Breaking Bad News: What's A Nurse to Do?
As a nurse, it’s important to master skills to deliver bad news, no matter how hard it is. Mastering these skills will give you the confidence and empathy patients and families need.
Delivering bad news is difficult—so difficult that it takes finely tuned skills, coaching, and practice to do it candidly and respectfully.
As an oncology nurse who has delivered plenty of disheartening news to families over 20+ years, I am constantly on the lookout for resources and helpful tips from others.
Here are a few strategies you may wish to consider when sharing bad news:
Step up to your role
Ask yourself, “What information will I deliver?” Think about how you would want it delivered to you. Most people do not like the “beat around the bush” approach. Be honest and truthful, without negativity and hopelessness.
Share the pain
When the patient and family express their feelings, acknowledge their pain and express your honest concern. Try employing therapeutic conversational phrases like, “I hear what you are saying” and “I understand your concerns.” Offer to connect patients and families to counselors or social workers as much as you can. Be present for questions and comfort.
During difficult times, people feel a strong need to be heard and to know you care about them. Be sure you are attentive to the person who is talking. Eye contact is key, so avoid your tablet or writing notes during the conversation. Be there to give feedback without judging the situation. Avoid saying, “This is what I would do” instead say, “Consider this…”
It’s ok to take a stepped approach
When people hear frightening news, adrenaline floods their bloodstream and they respond with strong emotions. Critical thinking can be impaired. Be prepared to adapt your communication approach to the needs of those involved.
I have learned to share clinical details about a diagnosis and plan of care in steps...when the patient is emotionally ready to receive. In a clinic setting, we don’t always have the luxury of time. I have found that setting up a process for phone follow up with patients & families can really be helpful. It gives the patient time to process & the nursing team the opportunity to reinforce clinical facts and connect folks with evidence-based resources to support decision making.
Practice makes perfect
Delivering bad news is a skill we all need to practice. Why not practice with a colleague or friend?
Beth Boynton, who is the author of Successful Nurse Communication : Safe Care, Healthy Workplaces & Rewarding Careers, posted an informative real life conversation with someone who was going through this scenario.
According to a recent article from the Advisory Board, training yourself through coaching makes you two times more likely to use empathetic phrases than those who don’t train for these specific conversations.
Another helpful tip Boynton advocates which I have employed with success, is to use role play. Having a hard time getting creative? Check out this YouTube video as a guide for practice.
How Should Providers Deliver Bad News?
While practice will help us prepare and hone our communication skills, sometimes it's good to focus on why we became nurses in the first place. We came into this profession because we excel at the science of caring. Caring through our nursing process and advocating for patients. Practicing the art of nursing by using our caring hearts to actively listen.
The bottom line is, it’s just the right thing to do.
Boynton relayed a story of a physician colleague who made a home visit and shared these profound thoughts:
"I've always respected the doctor for making that visit. Was it easy? I don’t think so. Was it billable? I don’t know. I think he did it because it was the right thing for him to do. Sometimes, we need to think of our patients and their families and just do the RIGHT thing."
What resources have helped you develop skill and empathy when sharing bad news?
Read to Lead
What’s The Best Way to Deliver Bad News to Patients?
SPIKES—A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer
How Should Providers Deliver Bad News? - IHI Open School - YouTubeLast edit by Joe V on Oct 20, '17
About Carol Bush, RN
Carol is Content Strategist, Writing Coach and Owner of The Social Nurse. She is founder of The Healthcare Writers Network. She has over 30 years experience as an Oncology Nurse & Clinical Consultant and is a graduate of the Mayo Clinic Social Media Residency. Carol followed a circuitous route to a career in oncology. Her first undergraduate degree is in Ag Journalism. A nursing degree followed 10 years later, after three children and an unknown number of pizza suppers. She lives on four peaceful acres, with her sweetheart, Don. She enjoys gardening, cooking, and stalking her adult children via social media.
Carol Bush has '30 and counting!' year(s) of experience and specializes in 'Oncology, Telehealth & Entrepreneurship'. Joined May '16; Posts: 16; Likes: 37.Jan 6, '17Great article! Thanks, Carol, for sharing this valuable advice. Nurses in many areas are faced with the difficult task of sharing bad news. Hopefully these suggestions will help them to feel better prepared.Jan 6, '17Such a helpful article. It make me think of the many, many times I've encountered a crying family in the hall or outside the elevators and knew they were suffering grief. I always want to be a comfort but not always sure the best thing to say or do.Jan 6, '17I literally just got off the phone with a charge RN who told me one of my pts just coded (I work as an APRN in several outpt dialysis units). I give bad news all the time and talk about end of life issues a lot.
I'm always on the lookout for tips to do it better and I got some from your article - thanks much.Jan 8, '17Great article. No one likes to give bad news but your article gives great advice to make it easier. Thank you!Jan 8, '17Carol,
this is a great article and will be helpful to many. As an oncology nurse practitioner, I share bad news more often than I'd like. I really appreciated the video; excellent to see the comparison.Jan 9, '17Carol, nicely written article.
Delivering bad news is such a fragile thing. I will never forget the time an ER physician and I went to tell a family member their loved one had died. As the ER physician was explaining what happened, he took the family on a roller coaster ride as he described what EMS did...how they gave medications, shocked the patient, and got a heart rhythm back. He described this cycle about three times before saying "We did everything, but he died." The look of shock on their faces after being uplifted several times by getting a rhythm back. Your point about being straight forward is well taken!
I have also learned to be prepared for a variety of reactions from the grieving family member. Everyone copes differently. Some people react by sobbing, others become angry and may want to punch the wall, punch the chair, punch something (but hopefully not me). An awareness of cultural differences is also important as burial requirements differ by religion. When you understand different cultural needs you can be a real advocate for meeting burial timelines etc...
As an ED nurse, I have been present for countless deaths. The one thing I have found to be very well received time and time again is when I tell the family (if true) that "I was there the whole time. I held her hand and talked softly to her." or whatever the scenario was. People find so much comfort knowing their loved one did not die alone.
Mastering the skill of delivering bad news is invaluable as the family will likely REMEMBER YOU for years to come.
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