Beginning the journey to skilled communication.

Intimidating behavior and deficient interpersonal skills create a culture of silence, where there can be a breakdown in team communications and an inability to collaborate and achieve high-quality outcomes. A study from VitalSmarts (Provo, Utah), Silence Kills: The Seven Crucial Conversations for Healthcare, described 7 crucial conversations healthcare professionals struggle with that contribute to patient harm and unacceptable error rates. The American Association of Critical-Care Nurses' first standard (from AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence), skilled communication, states: "Nurses must be as proficient in communication skills as they are in clinical skills." Once it is accepted that being competent in skilled communication is essential to excellent patient care, it then takes skill development and added courage to hold crucial conversations and address difficult situations. The first step begins with a self-assessment to determine current effectiveness as a communicator and manager of conflict and to realize opportunities for growth. Three key strategies to begin the development of skilled communication include: (1) understanding the importance of a climate of safety, (2) acknowledging one's mental stories, and (3) realizing that the only people we control are ourselves.