Learning Objective #1: explain the direct observation method for assessing communication behaviors of nurses in shift reports and students in laboratory settings.

Learning Objective #2: describe the nurse to nurse leader-follower communication-outcome link in health care environments.

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Nursing staff turnover, nursing errors, and discontinuity of care are driving the outcry for accountability in health care. Stone and colleagues (2006) identified a supportive environment as one factor in nurse retention. Yet, intervention studies have not measured these effects. However, Crew Resource Management (CRM) studies found that communication behaviors among aviation crews are linked to outcomes. The purpose of this research was to develop communication interventions built on videotaped nurse shift-report behaviors (Hays, 2006, 2005, 2002, 1995) and psychology students’ role playing report vignettes. Using nursing faculty and students as actors, 12 dyads were videotaped in routine and crisis shift report vignettes, a total of 24 recordings. One dyad was selected for observer training. Assessing interobserver agreement at 10 second intervals, 11 dyads were independently scored by the principal investigator and the research assistant who identified that interobserver agreement was less than desired for the effective leader-follower behaviors of supporting and accepting and the ineffective follower behavior of irrational responding. The investigator-developed Target Behavior Instrument was thus modified to strengthen the interrater reliability. A second analysis showed improved agreement. Five dyads were then videotaped using the same shift report vignettes. Each individual in the dyad completed a two-item Survey of Goals to prompt the selected interventions. Preliminary analysis identified a trend toward more effective behaviors of supporting and accepting and an increased interchange of interactions. Further developing intervention studies for nurse-nurse communication will allow for outcome comparisons between hospital units in varied clinical settings. The communication-outcome link will also be studied with nursing instructors and students to maximize desirable leader-follower behaviors. Behavioral interventions will follow the CRM techniques, which focus on removing authoritarian barriers between disciplines and peers to reverse ineffective communication patterns. The intent is to empower nurses to create and manage their own healthy work environment.