1. Miracle, Vickie A. RN, EdD, CCRN, CCNS, CCRC

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I have just finished reading a book entitled "Leadership Can Be Taught" by Sharon Daloz Parks.1 A different approach to teaching leadership is presented in this book. One of the concepts discussed in this book is the power of silence. Parks describes 2 types of silence: silence with presence and silence that is absent.1 Silence with presence puts you in the moment. You are there, just quiet. People know you are there. This occurs in nursing. Just your presence in a room can instill calm and reassurance without you ever saying a word. Silence as absence is different. This type of silence indicates that while you may be present, your mind is elsewhere.1 This does not work well in a clinical setting.


Many people are uncomfortable with silence. This includes patients and nurses. Take a moment to think how little silence we have in our lives. Between the usual conversations, the noise of daily living, television, radio, the sound of medical equipment, portable music players, cell phones, DVD players, and others, we are constantly bombarded with noise. When was the late time you went anywhere and did not hear the ring of a cell phone, perhaps your own? A friend of mine recently attended a funeral and was upset that someone's cell phone rang during the service and the person answered it.


Silence can make us uneasy but is a necessary component of the care we provide. Sometimes patients and their families just need us to be there. Our presence is all that is needed and desired. There is a time to talk and a time to be quiet. Silence can be used effectively in many situations, particularly silence of presence. The silence may allow one to become more open to new ideas or to think about matters more in-depth. The shared silence between a patient and a nurse creates a common bond and may strengthen the relationship.1


Even Florence Nightingale extolled the virtue of silence.2 Silence can promote sleep. Noise in the unit should be kept to a minimum. A restless sleep is as bad as no sleep. Sleep is necessary to recovery. Critical care nurses are very good at taking measures to promote sleep in their patients such as spacing care, dimming lights, limiting interruptions, and closing doors.


However, in addition to creating a silent environment in which to promote rest, critical care nurses must recognize the importance of silence at other times. Silence can be therapeutic for the patient. Not all patients want to talk all the time. Watch for cues that the patient wants silence and be comfortable enough with yourself to allow this. Staying silent in the room with presence is an effective nursing intervention.


In closing, it is important for you to take time for silence for yourself. If you do not plan for silence, it may not occur. All of us can think of other things we should be doing. Planning for silence may be harder than you think. Take one day and see how many sounds you hear. How many periods of silence during waking hours were there? I would guess not many.


So how do you plan for silence? First, choose a time of day in which you will have less chance of interruption. Then make sure all noise makers are off-televisions, radios, music, cell phone, household appliances, etc. Then set aside sometime (however much you desire or can take), and simply sit down. Use this time for silent meditation or prayer, to think, work puzzles, reads, or to simply clear your mind. Relaxation techniques may be helpful. Try to do this at last a few times a week. You may be pleasantly surprised at the results.


Vickie A Miracle, RN, EdD, CCRN, CCNS, CCRC


Editor, DCCN and Lecturer


Bellarmine University


School of Nursing


Louisville, KY




1. Parks SD. Leadership Can Be Taught. Boston, Mass: Harvard Business School Press; 2005. [Context Link]


2. Nightingale F. Notes on Nursing: What It Is and What It Is Not. New York, NY: Dover Publications Inc; 1969. [Context Link]