Talking on Placement: Communication Skills You Learn by Doing
Share
There is a particular kind of silence you notice when you first start placement. You have introduced yourself, asked whether the patient is comfortable, and then suddenly you have run out of things to say.
It can make you feel as though good nurses must have a natural ability to keep a conversation going. They do not. Nursing communication is something you learn, and much of it has very little to do with being naturally chatty. You are learning how to listen for information, ask a question without interrogating somebody, explain things clearly, notice when a person has not understood you and speak up when something concerns you.
Some of that will feel awkward at first. That does not mean the conversation is going badly.
You do not need a perfect opening line
Most conversations on placement begin quite ordinarily. Introduce yourself by name and role, check how the person prefers to be addressed and explain why you are there. If you are going to take observations, help with personal care or ask questions for an assessment, say so.
That small explanation changes the interaction. Instead of appearing beside somebody's bed and immediately asking when they last opened their bowels, you have given them some context for a fairly personal question.
From there, let the conversation respond to the person in front of you. “How have you been feeling this morning?” may give somebody room to tell you what has changed. Later, a closed question such as “Did the pain wake you during the night?” may help you clarify one particular detail. Open and closed questions are both useful. The skill is knowing what you are trying to find out.
Patients will not always answer in the order your assessment form expects. Somebody asked about pain may tell you that they have hardly slept, are frightened about going home and have not eaten since yesterday. Those details are not necessarily a distraction from the assessment. They may be telling you what is most important to them, and sometimes they change what you need to ask next.
Listening changes the assessment
Active listening is often described as eye contact, nodding and reflecting things back. Those techniques can be useful, but listening is not a performance. If you are concentrating so hard on looking like an attentive nurse that you miss what the patient has said, the technique has defeated the purpose.
Listen for changes, uncertainty and the details that do not quite fit. A patient saying, “It isn't really pain, I just feel funny when I stand up,” may need a different line of questioning from somebody describing a familiar aching knee. Clarifying what “funny” means could uncover dizziness, breathlessness, weakness or something else entirely.
Silence can be useful here. You do not have to fill every pause. A patient who stops after telling you something difficult may be thinking about what to say next. Giving them a few seconds can produce more useful information than immediately asking another question.
There will also be times when you need to bring a conversation back to the clinical issue. You can do that respectfully. Listening well does not mean allowing every assessment to become an unlimited conversation, particularly on a busy shift. Acknowledge what the person has said, explain what you still need to establish and return to anything that needs more time when you can.
Communication has to work for this patient
There is no single version of “good body language” that works for everyone. Eye contact, touch, personal space and the pace of conversation can mean different things to different people. Some patients need more processing time. Some communicate using British Sign Language, communication aids or another language. Hearing or visual impairment, learning disability, delirium, dementia, pain, fatigue, anxiety and acute illness can all change how a conversation needs to happen.
The Nursing and Midwifery Council expects nurses to use both open and closed questions appropriately, recognise verbal and non-verbal cues, check understanding and adapt communication to the individual. The useful question is therefore not “Am I communicating correctly?” but “Is the way we are communicating allowing this person to understand me and tell me what I need to know?”
Sometimes the adjustment is simple: reduce background noise, sit where the person can see you, slow down, give one piece of information at a time, use written or visual information, make sure hearing aids or glasses are available, or allow longer for a response. At other times you may need an interpreter or specialist communication support. Do not assume that a relative should automatically interpret clinical information simply because they are present.
If a patient has recorded communication needs, use them. If they tell you something works better, pass that information on and document it appropriately. Communication support is part of providing safe care, not an optional extra.
When you do not know what to say
This happens more often in nursing than students sometimes expect. A relative asks when the consultant is coming. A patient wants to know what their scan means. Somebody asks whether they are going to get better. You may know part of the answer, none of it, or know that it is not yours to give.
You do not need to manufacture confidence. “I don't know, but I'll find out who can answer that for you” is safer than guessing. If you know what is happening but not when, say that. If the question needs the registered nurse or medical team, explain that you will pass it on.
The same applies when somebody is upset. You do not always need a clever sentence. Acknowledging what you have heard can be enough: “That sounds as though it has been a difficult few days,” or “I can see you're worried about what happens next.” Then listen to the response.
Students sometimes worry about saying the wrong thing around grief, serious illness or bad news and compensate by saying too much. You may be present during conversations that are being led by senior clinicians. Your role might simply be to stay with the person afterwards, listen, answer what you can, notice what they have understood and get further support when they need it. Touch may be comforting for some people and unwelcome for others, so it should never be treated as an automatic part of compassionate care.
Talking with relatives without talking around the patient
Relatives and carers can tell you things that are clinically useful. They may notice that the patient is sleepier than usual, behaving differently, eating less or struggling with something that is normal for them at home. Listen to those observations and pass relevant concerns to the registered nurse.
At the same time, keep the patient at the centre of the conversation. When the patient can participate, speak to them rather than conducting the whole discussion over them. Be mindful of confidentiality and do not assume that being a close relative automatically means every piece of clinical information can be shared.
Your student role can make these conversations easier once you are comfortable stating it. You can be warm and helpful without pretending to know something you do not. “I'm a student nurse working with your mum's nurse today. Let me check that with them for you” is a perfectly professional response.
Speaking to the team is part of patient communication too
Communication on placement is not only about rapport with patients. At some point you will notice something that needs to be handed over or escalated, and saying it clearly can feel surprisingly difficult when you are new.
Start with the concern. If a patient's condition has changed, do not hide that information halfway through a long account of the shift. Tell the nurse what has changed, give the relevant background, explain what you have found and be clear that you are concerned.
SBAR (Situation, Background, Assessment, Recommendation) can help organise that information, particularly during handover and escalation. It is a structure, not a script. You still need to decide which information is relevant and how urgent the situation is.
You may occasionally raise a concern and feel that it has not landed. If the patient is continuing to deteriorate or you remain worried, say so again and follow the escalation process used in your placement area. Being a student does not mean you have to quietly abandon a concern because somebody more senior sounded unconcerned the first time.
Confidence usually comes after doing it, not before
You will hear experienced nurses use phrases that seem effortless because they have used them hundreds of times. It is completely reasonable to learn from that. Notice how a nurse introduces a sensitive question, brings a wandering conversation back to the assessment, explains a delay or tells a colleague that they are worried.
Over time you stop needing borrowed phrases because you develop your own way of speaking. You also learn that good communication does not always look smooth. You might need to rephrase a question. A patient may misunderstand you. You may stumble over an explanation and start again. What matters is recognising when communication has not worked and doing something about it.
That is probably the biggest change from your first placements to later ones. You stop concentrating quite so hard on what a nurse is supposed to sound like and start paying more attention to whether the person in front of you has been heard, understood and given the chance to understand you too.
Related Bleepbook resources
References and further reading
Nursing and Midwifery Council. Standards of proficiency for registered nurses.
Nursing and Midwifery Council. The Code.
NHS Quality, Service Improvement and Redesign. SBAR communication tool.