Nursing is highly relational, and the nurse-patient relationship is central to creating an optimal collaborative environment and the best possible patient outcomes. For nurses seeking to maximize their connection with patients, we must recognize how to work around obstacles in our way. This is where the relational rubber hits the road.
The Critical Importance of the Nurse-Patient Relationship
Dr. Kissinger Goldman, DO, MBA, is an expert emergency physician, patient experience improvement consultant, and the author of Dr. Goldman’s Guide to Effective Patient Communication.
In his work helping healthcare providers improve communication with patients and enhance care delivery, Goldman has discovered that positive change comes from many sources, including patient-centered care plans, improved communication, and patient satisfaction improvement strategies.
When asked how he would define the importance of the patient experience, Goldman states, “This is both critical and potentially life-changing. Patients and their families come to us for clinical advice. The interaction we have determines whether they will understand and trust us enough to follow that advice. Once they have the right support, the likelihood of a bad outcome drops precipitously.”
Dr. Goldman has specific observations regarding how we fall short. “We have shortcomings when it comes to effectively communicating with patients and their families. Here are some examples: we fail to realize that our tone of voice, facial expression, and body language matter; we fail to listen; and we fail to be very specific in the purpose, results, and capabilities of our tests.”
But this isn’t all. Goldman adds, “We also forget that patients don’t speak our technical language, and we forget that patient care doesn’t stop when patients leave our facility.”
Where Did We Go Wrong?
We can’t avoid the fact that healthcare is transactional; patients and insurers pay facilities to address injuries and illnesses. Healthcare is a business — at least here in the U.S. — and it’s largely profit-driven. Since that can’t be easily changed, other things must change, like how we approach relationships with patients and their families.
Goldman has a clear opinion on whether these skills are taught in nursing or medical school.
“Historically, medical programs have seen themselves as responsible for imparting clinical knowledge, often at the expense of how to deliver that care,” Goldman reflects. “The patient and family experience during clinical training is often dictated by preceptors’ beliefs and training. At the end of medical education, you’re left with a hodgepodge of providers who are asked to figure out how to effectively engage patients, their families, and other team members.”
Most nurses can relate, but some may have been lucky enough to attend a program that discussed communication, empathy, emotional and relational intelligence, and nurse-patient relationships. We may also have sadly witnessed our preceptors talking negatively about patients, treating them as burdens rather than moral and ethical responsibilities.
Solutions to Maximizing the Nurse-Patient Relationship
According to Goldman, we have work to do to make these relationships more meaningful and impactful, and providers and facilities do just that every day.
In terms of improving things, Dr. Goldman feels that even the now-common 15-minute visit can still be a positive experience.
“Is it possible to connect authentically in 15 minutes?” Goldman asks. “Often, the quality of a physician-patient interaction is more important than the duration of the visit. Even brief visits can lead to a meaningful connection if they are empathetic, respectful, and focused on patients’ concerns.”
Goldman recommends the post-visit process to improve outcomes. “To further extend its impact, the initial interaction should be supplemented by the provider understanding how the patient experience continues after the patient leaves, so making use of tools like email and phone calls can facilitate that post-discharge conversation.”
If our goal is to engage patients in their care and achieve optimal outcomes, we need to have a sense of purpose. Goldman shares three points:
“The first determinant of effective patient engagement is our disposition and attitude before we enter the patient’s room. That attitude is born out of ensuring we have a clear sense of purpose as providers. Satisfaction from our personal and professional lives also contribute to that disposition.”
He continues, “My second would be to see the patient and their family as partners who will collaborate about the patient’s care in our absence. Third: we must touch the patient by examining them in a friendly manner. Touch is an integral part of caring and building trust. The fourth is to use language that everyone can understand.”
We’re All in it Together
As healthcare providers, we can individually contribute to patient engagement by creating excellent collaborative relationships. Nurses’ skills in relationship-building, motivational interviewing, communication, and emotional and relational intelligence can contribute to this goal.
However, Dr. Goldman feels that healthcare organizations must do more to engage their employees and treat them like the human beings they are. After all, it’s not robots caring for patients — nurses and their colleagues are flesh-and-blood and have their own needs.
He advises, “First, focus on the employee/provider, ensuring that they’re fully engaged. Ensure that organizational leaders have clearly demonstrated through actions (not just providing pizza) that they care about the intricate human beings caring for their patients.”
Goldman is referring to the fact that many organizations feel they care about employees by serving pizza on special occasions. Nurses often complain that Nurses Week appreciation usually defaults to pizza, tote bags, or travel mugs, all of which can feel demeaning and insignificant in the face of their challenging life-saving work.
“Second, an organization must have complete buy-in from the entire leadership team, starting with the C-suite,” Goldman continues. “They will not only have to talk the talk but lead by example.
“Third, only then can an organization operationalize a patient experience program, and that must start early by including a valuation of the patient and family experience in the new employee interview. For long-term effectiveness, the patient experience program must include: a mandatory onboarding patient experience training program, a patient experience monitoring component, a coaching/reinoculation (as needed) component, and a celebratory component.”
Fourth, Goldman recommends having “a practicing clinician at the organization’s helm.”
A multifaceted approach is essential to maximizing nurse-patient relationships. Every clinician has a role, but leadership must also be involved at the institutional level.
Patients are our reason for being the central characters of the plot. If we remain focused on the quality of that relationship, we can improve outcomes and the ultimate satisfaction of patients, their families, and the nurses and other staff who serve them with dedication, professionalism, and kindness.
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