Communication Styles of Nurse Practitioners

Marilyn W. Edmunds, PhD, CRNP; Laurie E. Scudder, MS, NP


September 29, 2009

Nurse Practitioner/Patient Communication Styles in Clinical Practice

Berry JA.
J Nurse Pract. 2009;5:508-515

Study Summary

Although nurse practitioners (NPs) may spend as much as two thirds of patient-encounter time in interpersonal communication, the literature is sparse when it comes to NP-patient communication styles. The purpose of this study was to describe the most common verbal communication styles used by NPs in NP-patient interactions.

NP communication is assumed to differ from nurse-patient communication and is probably more like physician-patient communication. Extensive research has addressed physician communication styles. Physicians use 2 major forms of communication in patient encounters: (1) provider-centered and (2) patient-centered. The provider-centered style has been described as meeting the provider's agenda and limiting the patient encounter, often through the use of closed-ended questions. This style of communication has been found to have a negative effect on the patient-provider relationship and is considered less desirable. Conversely, the patient-centered style is based on more open-ended questions; the physician uses more statements of concern, agreement, and approval than in the provider-centered style. The patient-centered style is correlated with a positive effect on the patient-provider relationship and is the desired communication method. Research has also found that a physician's communication style is consistent from one patient to another.

The current study had 3 phases of data collection. In phase 1, investigators identified and enrolled 53 NP participants and 1 patient for each NP, along with the corresponding NP-patient encounter. The NP-patient encounters were audiotaped. During phase 2, the 53 audiotapes were transcribed by a professional transcriptionist and coded by 2 reviewers. In phase 3 of the study, the data were analyzed.

The 53 patient participants were fairly evenly distributed between men (n = 24) and women (n = 29), with an age range from 18 to 89 years. Most patient visits to the NP were for follow-up visits or monitoring of chronic health problems. The average encounter lasted 17.8 minutes (range, 5-45 minutes).

Quantitative manifest content analysis was used in the study to analyze transcript data and to identify communication variables present in NP-patient encounters. Data were coded according to 6 different types of communication:

  • Information giving, in which the NP gives information, opinions, suggestions, or instructions;

  • Information seeking, in which the NP asks for information, takes a medical history with open-ended and closed-ended questions, or seeks patient ideas;

  • Social conversation, in which the NP engages in social comments or greetings;

  • Positive talk, in which the NP agrees, shows approval, offers support, or shows empathy;

  • Negative talk, in which the NP disagrees, confronts, shows antagonism, or shows tension;

  • Partnership building, in which the NP asks for the patient's opinion, understanding, or suggestions or reflects on patient's statements, an important element in patient-centered care.

The study analysis showed that all NPs used information-giving and information-seeking methods of communicating. Only 16 NPs (30.2%) used a patient-centered communication style, while 37 (69.8%) used a provider-centered communication style. Overall, NPs used information-giving slightly more often than information-seeking. Thirty-seven NPs (69.8%) used partnership-building, but not with great frequency. Of all the communication variables, NPs used negative talk the least. The other communication variables differed in their occurrence during NP-patient interactions.

The study's hypothesis stated that most NPs would use a patient-centered communication style. The findings did not support this hypothesis. NPs claim they use a patient-centered communication style in clinical practice, which differentiates them from other providers. However, only 16 (30.2%) of the 53 NPs actually used this style in their interaction with patients.

On the basis of the study findings, the author made several recommendations:

  • Even though patient satisfaction is often lower with provider-centered communication, conduct further studies to compare the revenue generated with each communication style.

  • Investigate the relationship between NP-patient communications, partnership-building, positive and negative talk, and patient adherence with outcomes of care.

  • Analyze NP use of open-ended questions during the patient encounter to see whether this might strengthen the claim that NPs use patient-centered communication in their interactions.

  • Investigate patient sex, race, and ethnicity to see whether NP interactions differ according to these variables.


Nurse practitioners often pride themselves on clear communication with patients that serves as the basis for education, counseling, and advocacy. This research highlights the continuing need to document actual role behaviors rather than perpetuating unfounded beliefs. Nursing faculty should look critically at these findings and use the information to strengthen NP educational curricula so that patient-centered communication becomes the norm and not the exception.


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