Effective Communication: Foundation for Nurse Safety

By Rhonda Collins, DNP, RN, FAAN, Chief Nursing Officer, Vocera

Over the past year, as we’ve all seen how nurses impact the health and healing of our world, we’ve also seen them embrace the mantra “Never Again” and leave the profession at an unprecedented rate.

The need for change is clear. We must heed the call from all corners to listen to, support, and protect nurses.1 We must envision new ways of staffing and new ways of communicating and engaging, and focus on changing complex work environments and workflows – the source of most workplace fatigue and burnout.

I have been researching, writing, and speaking on the topic of nurses’ cognitive burden for more than two years. I continue to be invited to talk about the cognitive burden and how it affects nurse safety. At every CNO roundtable, I attend, I meet nurse leaders who are perplexed and frustrated over how to fix what’s wrong. They are experiencing everything their staff is suffering and more, and they are asking for workable solutions.

Often, nurse leaders focus primarily on building nurse resiliency. While resiliency is important, we also need to address the mental fatigue and moral injury this pandemic has wrought on our healthcare workers. It’s helpful to give people a safe place to go or a dedicated expert to talk to. There is nothing wrong with offering nurses space to meditate or listen to a mindfulness recording. 

But if nurses take five minutes every hour to go collect themselves and they come out of that space and the work environment is still chaotic, newfound serenity can’t be sustained. It’s not the nurse that needs to change. It’s the work environment. Nurses need tools to minimize the stress and make it easier to do their job. To this end, there are tangible actions nurse leaders can take to improve the work environment and strengthen nurse safety.

Six Solutions for Strengthening Nurse Safety

Communication is the underpinning of everything that happens in a hospital, and effective communication is the primary foundation of a safe and effective work environment. In my 2021 CNO Perspective report, “Protect the Nurse, Protect the Practice,” I propose six solutions to help nurse leaders create a safe and effective work environment, all rooted in strengthening communication. 

These solutions factor in lessons learned from the COVID-19 pandemic and include:

  • Keeping nurses protected and safe
  • Empowering nurses with control over patient-family communication
  • Reducing the stress of crisis care
  • Enabling smooth movement from novice to expert and back
  • Protecting nurses from workplace violence
  • Measuring and solving for communication task load

I invite nurse leaders to make their nurses’ voices heard as part of an unprecedented study that aims to measure how the effort involved in communicating affects nurses mentally, physically, and emotionally. The study will provide insight and a body of knowledge to solve for the task burden of communicating more effectively going forward.

Let’s Partner to Measure and Solve for Communication

My plan is to measure nurse communication in hospitals using the NASA Task Load Index (TLX). The NASA TLX has been used to measure the task load of workers in high-intensity jobs, such as pilots and air traffic controllers. It’s been used to measure the task load of ICU nurses2– and this is the first time it will be used to measure the task load involved in clinical communication. Nurses will be able to anonymously answer seven questions while thinking about a clinical communication task or effort during their most recent 12-hour shift. For example, trying to reach a physician or obtain a lab result.

The NASA Task Load Index (TLX) measures on 6 dimensions:

  • How mentally demanding was the task?
  • How physically demanding was the task?
  • How hurried or rushed was the pace of the task?
  • How successful were you in accomplishing what you set out to do?
  • How hard did you have to work?
  • How insecure, discouraged, stressed, or annoyed were you?

The more we listen to nurses’ voices, the better we can support and protect them, and the better we can engage the creative thought process of nurse leaders. Join me in this conversation. Work with me as we ask the questions and look for answers to improve communication, facilitate nurse safety, and ease the work of nurses caring for patients and families.


1. Brown, Theresa, and Rushton, Cynda. Frontline Nurses WikiWisdom Forum. 

2. Hoonakker, Peter, et al. “Measuring Workload of ICU Nurses With a Questionnaire Survey: The Nasa Task Load Index (TLX).” PMC, 12 Oct. 2011. 


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