1. Childs, Jody MBA, RN

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Most people agree that effective communication is integral in any workplace. However, it's arguably more critical in healthcare settings where lapses in communication or inadequate communication may negatively impact safety and outcomes for patients. In fact, The Joint Commission identified communication as the third most frequent cause of sentinel events in 2015.1

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What makes effective communication so challenging? There are many common barriers, such as language and cultural differences, as well as differing viewpoints. There's a potential for communication gaps to be more prevalent in industries like healthcare that require shift work. Workers on one shift may not relate to the issues of workers on another shift. The logistics of communicating with a colleague on the opposite shift can be daunting for leaders and staff, and may result in delays in the exchange of important information. Additionally, communication challenges don't always originate from the delivering end. There may be barriers on the receiving end due to distractions that are quite common in healthcare settings.


Preferred methods

As a group of more than 2,700, our nursing team is the largest employee sector at Texas Children's Hospital; as such, it's viewed as an important focus area of our hospital's communication strategy. With communication channels such as e-mail and staff meetings in place, nurse leaders felt that they were adequately conveying important information. However, a consultant assessment revealed a gap in clinical nurse awareness of nursing strategies, issues, and accomplishments, as well as variations in nurse awareness between campuses. With these observations, nursing leadership partnered with marketing to survey nurses regarding their preferred method of receiving communication. Survey findings reinforced nurse leaders' preexisting desires to strengthen communication within the nursing audience by leveraging social media and served as the catalyst for the development and implementation of The Voice of Nursing-a blog for nurses, about nurses (


An internal survey of nursing staff validated that social media and blogging were among the preferred communication methods and revealed key areas of interest for blog content, as well as ideas for the blog's name. Collaboration between the marketing and nursing teams led to the development of the strategy and structure for the blog, incorporating survey feedback.


The concept of blogging-using a website to write about one's personal experiences, activities, and opinions-was introduced and demonstrated to nurse leaders in a systemwide nursing leadership meeting. The initial blog post also served as an introduction to the blog and blogging as a communication tool. During National Nurses Week, a special print issue of the blog was used with a corresponding graphic to further illustrate functionality and promote blog utilization among nurses.


Blog benefits

Ensuring that important information is adequately conveyed was the impetus for our blog implementation. However, there's also potential for our nurses to benefit in other ways. Blogs are well known as resources for patients and caregivers as they seek information from individuals who've dealt with the same diagnosis and similar experiences. Blogs have also emerged as virtual support communities for both patients and caregivers as they embark on treatments and plans of care. Researchers have noted that patients and caregivers who blog often report increased quality of life; blogging provides them with an opportunity to share, vent, and connect with other patients and caregivers.2 It's reasonable to assume that nurses may benefit from blogs in the same or similar ways.


Today more than ever before, nurses are called on to care for increasingly complex patients and their families. In particular, nurses working in critical care areas are caring for the most complex patients, making meaningful connections and supporting families through challenging times and loss. Providing this kind of care on a daily basis can be very rewarding, but may also cause nurses to become emotionally drained. It has been noted that healthcare workers who engage in blog writing or reading identify this activity as an important coping and self-care mechanism.3 The Voice of Nursing has also become a place to share best practices when dealing with difficult workplace issues such as bullying.


We've continuously assessed and evaluated the blog since its launch in October 2014. Review of blog analytics has revealed favorable results in terms of viewership. In the first 90 days, our blog was visited 16,890 times, with 38,321 page views. With a staff of more than 2,700 nurses, it's a fair assessment that the blog is reaching the greater internal audience, facilitating dialogue and strengthening the partnership between nurses and others within the organization. Since its launch, the blog has received 635 comments. Comments reveal an exchange of ideas with physician partners and other clinical staff colleagues, and an open dialogue between nurses and leaders.


Lessons learned

Several lessons were learned during and subsequent to our blog implementation process.


1. Editorial board: Convening a blog editorial board with systemwide staff and leader representation has provided a forum to review measures of success that tell a story beyond just page views and allowed for the opportunity to brainstorm and discuss topics and authors for upcoming blog posts.


2. Moderation policy: The need to establish and communicate a blog moderation policy consistent with industry standards emerged after comments from unknown outside e-mails began to emerge. Sharing the moderation policy promotes open dialogue that's conveyed in a professional tone suitable for the workplace. In 2011, the American Nurses Association released its Social Networking Principles Toolkit, which lends direction to the nursing profession.4 Among other principles, the toolkit validates our finding that it's important to engage blog users in the process of developing moderation policies and blog conduct guidelines.


3. Community engagement: The capacity of a blog to be an effective method to connect nurses with a wider community of nurse colleagues emerged as the review of blog analytics revealed international viewership.


4. Critical communication: Unintended utility emerged as our blog became a very useful tool to communicate critical information, such as Ebola guidelines and leadership changes.



Future considerations

Interest in our blog via guest blogging and commenting was observed among many nonnurse employees. The high level of interest beyond nursing has raised the question of whether to include other disciplines or launch an additional blog for these nonnursing participants. Although blogging is a relatively new communication tool in our scenario, it has become evident that consideration should be given to adapting to microblogging via platforms such as Twitter. The experience of being able to provide succinct, real-time communication may prove to be an even more desirable communication method for nurses working in fast-paced, increasingly complex healthcare environments.




1. The Joint Commission. Sentinel event data-root causes by event type. [Context Link]


2. Seale C, Charteris-Black J, MacFarlane A, McPherson A. Interviews and internet forums: a comparison of two sources of qualitative data. Qual Health Res. 2010;20(5):595-606. [Context Link]


3. Miller EA, Pole A. Diagnosis blog: checking up on health blogs in the blogosphere. Am J Public Health. 2010;100(8):1514-1519. [Context Link]


4. American Nurses Association. Social networking principles toolkit. [Context Link]