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Vol. 26, No. 3, MARCH 2009

Don’t Listen at Your Own Peril

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To listen well is as powerful a means of communication and influence as to talk well.
—John Marshall

Shouldn’t communication become easier with the proliferation of computers and other technology? Yet, it feels like the opposite to me as our systems and environments become increasingly complex. Maybe technology simply expedites already bad communication, just like when we automate bad processes.

What comes to mind when you hear the words “skilled communication”? Probably the ability to clearly articulate important information or convey your point of view. Then there is the critical and often overlooked skill of listening. I learned about “active listening” in nursing school. You probably did too. But do you ever use active listening as a skill to develop a shared sense of trust, respect and engagement with colleagues? Or is it reserved only for patients and families?

A Project Planning Logjam
Consider this. Your unit is about to implement a major project led by experts from another department. It might be a new medication packing system. Or a new module in the hospital information system. Six weeks before the start date, a group of experts and unit nurses begins meeting weekly to develop the implementation plan. The nurses try to communicate their needs because the project will change clinical practice. In turn, the experts try convincing the nurses that the simple change needs little advance preparation. A month later, the launch date is perilously close and the group is no closer to having a plan.

The nurses tried restating their perspectives in different ways, unfortunately without also listening to what the experts were saying—or what they were not. Had the nurses listened more carefully to what was not being said, they might have identified the reason for the hesitation and asked why their point of view was not being recognized. What might have caused them to talk past each other? Opening their frank concerns for discussion, the group might have more readily acknowledged the barriers and embraced creating a mutually beneficial plan. Why did no one stop the process and speak directly to the impasse?

True Listening
In his engaging Relationships 101 book, John Maxwell suggests that true listening results in many positive outcomes. For example, showing respect, building relationships, increasing knowledge, generating new ideas. True listening, as Maxwell calls it, is a core element in each of AACN’s healthy work environment standards. Authentic leaders bring value when they listen to the staff to get accurate information from which they can problem solve, while role modeling respect and engagement. True collaboration is based on openness to one another’s unique skills and perspectives, which will be revealed only through skilled communication. Effective decision making and appropriate staffing requires sharing accurate information. Recognition can only be meaningful if one listens closely to find out what is indeed meaningful to each individual. How can we hone our listening skills?

The opposite of talking is not listening. The opposite of talking is waiting.
—Fran Lebowitz

Focus on the speaker and maintain eye contact. It expresses our engagement in the interaction and helps to block other distractions. Former President Bill Clinton is considered a master at conveying to a person that they are the most important person at that moment. Instead of planning your next statement, seek to understand the meaning of what the other person is attempting to communicate. This curbs the urge to interrupt. It’s important to suspend judgment and keep our emotions in check, which allows us to hear the message as it was intended to be received. The moment we feel most frustrated at not being heard may be when we need to listen most. Asking questions for clarity and summarizing what we believe we have heard shows the speaker we are committed to accurately hearing what he or she is trying to say.

Many of us believe we are good listeners. Today’s communication overload makes it easy to presume we already know what we’re being told and move on to the next interaction or task. Skilled listeners hear the whispers—the nonverbal messages, what is not being said, the early murmurs of discontent, new patterns as they emerge.

Every day, a patient’s spouse confronts the staff with an endless list of issues and complaints about his wife’s care. The frustrated staff ask the manager to intervene. Gently placing her hand on his shoulder she asks, “How long have you been caring for your wife?” “Seventeen years,” he sighs. “And who is caring for you?” she asks. “No one,” he sobs. The gates to finding the right interventions had just opened.

How would you have handled this delicate situation? Have you had successful experiences using skilled listening? Have you seen its absence lead to failures? If you would like to share these, please write to me at insights@aacn.org.

What do you see?

See something a new way and you’ll never see it the old way again. Each of my columns this year will feature a different graphic so we can share a different dimension of seeking insights. —MFT

The tables are identical in shape and size. Some have found the illusion to be so strong that they have saved the image and opened it in Adobe® Photoshop® to see for themselves.

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