Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere

Communication & Coaching: A
Nurse’s Guide to Creating a
Harmonious Atmosphere
HARMONY UNIVERSITY
The Provider Unit of
Harmony Healthcare International, Inc. (HHI)
Presented by:
Beckie Dow, RN, RAC-MT
Director of MDS/Nursing Program Development

Speaker Bio
Over 20 Years Experience in Long-term
Care
Clinical and Reimbursement Accuracy in
Assessments
Quality Assurance Activities
Interrelation between MDS, Care
Planning, QA, and Clinical Excellence at
the Bedside
AANAC Master Teacher
Copyright © 2013 All Rights Reserved 2Harmony Healthcare International, Inc.

Communication & Coaching:
A Nurse’s Guide to Creating a Harmonious Atmosphere
Disclosures: The planners and presenters of this educational
activity have no relationship with commercial entities or
conflicts of interest to disclose
Planners:
Elisa Bovee, MS, OTR/L
Diane Buckley, BSN, RN, RAC-CT
Keri Hart, MS CCC, SLP, RAC-CT
Kristen Mastrangelo, OTR/L, MBA, NHA
Christine Twombly, RNC, RAC-MT, LHRM
Presenter:

Disclosure
Speaker:
Beckie Dow, RN, RAC-MT Director of MDS/Nursing Program
Development
The speaker has no relevant financial
relationships to disclose
The speaker has no relevant nonfinancial
relationships to disclose
4Harmony Healthcare International, Inc.Copyright © 2013 All Rights Reserved

Criteria for Successful Completion
Complete Sign-in and Sign-Out on
Attendance Form
Attendance for entire session
Completion and submission of
speaker evaluation form.

Program Objectives
The learner will be able to discuss the positive
impact of clear communication to address
areas of improvement on staff members and
customers
The learner will be able to articulate the
positive impact of a cohesive clinical team to
promote staff and customer satisfaction
The learner will be able to list three
techniques to better communicate with a
cognitively impaired elder

Program Objectives
The learner will be able to give examples
of workplace bullying, and offer
techniques to eliminate bullying in the
workplace
The learner will be able to describe how
proactive communication with co-workers
and employees can stop the cycle of
miscommunication and create a more
harmonious workplace for staff and
customers

“I’ve learned that people
will forget what you
said, people will forget
what you did, but
people will never forget
how you made them
feel”
-Maya Angelou

Frustrated Employees Say…
“Management doesn’t care about us”
“They never get rid of bad employees;
they just get away with everything”
“We always have to deal with the
fallout, and they get to go home”
“If I speak up and then nothing
changes, why should I even bother?”

Frustrated Employees Say…
Your front-line staff spends the most
time with your customers
They are, essentially, the face of your
organization
Effective communication with your
staff can increase employee satisfaction,
which will influence customer
satisfaction

Communicating Well…

Good communication is a powerful tool
that can help you to:
Connect with others
Express what you really mean
Navigate challenging situations
Build better relationships
Earn the respect and loyalty of your team

The way you listen, look, move, and
react influences the listener
It shows whether or not you care, if you
are being truthful, and how well you
are listening
As a manager or caregiver, your staff
and patients will often base their
opinion of you on how they feel after
they interact with you

When non-verbal communication
supports verbal communication you
will increase trust, clarity, and rapport
When non-verbal communication does
not support verbal communication you
will generate tension, mistrust, and
confusion

Be sensitive to someone’s physical
response to your communication
This non-verbal communication can
offer you valuable clues as to their true
response to your words
Be aware of the non-verbal
communication you are displaying, so
others do not misinterpret your
meaning

Non-verbal communication can be
modified and controlled…to a point
Even the best communicators do not
fully eliminate all non-verbal
communication
By managing your staff effectively, you
will decrease your own frustration and
be able to communicate better

Communication Ability for the
patient with Dementia
Dementia can gradually diminish a
patient’s ability to communicate
Patients with Dementia have increased
difficulty expressing their thoughts and
emotions—and more difficulty
understanding them in others
The ability to communicate is a basic
need

Communication Is…
Sending and receiving messages
How we relate to one another
An important part of our relationships
A way to express who we are
More than talking or listening
About attitude, tone of voice, facial
expression, and body language

Changes in Communication
Difficulty finding the right words
Using familiar words repeatedly
Inventing new words to describe
familiar things
Easily losing train of thought
Difficulty organizing words logically

Changes in Communication
Reverting to speaking a native language
Using curse words
Speaking less often
Relying on gestures rather than
speaking

Help The Patient Communicate

Be Patient and Supportive. Let the
person know you are listening and
trying to understand what is being said.
Show Your Interest. Keep good eye
contact and show the person you care
about what he or she is saying.

Offer Comfort and Reassurance. If the
patient is having trouble
communicating, let them know it is OK.
Encourage. Have the patient continue
to try to explain his or her thoughts.
Give the Patient Time. Let the patient
think about and describe what he or she
wants.

Don’t Interrupt. Gently stop a
rambling thought in a respectful
manner.
Avoid Criticizing or Correcting. Don’t
tell the person that they are incorrect.
Try to find the meaning in what they
are saying.
Avoid Arguing. If the patient says
something you disagree with, let it go.

Offer a Guess. If the patient uses the
wrong word or cannot find a word, try
guessing the right one. If you
understand what they mean you may
not have to give the exact word.
Be Careful Not to Cause Frustration
Encourage Non-Verbal
Communication. Pointing or gesturing
to clarify what is being said.

Limit Distractions. Find a quiet place.
The surroundings should always support
a person’s ability to focus on his or her
feelings.
Focus on Feelings, not Facts. Sometimes
the emotion being expressed is more
important than what is said. Look for the
feelings behind the words. Tone of voice
and actions may provide clues.

A Challenge For You:
Consider the following scenario:
A confused resident approaches the nursing
station. “I would like my hair done today,”
she requests.
The nurse replies, “No, you can’t get your
hair done. The hairdresser is only here on
Tuesday and Thursday.”

A Challenge For You…
Avoid the following words for 24
hours:
No
Don’t
Can’t
Won’t
Not

What is “Customer Service?”
An expression of human decency
which creates mutual benefit for
the customer and service provider
A series of activities that enhances
the customers feeling that the
product or service meets their
expectations

What is “Customer Service?”
Creating an atmosphere of trust
and loyalty
Sacrifice and serving
Doing what you say you will do
Putting customers needs first
Treating others with dignity

First Impressions…

Residents and family members
have the opportunity to observe
you and how you interact with all
residents.
What kind of impression
are you making?

People generally form a first impression
of you in 3-5 seconds
This first impression will influence how
residents and family members perceive
you will provide care
A poor first impression is often difficult
to change

What influences a first impression?
Your facial expression
Your appearance and attire
Your posture
Your speech and inflection
The overall attitude you display

Identify your role--let the patient and
family member know what you are
responsible for, and direct them to the
person responsible for their other
requests
Don’t try to do what you do not have
the capability or authority to do,
because if you fail, the patient will feel
more insecure

Ownership of a Task
Not Acceptable
She is not my
assignment
Her nurse is on
break
She is not here.
Call back
tomorrow
Acceptable
I am happy to help
you
I can assist you
I will give her a
message that you
wish to speak to her.
What is your name
and contact
information?

Ownership of a Task
How you respond to an initial request
sets the tone for the remainder of the
interaction
At times, customers will approach you
in an angry way even if you don’t
deserve it
It is important to always respond
kindly and courteously to a request or
complaint

Communication and Meeting
Government Initiatives
Two themes are common in today’s
debate about the long-term care
industry:
Many patients receive, or are at risk for
receiving, sub-standard level of care
Long-term care employees may be
dissatisfied with work environment or job
duties which will affect residents

Communication and Meeting
Government Initiatives
Employee turnover is a serious concern
for all levels of the health care industry
Retention of valuable employees is
essential for patient satisfaction and
financial stability
Increased governmental attention to
“quality care” in healthcare
Higher customer expectations

What is “Quality Care”?
Each person may define quality care
differently, based on personality,
values, culture, etc.
Common themes:
Treat patients with dignity and respect
Patient involvement in decisions
Control of ones own life
Physical and emotional needs met

The CMS Nursing Home Action
Plan: A Three Part Aim

The CMS Nursing Home Action
Plan: Five Approaches
Enhance consumer engagement
Strengthen survey processes, standards,
and enforcement
Promote quality improvement
Create strategic approaches through
partnerships
Advance quality through innovation and
demonstration

The Regulatory Aspects of
Communitation--F280
“The care plan must be prepared by an
interdisciplinary team that includes the
attending physician, an R.N. with responsibility
for the resident, and other appropriate staff in
disciplines as determined by the resident’s
needs, and, to the extent practicable, the
participation of the resident, the resident’s
family, or the resident’s legal representative
[42CFR483.20(k)(2)]”

A Bottom-Up Approach to
Communication
Valuing direct caregivers input in
patient care policy decisions
Care planning becoming more relevant
to the patient
Care plan more closely represents
patients status and is better
individualized to the patient

Communication
Encouraging input from front-line staff
may increase their acceptance of policy
change…or at least their understanding
Feeling valued increases employee
satisfaction and retention
Opens up dialog about other topics

Communication
Truthfulness with employees is a key
aspect of caring for employees
Telling employees what they need to
hear, which may not be what they want
to hear, is a necessary first step
This may cause the manager discomfort
at first, but is a skill that needs to be
practiced
Be ASSERTIVE!

Assertiveness
“Disposed to or
characterized by bold or
confident statements or
behavior”
--Merriam Webster dictionary

Assertiveness
Assertiveness is not forcing others to do
what they do not want to do
Assertiveness is clearly pointing the
way for the team to go, and inviting
others to take that journey with you
Anyone can force compliance, but a
manager encourages commitment

Assertiveness
Assertiveness is…
Clearly
communicating
expectations
Following up
Coaching and
encouraging
Having the same
standard for everyone
Assertiveness is not…
Bullying
Manipulating
Intimidating
Forcing compliance
Threatening

Assertiveness
Many managers struggle with
employee behavior that is not in line
with the organizations vision
It is up to the manager to set clear
expectations regarding behavior and
follow up
The clearer expectations are, the easier
it is to address problem behavior

Effective Communication
An effective manager will:
Set clear boundaries and expectations
Practice accountability
Honor your staff’s rights
Choose your battles carefully
Deal with problem behavior swiftly and
fairly

Boundaries and Expectations
Managers who do not clearly define
boundaries and expectations are just
asking for trouble
Don’t expect your employees to be
mind readers
Communicate what you expect—and
what will not be tolerated

Accountability
Managers must hold staff accountable
when they do not meet expectations
It can be uncomfortable for some
people to have this type of
confrontation
These behaviors will rarely resolve on
their own, without coaching or
discipline

Accountability
Remember—it is your job as a manager
to consistently hold staff accountable
Holding those who engage in bad
behavior accountable will create respect
with other employees
Having the same standard for all
creates an atmosphere of trust

Honor Staff Rights
Staff members should be able to expect
that they will be treated fairly at work
and have an appeals process available
to them
Staff should also be able to expect
equity in how they are treated and
spoken to by peers and managers

Choose Your Battles
Some areas are not available for debate,
such as patients rights, regulatory
mandates, etc.
Other areas may be more flexible and
may provide an opportunity for
collaboration on a small topic that
makes a big difference

Choose Your Battles
Psychology Today says there are four
things that motivate employees
Desire for compensation and material
things
Need to bond with others and feel they
belong
Need to make sense of the environment
Desire to defend their accomplishments

Performance Evaluations
The cost of employees who do not
perform as we expect them to is hard to
quantify
Consider time, money, lost
productivity, and lower morale
The most effective management
technique is preventing performance
problems proactively and addressing
issues quickly and decisively

Performance Evaluations will enable
the manager to:
Examine each employee as an individual
Evaluate strengths and weaknesses
Reward employees who perform well
Provide continuous feedback
Be better aware of the needs of your staff

the manager to:
Reduce legal risk by ensuring that each
employee feels they are treated fairly
Identify and deal with problem behaviors
Create valuable employees
Lay the foundation for formalized
discipline and/or termination

the manager to:
Provide legal protection for the employer
in the form of documentation that supports
repeated attempts to correct behavior
Provide a consistent and objective
framework for all employees, so that no
one employee feels “singled out”

Performance Objectives
Performance objectives identify what
you expect from the employee and give
the employee something to strive for
Job Requirements are what you want
the employee to accomplish and how
you want the job performed
Result requirements
Behavior requirement

Performance Objectives
Developmental Goals are
individualized for each employee
These goals should directly relate to the
employees job to prevent spending time
and assets on developing a skill that
does not benefit your company
Only a few goals are needed to be
effective

Observe and Document
Be mindful of employee performance
throughout the year, not just in the
weeks leading up to their performance
evaluation
Having an entire years worth of
documentation about performance will
paint a fairer picture of performance

Keep in Touch
The annual evaluation should not be
the only opportunity for feedback
Six months—checking in halfway
Brief review of progress to goals thus
far in the year
Provide an opportunity for the
employee to give feedback

The Annual Evaluation
Preparation is key in giving an effective
performance evaluation
Use objective data—numbers, facts
Use subjective data—customer
complaints or compliments
Draw conclusions and summarize your
conclusions on the Evaluation
Document

Pitfalls of the Evaluation…
The “Blame Game” when things go
wrong
First impressions clouding future
performance
Liking those who like you
Judging an employee based on one
aspect of their performance

Pitfalls of the Evaluation…
Calling everyone “average”
Placing more weight on recent events
Stereotyping employees
Reviewing based on fear—softening the
evaluation
Avoiding the evaluation

Progressive Discipline
Benefits of Progressive Discipline:
Allows managers to intervene and correct
employee behavior at the first sign of trouble
Enhances communication between manager
and employee
Helps managers achieve higher performance
from employee
Improves employee morale and retention by
demonstrating rewards for good behavior and
consequences for bad behavior

Benefits of Progressive Discipline:
Avoids expensive replacement costs
Ensures consistency and fairness in dealing
with employee problems and
Lays the ground work for fair, legally-
defensible employment termination for
termination of employees who cannot or
will not improve.

Steps of Progressive Discipline:
Coaching
Verbal Warning
Written Warning
Termination
The disciplinary response should be
appropriate and proportionate to the
employee’s conduct

Coaching
At the first sign of an issue, sit down
with the employee to discuss the issue
“What can you tell me about…”
Allow the employee time to explain
Give the employee your perspective
and offer guidance on correcting the
issue

Coaching
Plan your coaching sessions
The goal is to correct the issue and lead
the employee on the path of
improvement
Don’t be emotional or threaten further
action
Stay positive and encourage the
employee that you have confidence
they can correct this issue

Coaching
Clearly explain what the issue is and
what negative effect the issue is having
on the company
The purpose of this meeting is to
discover the underlying issue and find
a resolution that works for all
Clearly outline what will be expected
for future behavior

Coaching
Follow up with the employee even if
the problem is resolved
After 2-3 face-to-face coaching sessions
with no resolution to the problem the
discipline will progress to the next step

Verbal Warning
A verbal warning serves as notice to the
employee that this issue is serious and
must be corrected
A verbal warning is a written warning
that has no signatures
The employee is placed on notice that if
the issue is not resolved it will lead to
further disciplinary action, up to and
including termination of employment

Verbal Warning
If you have not already done so, contact
your Human Resources (HR)
department
They are experts and can provide
guidance
Keep a written record of your
conversations with the employee,
including the coaching sessions

Verbal Warning
Be specific about deadlines for
improvement, along with a timeframe
for the next meeting
Example: “You are expected to be on
time for work each day, which means
no later than 8:05 am. In two weeks we
will meet again to follow up on your
performance.”

Verbal Warning
After 2-3 verbal warnings the discipline
will progress to the next step
The employee will be aware of the
consequences of their actions should
they choose not to change
By this time, you have had 2-3 coaching
sessions and 2-3 verbal warnings

Written Warning
All interactions up until this point
should be documented in the employee
file
Do not document after the fact
Keep your HR department informed of
the progression
Written warnings are serious

Written Warning
As with the verbal warning, give
specific details of what aspect of the
employees behavior must change
Provide a timeframe for follow up
Include language stating that if the
issue is not resolved further
disciplinary action will be taken
This action may be up to and including
termination

Written Warning
The written warning should be signed and
dated by the employee and manager
If the employee refuses to sign, write
“Refused to Sign” on the document
A separate Performance plan may be
written to outline goals and timeframe for
improvement of the employee
This is helpful when dealing with multiple
issues

Written Warning
Continue to coach the employee, and
stick to the timeframe for improvement
outlined in the written warning
If the issue remains unresolved, issue a
second written warning that contains a
specific timeframe for improvement

Written Warning
At the end of the established timeframe
for improvement issue a Final Written
Warning
A Final Written Warning is open-ended
Example: “You are expected to be on
time for work, which means no later
than 8:05 am. If you are late even one
more day your employment will be
terminated.”

Progressive discipline is not intended to
punish or demoralize
Progressive discipline is intended to be
fair
Progressive discipline invests the
employee in the improvement strategy
This increases the likelihood of follow
through and employee improvement

Progressive Discipline can improve
morale and foster feelings of employee
loyalty
Treating employees fairly and with respect
Enhances communication
Avoids expensive replacement costs
Lay the groundwork for a fair, defensible
employment termination for employees
who cannot or will not improve

Why Progressive Discipline is
Difficult for Some Managers
Don’t want to be a “bad guy”
It is uncomfortable to confront others
Don’t want to deal with an angry, hurt,
or critical employee
Fear of conflict
Desire to be liked
Fear of retaliation

Why Progressive Discipline is
Difficult for Some Managers
Reasons to “do it anyway”:
Helps employees improve
Gives you the personal satisfaction that
you have done all you could as a manager
to help this person improve
Gives legal footing that a termination was
just and fair
Promotes morale of team as conflicts are
dealt with fairly and equitably

The goal of the Progressive
Discipline process is for the
employee to change their
behavior to meet your
company’s standards.

Termination
Termination of employment is not
simply a disciplinary measure
Termination is a representation of the
failure of the disciplinary process
The behavior of the employee has not
changed, despite numerous warnings
Or, the initial offense was egregious
(stealing, workplace violence)

Termination
Have the termination document
prepared before the meeting
Be brief when disclosing the contents of
the document to the employee
Have the employee sign the document
Stand up to signal the meeting is over

Workplace Bullying
Workplace bullying might be becoming
more prevalent—or we may be
identifying it more often
Bullying can lead to decreased
productivity and decreased morale
A good environment for patients, staff,
and guests must be bully-free

Workplace Bullying
Bullying: The use of persistent
aggressive or unreasonable behavior
against a coworker or subordinate
Can be covert or overt
May be difficult to identify because the
bully may stay within established rules
and policies of the organization
No universally accepted definition

Workplace Bullying Statistics
13% of workers state they are currently
being bullied
24% of workers say they have been
bullied in the past
12% have witnessed workplace
bullying
49% of workers affected by workplace
bullying
Source: 2007 WBI-Zogby Survey

Dealing With Workplace
Bullying
First step is to have a no-tolerance
policy for bullying—positive workplace
culture starts from the top!
Consider progressive discipline for the
bullying individual
Investigate complaints of bullying per
your facility procedure
Take all complaints seriously

Final Thoughts
Patients, staff, visitors, and customers
always want to be treated with dignity
People respond more positively when
they feel they are heard and were dealt
with honestly
Good communication is not a luxury—
it is a necessity to providing good care

Questions/Answers
Harmony Healthcare International
1 (800) 530 – 4413
Bdow@harmony-healthcare.com
www.harmony-healthcare.com
Harmony Healthcare International, Inc. 97Copyright © 2013 All Rights Reserved
97Harmony Healthcare International, Inc.

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Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere

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