EDITOR'S NOTE: Nancy J. Brent, MS, JD, RN, Nurse.com's legal information columnist, received her Juris Doctor from Loyola University Chicago School of Law and concentrates her solo law practice in health law and legal representation, consultation and education for healthcare professionals, school of nursing faculty and healthcare delivery facilities. Brent has conducted many seminars on legal issues in nursing and healthcare delivery across the country and has published extensively law and nursing practice. She brings more than 30 years of experience to her role of legal information columnist. Nancy Brent’s posts are designed for educational purposes and are not to be taken as specific legal or other advice.
The practice of nursing in today’s world is very different than in past years.
Communication must fit each generation
Take this course on risk management
The multigenerational team varies, depending on each hospital. Even so, there are four generations (or cohorts) that are seen in most acute care settings: the traditionalists, the baby boomers, Generation X and Generation Y (or millennials), according to an American Nurse article, “Creating A Practice Environment That Supports Multigenerational Workforce Collaboration.”
Clearly, these generations bring with them differences that affect their approach to patient care.
For the most part, the silent generation values face-to-face communication. In contrast, Generation Y members prefer to communicate by texting and instant messaging, according to the article.
Neither method of communication is necessarily better, but a cohort’s preferred manner of communication may create potential problems in the delivery of safe patient care if not accepted by another generational group member who does not use the same style of communication.
Communication between and among nursing staff members is a key component to the provision of safe care. CRICO, a research and analysis subsidiary of the company that insures Harvard-affiliated hospitals, reported that of 1,744 deaths examined from 2006-2010, communication failures were a factor in 30% of them.
Moreover, nearly 40% of the communication failures in the study were generated or worsened by breakdowns in communication between two or more healthcare providers, including nurses, reports the CRICO article, “Communication Factors in Malpractice Cases.”
One author stated communication among and between healthcare providers is complex because communication is “really about behavior.” Behavior in the workplace includes individual behavior and organizational behavior.

Adding to those two major categories are factors such as educational and multigenerational differences, according to the Becker’s Hospital Review article, “The Chronic Problem of Communication: Why It’s A Patient Safety Issue, and How Hospitals Can Address It.”
If communication is complex and is really about behavior, how can a multigenerational nursing staff, with different ways of communicating, as well as other differences, successfully exchange information vital to safe and efficient patient care?
Risk management’s objective in the healthcare setting is to prevent any type of risk to the facility, including preventable patient injuries.
According to an article I authored on the Avoiding Liability Blog, risk management involves four steps:
  1. Risk identification
  2. Risk analysis
  3. Risk treatment
  4. Risk avoidance
Because communication failures can lead to patient injury or death, the identification of this risk is clear. Its analysis already exists as well, as was cited in the CRICO study above.
Now, comes the treatment of this risk in multigenerational nursing staff.
New technologies, changes in health insurance coverage, increasing outpatient centers and an increased emphasis on prevention of disease are just a few of the characteristics of current practice.
The make up of nursing staff also has changed, especially in the hospital setting.
Back in the day, most nurses had similar values, practiced based on standard, established approaches to patient care, and communicated in customary ways, such as by telephone, nursing notes and face-to-face exchanges of information.
Today’s practice setting includes high-tech devices, electronic documentation and texting. It also includes a different nursing staff mix — the multigenerational team.
By Nancy J. Brent
MS, JD, RN
How risk management can improve behavior
Although not an easy “treatment,” interventions for improving communication among such staff exists.
First and foremost, using the strengths among the nursing staff cohorts is important.
Millennials, for example, are multitaskers connected through social media who are tech savvy, according to the LinkedIn blog, “8 Millennials’ Traits You Should know About Before You Hire Them.”
A millennial nurse could be responsible for several nursing care responsibilities for certain patients on his or her team and the documentation of those outcomes in the e-medical record would be a stress-free obligation.
Clearly, a positive result would be competent and safe patient care and the successful communication of that care to other team members.
Millennials also are team-oriented and enjoy collaboration and building friendships with colleagues, according to the blog.
A millennial staff member may be a good pick as a team leader based on these identified traits and is someone who can easily share patient care issues with others on the team if those other team members are receptive to that sharing.
These characteristics fit well with some of the traits of the baby boomer generation.
Because baby boomers have a strong work ethic, placing a nurse in this cohort with a millennial staff member on a patient care team increases the team collaboration that can improve patient care and, thus, avoid a risk to patient safety.
Another interesting treatment for the identified risk of communication failure among multigenerational nursing staff is the concept of affirmation.
In a Canadian study of preceptorship during different multigenerational students’ clinical experience with older nursing staff, being affirmed (rewarded) by both the students and the nursing staff was identified as being very important, albeit manifested differently for each group, according to a Nursing Research and Practice article.
Although further research is indicated, applying this treatment to the practice setting as well as the educational setting may go a long way in avoiding risks to patient safety.
The last step of risk management — risk avoidance — is one that may indeed need more research.
Nurses should use the strengths of each multigenerational group and the simple, yet essential, technique of affirmation. These will go a long way in having a team that works well together and contributes to safer patient care.
How to improve multigenerational contact

How risk management can improve communication

Nursing staff of all ages must collaborate to improve patient care
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