Stop!! Don't forward that e-mail (or copy it to everyone under the sun)-at least not yet. Have you carefully considered who needs to know and what they need to know about the message you are forwarding? Have you examined the content closely to see whether there is further information or clarification necessary for the application of the information in the emergency department (ED[AQ1])? Or, are you a vector of information overload? Like the boy who cried "wolf," filling up people's mailboxes with nonessential, nonapplicable, or incomplete information almost ensures that they won't pay attention to the messages that really are important. It's a classic case of TMI (too much information), a condition that has reached pandemic proportions.
Translation and communication of information is the responsibility of all leaders and a key role for advanced practice nurses. In fact, one could argue that information brokering is the very essence of the clinical nurse specialist role. So, how do we do our jobs while helping prevent the spread of information overload? To be an effective conduit of information, consider the following Five Rights of Information Dissemination before you hit the Send button.
1. THE RIGHT INFORMATION
Is your reason for sending the message clear? Does the information apply to the ED or matter to the people you are copying the message to? Many messages about inpatient processes do not pertain to ED practice. But, if you board inpatients in the ED (and who doesn't these days?), there will be messages or parts of those messages that you need to heed in the ED, it just won't be all of them. Similarly, not all recipients need to be included in every response to a message.
Do you understand the full implications of the information you are forwarding? Everyone will appreciate it if you delete the nonapplicable content and highlight or summarize the pertinent aspects of the message. It may make more sense for someone else to review the information, edit it, and forward it if the content is outside your area of expertise. At the very least, you should discuss the information with someone more knowledgeable if you are not sure about the applicability or impact of the information on the recipients. Has someone else already sent the information out? If several people receive the same e-mails and forward them on to the same people, it is obvious that they are not paying attention but are just indiscriminately forwarding everything. If you come back from time away to an overflowing electronic in-box and are not sure which messages have been forwarded in your absence, sort the messages by subject. Then you can scan the list for duplicates, check the recipient lists, and quickly determine which messages your colleagues have already forwarded.
2. THE RIGHT PEOPLE
Obviously, much of the information we disseminate is to nurses. However, many times there are components of the message that apply to nursing assistants, technicians, secretaries, physicians, and so on. For example, if there is a change to a frequently used item such as a needleless injection port, nursing assistants or technicians are probably responsible for stocking it and, even though they do not personally use the product, they may need to be aware that the packaging will look different. It is unlikely that the physicians will be significantly impacted by (or even notice) the change and it won't matter at all to the secretaries. For the most part, we are pretty good at forwarding information to everyone, the challenge is in sending it only to those who really need it.
3. THE RIGHT FORMAT
E-mails with paragraph after paragraph of solid text will try anyone's attention span, especially a nurse who is quickly reading messages between patient care duties. Format or reformat information for quick comprehension by eliminating nonessential content; this is not literature, it's communication. Look at every sentence and see which words can be eliminated without compromising the integrity of the information. Edit and re-edit the message until it is succinct and clear. Bullet points are easy to read and help emphasize essential information. And please, spell and grammar check your message. Poor writing can distract the reader, confuse the message, and it will reflect poorly on you.
Two may be better than one. There is a balance to be struck between the number of messages and the length of messages. A long, multitopic message will be harder to digest and may cause confusion if unrelated subjects appear to be related because of their proximity in a message.
Consider the communication vehicle. Is e-mail the best way to disseminate this information? The answer is not always yes, even though you may have originally received the information via e-mail. It may be more effectively communicated to others via posters, classes, in person, or in a hard copy. Consider various learning styles and remember that some people learn best by seeing pictures or diagrams while others benefit more from reading or hearing, and some are best served in medium that involves hands on, touching, or doing. In fact, the more important the information is, the more modalities you should employ to get the word out. You may need to send an e-mail, put a poster in the bathroom, and discuss it at shift report. Just don't use a multimedia blitz for every mundane piece of information that someone sends you.
The type of information to be conveyed will also help determine the medium. Psychomotor skills of any complexity will require an interactive, hands-on opportunity for the learners to practice. Detailed information about a new process or procedure may necessitate a discussion so there is an opportunity for questions and answers.
4. THE RIGHT PLACE
Consider the future retrievability of the information. If it is a new piece of equipment or a process that will be integrated into daily practice, posting the information on a bulletin board for a period of time will probably provide an adequate reference. If the information will be permanently integrated into a policy or procedure, state that in the e-mail and consider posting a copy of the revised policy to provide a visual reminder that the policy has changed and that the information is readily available in the policy. Single-topic messages with a clear, descriptive subject line facilitate electronic and hard copy archival for future reference. Notebooks are convenient hard copy archives, and a departmental Web page can provide an electronic archive.
5. THE RIGHT TIME
It is tempting to send messages forward as soon as possible to get them out of your in-box and off your To Do list. In some cases, this makes sense, but in others it may be prudent to delay. If there is groundwork to be accomplished before an initiative can be rolled out, you may want to wait until you can send one message with complete information. And, for things in the distant future, sending the information now may mean that the content is forgotten before it is used. On the other hand, if a major or complicated change is coming or in progress, bite-sized pieces of information on a regular basis or preliminary messages to help everyone anticipate the change are useful. For routine information that is brief and not time sensitive, a weekly compilation of messages can help reduce in-box clutter. However, make sure that important information is not buried in a large collection of messages-consider making it the first topic or sending a separate e-mail.
In sum, respect others' time by taking your time to make sure that the information you send is the right information, to the right people, in right format, in the right places, and at the right time. Effective information brokering is a lot of work. Editing a two-page e-mail down into bullet points of pertinent information, remembering to send it at a later but more appropriate time, and making sure that the information is retrievable for future use is no small feat but the rewards are great. When done well, you can count on improved comprehension and retention of information and an increased likelihood that the message will be read and understood. Maybe there will even be gratitude from your colleagues-the overworked and overwhelmed emergency personnel.
Jean A. Proehl, RN, MN, CEN, CCRN, FAEN
Emergency Clinical Nurse Specialist, Dartmouth-Hitchcock Medical Center, Lebanon, NH
K. Sue Hoyt, RN, PhD, FNP-BC, CEN, FAEN, FAANP
Emergency Nurse Practitioner, St. Mary Medical Center, Long Beach, CA