in meeting thisobjective. Having such strategies is a good invest-ment in developing staff for multiple challengessuch as regulatory reviews, Magnet, team devel-opment, and customer relations among others.Such steps include:1. Identify internal and external audiences and

have a clear plan for reaching them; in addi-tion to verbal encounters, proactively developvideos and share quotes of nurses going aboveand beyond.

2. Instill confidence by regularly encouragingdiscussion of all of the positive aspects of theprofession.

3. Train and rehearse utilizing video. One of themost powerful teaching tools is video.

4. Practice effective interview techniques.Handling tough questions is part of the job,but accentuating the positive must be a part ofthe exchange.

5. Avoid using negative words and examples,replace with positive stories and quotes; shar-ing truthful stories is a great way to counter anegative topic.

• Utilize Staff in Multiple Marketing OpportunitiesBased on Stories They Have to Share. A work-force comfortable with communications can be amajor asset for an organization to tell its storyexternally in a compelling manner.

• Celebrate Success. Highlight nurses on the webpage, and communicate their success broadly tobuild and maintain good will.Empowering nurses to articulate their value is

priceless. This strategy is an effective way to get ournurses to set aside their humility and verbalize theiramazing attributes that make our hospital systemsand health care in general, exceptional. $

continued on page 43

Table 6.Acknowledgment Phrase

Question Response

“Are you ever asked to take shortcuts for budgetary reasons?” “No, we aren’t asked to take shortcuts.”

Question Acknowledgment Headline+Proof

“Are you ever asked to take shortcutsfor budgetary reasons?”

“On the contrary.” “Delivering quality patient care is our promise. In fact, we haveweekly meetings to ensure that we stay on budget and all ofthe items we need to provide quality care are ordered wellahead of time and are in stock when we need them.”

Table 7.Successful Exchange

43NURSING ECONOMIC$/January-February 2013/Vol. 31/No. 1

Impacts & Innovationscontinued from page 38

REFERENCESAgarwal, R., Sands, D., & Schneider, J. (2010). Quantifying the

economic impact of communication inefficiencies in US hos -pitals. Journal of Healthcare Management, 55(4), 265-281.

Apker, J., Propp, K., Ford, W., & Hofmesiter, N. (2006). Colla -boration, credibility, compassion and coordination: Prof -essional nurses communication skill sets in health teaminteractions. Journal of Professional Nursing, 22(3), 180-189.

Jones, J.M. (2011). Record 64% rate honesty, ethics of members ofCongress low. Retrieved from http://www.gallup.com/poll/151460/Record-Rate-Honesty-Ethics-Members-Congress-Low.aspx

Landro, L. (2010, July 6). Taking medical jargon out of doctor vis-its. Wall Street Journal. Retrieved from http://online.wsj.com/article/SB10001424052748703620604575349110536435630.html

ADDITIONAL READINGSAmerican Association of Critical-Care Nurses. (2005). AACN

standards for establishing and sustaining healthy work envi-ronments: A journey to excellence. Retrieved fromhttp://www.aacn.org/WD/HWE/Docs/ExecSum.pdf

Buresh, B., & Gordon, S. (2006). From silence to voice: What nurs-es know and must communicate to the public (2nd ed.). NewYork, NY: Cornell Press.

Gordon, S. (2010). When chicken soup is not enough: Nursingagainst the odds. Ithaca, NY: Cornell University Press.

Mangum, S., Garrison, C., Lind, C., & Hilton, H. (1997). First im -pression of the nurse and nursing care. Journal of NursingCare Quality, 11(5), 39-47.

Wang, S.S, (2012, February 15). More doctors “fire” vaccinerefusers. Wall Street Journal. Retrieved from http://online.wsj.com/article/SB10001424052970203315804577209230884246636.html