Examining Relational Coordination Among Nurses and Nursing Assistants in VA Community Living Centers

The Veterans Health Administration (VA) is the largest healthcare entity in the United States dedicated to serving Veterans. The VA has focused on improving resident-centered care through increased communication and strengthened relationships among staff who work in Community Living Centers (CLCs). This study employed the Relational Coordination (RC) survey to assess communication and relationships among nurses and nursing assistants in CLCs.

The study is a secondary analysis of relational coordination data as reported by nurses and nursing assistants from 8 VA CLCs. As part of a parent study of person-centered care implementation, these CLCs were selected from the national population of 134 CLCs for high resident-level quality indicators and artifacts of culture change. The Relational Coordination Survey was administered to assess dimensions of communication (timeliness, frequency, accuracy, and problem-solving vs. blaming) and relationship (shared goals, shared knowledge, and mutual respect). A total of 153 nurses and 133 nursing assistants responded (25% response rate). Within-group and between-group mean ratings for each dimension were computed and classified via the survey benchmarks as 'weak,' 'medium,' or 'strong.'

Nursing assistant ratings met benchmarks for 'strong' when assessing the frequency of communication with both fellow nursing assistants and with nurses. Nurse ratings also met benchmarks for 'strong' when assessing communication frequency with fellow nurses, though 'moderate' when assessing communication frequency with nursing assistants. For domains of timely, accurate, and problem-solving communication, ratings by nurses and nursing assistants were 'weak.' Shared goals and mutual respect fell into the weak category for within-role and across-role relationships for nurses and nursing assistants. Nursing assistant ratings for shared knowledge with nurses fell into the moderate rating category.

High frequency of communication may co-exist with low quality of communication and relationships.