Layout 1This blog post is the re-posted article from Creative Nursing, Volume 19, Number 1, 2013 , pp. 21-25(5). Full sample downloads of this journal are available here.

Electronic communication has had a profound impact on generations, in the nursing profession as well as in society as a whole. Nursing educators struggle with facilitating verbal communication skills in didactic and clinical settings, particularly with the Net Generation. Online education is rapidly becoming the norm in degree-completion programs. Nursing educators must assure that empathetic communication with patients will not become a lost art.

Many of the current trends in electronic communication appear to work against the kinds of empathetic listening and conversation that nurses need to employ with patients and their families and with colleagues. The concern is that we will become a silent profession, with limited verbal communication in our workplaces, homes, and personal lives. With e-mail, texting, tweeting, video games, and social media becoming the predominant way for many people (especially those in what is being called the Net Generation) to send and receive messages, will nursing communication for patient care become a lost art?


Our society is in the midst of a technology explosion. According to Bauerlein (2009), the average teenager sends or receives 2,272 text messages a month; middle and high school students spend 9 hours a week on social networking—an average of more than an hour a day of communication that does not use verbal skills. Individuals communicate 24 hours a day but with minimal face-to-face interaction (Bauerlein, 2009). This is the generation that will soon be entering the profession of nursing.

The generation born after 1980 has never known a time when the Internet has not been a major presence in our lives. Regarding their relationship with technology, this demographic group is described as the Net Generation. Feiertag and Berge (2008) suggest that members of the Net Generation (as employees and/or as students) have a particular learning and communication style. They tend to be less independent in learning than other generations, preferring to work collaboratively. They seek structure and feedback and need information that is tailored to them. Communication focuses on expression of ideas rather than on interpretation of language. Instead of the traditional lecture format, an active learning environment with interactive information delivery that engages students and trainees (e.g., using role play to teach empathetic communication) is more effective (Feiertag & Berge, 2008).

What are the implications of the technology explosion and the Net Generation for the profession of nursing?


Individuals whose predominant modes of communication are electronic can rapidly lose the ability to interact with others face-to-face. Technologies such as iPads and e-books can be particularly fascinating to children; overuse of these devices can limit daily interactions with adults and other children.

The personalized digital age has forced changes in educational methods throughout the elementary, middle school, high school, and college domains. The element of entertainment that has been incorporated into most digital technologies has led some faculty to feel that they must become actors and actresses to keep pace with the entertainment expectations engendered by their students’ handheld devices. Nursing education has become a multitasking endeavor to hold the attention not only of students of the Net Generation but also of students from previous generations who are distracted by instant, constant input.


The process of approaching, connecting, and collaborating with patients and their families is a learned skill at which nurses become adept over time. Handheld devices that are becoming standard equipment in many patient care settings deliver instantaneous information while de-emphasizing physical contact and verbal communication with patients.

Care plans consist of computerized forms that contain evidence-based interventions (the hallmark of the health care professions). Electronic plans of care have the capability to be individualized to the patient, but the process of creating and updating these electronic documents, with their forced choices and limited menus, does not lend itself to the reflection and critical thinking necessary for individualizing and prioritizing interventions to meet the needs of the patient. Nurses who have become dependent on computerized screens and applications to guide their thinking processes may lose the ability to reflect and contemplate.


Empathy, the foundation of the nursing profession, is learned through the experience of caring relationships between nurse and patient. Empathy instills a sense of caring and is paramount in nursing care. Spiro (1992) stated that empathy is necessary to understand human needs. Verbal communication is necessary to maintaining the empathetic bond between nurse and patient.


Nursing connects people face-to-face in the art of caring. Hall (1959) stated that nonverbal cues convey feelings, attitudes, reactions, and judgments; he called this nonverbal expression the Silent Language. Electronic communication is exempt from the need, and therefore the opportunity, to interpret posture, hand gestures, eye movements, shifts in personal space, and other nonverbal expressive behaviors (Bauerlein, 2009). Symbols can be inserted into electronic messages, but the human face—voice, tone, facial expression—is absent. Children who devote hours to messaging are less likely to develop this silent fluency, the ability to interpret nonverbal cues (Bauerlein, 2009).


Nursing curricula must shift from helping students gain knowledge to engaging students in the construction of knowledge (Oblinger & Oblinger, 2005). Net Generation nursing students want to contribute to the discussion about how they will learn and to participate in active learning (Feiertag & Berge, 2008). A major objective in educating the Net Generation of nurses involves the preservation of communication skills. Treating students as adult learners and using andragogy and constructivism will help produce nurses who are able to communicate while implementing caring in today’s goal-oriented health care environment (Feiertag & Berge, 2008).


Nursing education takes place in virtual as well as traditional classrooms. Clearly, learning through online programs is here to stay. Online classes are designed to foster communities of learning through nonverbal discussion groups. Nagel, Blignaut, and Cronje (2009) studied a group of degree-completion students whose entire curriculum was online. The authors found that these students, who were already members of a working community through their professional roles as nurses, experienced their online education community as merely an adjunct to their primary community as caregivers and thus as secondary in importance. The students did not feel the need to see one another in person. They easily adapted to the online education community and communicated through a novel way of social engagement, with the role of the faculty as one of facilitation.

Campbell, Gibson, Hall, Richards, and Callery (2008) found that Web-based technologies were being used to create online learning systems without the evaluation of their effects. These educators conducted a nonrandomized study of master’s and doctoral students enrolled in a Web-based research course; the goal of the study was to compare the effects of face-to-face discussion seminars and online asynchronous discussion on educational attainment. The study demonstrated through statistical analysis that students preferred asynchronous learning. Despite the limited generalizability of the study, the results indicate a trend for minimizing face-to-face education.

Cobb (2009) explored social presence (the degree to which a person is perceived as real) in an online learning experience. The subjects were students in online RN-to-BSN courses that used Blackboard as a platform. The study determined that social presence remains a key component of the quality of the online learning experience from the student perspective (Cobb, 2009).


Texting involves a shorthand grammar and syntax that is appropriate for brief messages but is inadequate for written communication with patients and their families and with colleagues and for narrative documentation in the medical record. Nurse educators must assure that students are fluent in written English by continuing to assign formal papers that require correct grammar and punctuation. Clear and articulate verbal and written communication is crucial to compassionate, collaborative nursing care.


How will nurses continue to communicate in real life? How will they learn to talk to patients with acute and chronic illnesses in their daily work? Davis (2011) describes the use of Skype as a more personalized mode of technology-mediated communication for situations such as teachers’ visits with homebound students. Skype is easily used by nurses to continue the face-to-face contact with patients who are homebound or recently discharged.


The true essence of nursing communication is empathy. As a profession, we must continue to promote empathetic communication with patients to fully provide the optimum of compassionate nursing care. Future generations of nurses must remain expert empathetic communicators to be authentically present. Our patients and their families deserve this full presence from their caregivers, and the ability to provide authentic presence will be the test for the emerging generation of professional nurses.


Bauerlein, M. (2009, September 4). Why Gen-Y Johnny can’t read nonverbal cues. The Wall Street Journal. Retrieved from

Campbell, M., Gibson, W., Hall, A., Richards, D., & Callery, P. (2008). Online vs. face-to-face discussion in a Web-based research methods course for postgraduate nursing students: A quasi-experimental study. International Journal of Nursing Studies, 45(5), 750–759.

Cobb, S. C. (2009). Social and online learning: A current view from a research perspective. Journal of Interactive Online Learning, 8(3), 241–254.

Davis, M. R. (2011). Socializing the virtual student. Education Week, 30(15), S10.

Feiertag, J., & Berge, Z. L. (2008). Training Generation N: How educators should approach the Net Generation. Education and Training, 50(6), 457–464.

Hall, E. T. (1959). The silent language. New York, NY: Wiley.

Nagel, L., Blignaut, A. S., & Cronje, J. C. (2009). Read-only participants: A case for student communication in online classes. Interactive Learning Environments, 17(1), 37–51.

Oblinger, D. G., & Oblinger, J. L. (Eds.). (2005). Educating the Net Generation. Retrieved from

Spiro, H. (1992). What is empathy and can it be taught? Annuals of Internal Medicine, 116(10), 843–846.