Introduction

For many years, nurse-patient communication has been a hot and challenging topic in nursing education and research. To meet the growing demands of the healthcare environment, nurses must possess superior communication competence1. Effective nurse-patient communication is crucial for nurses to understand patients’ conditions and needs, deliver personalized care, and enhance the quality and effectiveness of nursing care2. However, nursing staff often focus on task-centered care practices, which can negatively affect nurse-patient interaction and communication. Previous studies have shown that many factors affect nurses’ communication competency, including the complexity of the work environment, the cultural and social environment of patients, nurses’ work experience, and personal traits4,5,6,7. In China, tertiary hospitals are typically the core of medical services, offering a wide range of outpatient and inpatient services. Due to the large population base and relatively insufficient medical resources, medical staff must treat a large number of patients in a short period, which increases the likelihood of miscommunication and medical conflicts8.

In this context, humanistic nursing theory is critical, emphasizing the subjective experiences and emotional needs of individuals, as reflected in the recognition and support of patients’ emotions by nursing staff, which is similar to caring ability9. Caring ability is a crucial concept in medical care, emphasizing effective communication and exchange with patients, as well as respect for their opinions and feelings10. This approach can enhance patients’ trust in nurses, increase their willingness to cooperate and receive treatment, and ultimately contribute to improved medical effectiveness and patient satisfaction11,12. Providing humanized, personalized, and comprehensive care services during the medical process can help alleviate nurse-patient conflicts and promote the development of harmonious nurse-patient relationships13. Nevertheless, an absence of caring ability can impact the professional performance of medical personnel, the quality of life of patients, as well as the cost and outcomes of healthcare14.

Although there have been many domestic and international studies focusing on the caring ability and communication competence of nursing staff, most of them only evaluate caring ability or communication competence in a single way. Dong et al. explored the relationship between workplace stress and social support in terms of humanistic caring ability among Chinese nurses15. Lee et al. examined the association between improved communication competence and reduced burnout rates among Korean operating room nurses from a communication perspective16. These studies separately examined the impact of communication competence and caring ability on clinical nurses’ work situations, but the interaction or influence between the two has not been explored. In studies on the interaction between them, some scholars have conducted investigations; however, the research population was limited to nursing students17. Specifically, Yang et al.‘s study revealed the chain-mediated role of empathy and communication ability in influencing emotional intelligence and caring ability18. Li et al. found that communication ability can indirectly influence nursing students’ caring ability19. As a core concept in nurses’ clinical capabilities, caring ability emphasizes communication and interaction with patients, which can help alleviate nurse-patient conflicts. However, the exact relationship and internal mechanisms through which caring ability influences communication competence remain poorly understood in clinical nursing populations. Understanding the current state of clinical nurses’ communication competence and the mechanisms through which they are influenced by caring ability is crucial in high-stress work environments and complex medical settings.

Therefore, this study aimed to explore the current status and related factors of nurses’ clinical communication competence at a tertiary hospital in China and evaluate the impact of clinical nurses’ caring ability on clinical communication competence to improve communication efficiency and quality, build a harmonious and stable nurse-patient relationship, enhance patients’ medical experience and satisfaction, and provide a scientific basis for developing effective intervention measures in the future.

Methods

Aim

To assess the level of nurses’ clinic communication competency and caring ability among staff nurses, their mutual relationships, and further explore the influencing factors of nurses’ clinic communication competency.

Study design

A descriptive correlational study among 1977 staff nurses was carried out at a tertiary hospital in China from September 2023 to October 2023. The study was conducted in line with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines17.

Study participants

A convenience sampling method was used to select the study group. The justification for choosing a convenience sample for the study was primarily to streamline data gathering. To mitigate potential bias, we gathered general information about the participants from the completed questionnaires and rigorously compared it with the study’s inclusion and exclusion criteria. The inclusion criteria for the study are as follows: (1) obtaining a nurse professional qualification certificate; (2) age > 20 years old; (3) working in this hospital for more than 6 months. Exclusion criteria: (1) work content does not directly contact the family members; (2) vacation time > 1 month; (3) not willing to cooperate with the investigation; (4) nurse trainees or assistant nurses. The basis for determining the sample size refers to Kline’s sample size calculation formula, which recommends 10–20 times the measurable variables18. There were a total of 15 variables in this study, and considering a 20% dropout rate19the minimum sample size required for this study was 180.

Ethical considerations

Before the questionnaire survey, we explained the study’s objectives, methods, and significance to the participants on the first page of the questionnaire, ensuring that they have a complete understanding of the research process and willingly take part in the study. Informed written consent was collected from all participants in the study and their participation was kept anonymous. The study was conducted by the Declaration of Helsinki20 and was approved by the Medical Ethics Committee of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science & Technology, China (approval number: TJ-IRB202401086).

Instruments

We administered a survey throughout on-line platform wenjuanxing (wjx.cn) to measure different variables in this cross-sectional study, including the following:

General characteristics

According to the purpose of the research, the general information questionnaire was made, and the content included: age, gender, nursing years, education, professional titles, and department.

The caring ability inventory (CAI)

CAI is defined as the ability to provide care to patients, a concept developed by nursing expert Professor Nkongho in 199021 and later translated and revised by Ma Yulian in 2012 into a Chinese version22. It contained 37 items (items 4, 8, 11, 12, 13, 14, 15, 16, 23, 25, 28, 29, and 32 are reverse items) and was classified into three dimensions: knowing dimension (14 items), which referred to the degree of understanding, grasping, and processing of objective information such as individuals, others, and the surrounding environment; The dimension of courage (13 items) referred to the degree to which one actively cared about oneself and others, and dared to face unknown situations; The dimension of patience (10 items) referred to the ability to endure and persevere with perseverance. According to the Likert 7-point scoring system, the CAI scale was assigned 1–7 points based on the degree of opposition or agreement, with 1 being “completely opposed” and 7 being “completely agreed”. The higher the total score, the stronger the ability to care. The Cronbach’s alpha for the entire CAI was 0.925, and the Cronbach’s alpha values for the three factors ranged from 0.816 to 0.929. The Cronbach’s alpha of the scale in this study is 0.856, and the Cronbach’s alpha values for the three factors ranged from 0.846 to 0.922.

The nurses’ clinic communication competency scale (NCCCS)

NCCCS is defined as patient-centered exchange of information with patients, their families, and other Health professionals to restore and promote the patient Health and meet their needs. It was developed and applied by Zeng Kai of Central South University in 201023, which comprehensively evaluated 58 indicators of communication competence between nurses and patients, and can better reflect the level of clinical communication competence of nurses. This scale included six dimensions24: team communication competency (6 items), basic language communication competency (11 items), basic non-language communication competency (7 items), emotional perception competency (9 items), emotional support competency (6 items), and communication competency in difficult clinical scenes (19 items). The Likert 5-point system scores from 1 point (very poor) to 5 points (very good), with a total score of 58 ~ 290 points. The higher the score, the stronger the nurses’ clinic communication competency. The homogeneity reliability of the whole scale was 0.978, and the coefficients of the six aspects ranged from 0.868 to 0.954. The Cronbach’s alpha of the scale in this study is 0.995, and the Cronbach’s alpha values for the six factors ranged from 0.964 to 0.990.

Data collection process

This study conducted an anonymous survey in the form of an electronic questionnaire, and the data was strictly confidential. Anonymity was guaranteed by disabling WeChat user ID collecting and employing encrypted survey Links. Data were preserved on password-protected servers available solely to the research team. Data were stored on password-protected servers accessible only to the research team. Participants received a disclaimer stating that responses were non-traceable and would be aggregated for analysis. The director of the nursing department would send the questionnaire link and the inclusion and exclusion criteria of the survey subjects to the Head nurse WeChat group, and then the Head nurse of each department would forward it to the Head nurse WeChat group of each department, and strictly implement the inclusion and exclusion criteria of the research subjects. A questionnaire survey would be conducted by a dedicated research team member. After obtaining the informed consent of the nurses, the investigators used unified guidance language for guidance, and the questionnaire was independently completed by nurses based on their own situation. Of the 3000 nurses of different grades in the hospital invited to participate in this study, 2050 nurses participated voluntarily (response rate = 68.3%). The criteria for considering a questionnaire invalid are25: (1) Questionnaire completion time < 120 s; (2) More than 50% of completed questions have the same answer; (3) There are unanswered questions in the questionnaire. If the questionnaire meets any of these criteria, it is considered invalid. In all, 2050 questionnaires were collected, and after excluding invalid questionnaires, the final sample included 1977 valid questionnaires for further analysis.

Statistical analysis

Continuous variables were presented as mean ± standard deviation or as median and interquartile range, depending on whether the variable conformed to a normal distribution. The frequencies and percentages of categorical variables were presented in descriptive statistics. We used SPSS software to judge the distribution (skewness: |Sk| < 3; kurtosis: |Ku| < 10) and multicollinearity (variance inflation factor: VIF > 10)26,27. The data of NCCCS and CAI presented a normal distribution (skewness ≤ |1.187| and kurtosis ≤ |1.789|), and there was no multicollinearity (VIF ≤ 6.186). Data for independent samples were compared using the Student’s t-test and analysis of variance, as appropriate. Evaluate the differences between groups based on the results of multiple comparisons. Exploring the relationship between nurses’ clinic communication competency and caring ability using Pearson correlation analysis. Using multiple linear regression analysis to explore the influencing factors of nurses’ clinic communication competency. Multiple categorical variables were converted into dummy variables, which were analyzed using the Enter regression method. Stepwise regression analysis was used for the other binary and continuous variables. Statistical significance was set at P < 0.05 and data were analyzed by SPSS version 24.0 (Armonk, NY: IBM Corp., URL https://www.ibm.com/support/pages/downloading.

-ibm-spss-statistics-24).

Results

General characteristics of participants

The general characteristics of the 1977 staff nurses are summarized in Table 1. The median age of nurses was 33.0 years (interquartile interval [IQR] is 29.0–38.0).

Table 1 General characteristics of nurses (N = 1977).
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The level of nurses’ clinic communication competency and caring ability.

The sum scores and mean scores of nurses’ clinic communication competency and caring ability of the 1977 staff nurses are summarized in Table 2. The total score of nurses’ clinic communication competency was 259.35 (SD = 32.53). The total score of caring ability was 192.21 (SD = 22.23).

Table 2 The score situation of NCCCS and CAI (N = 1977).
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The differences of nurses’ clinic communication competency by general characteristics

A comparison of nurses’ clinic communication competency by general characteristics is shown in Table 3. There was a statistically significant difference in nurses’ clinic communication competency in terms of age (F = 63.291, P < 0.001), gender (t = −3.391, P < 0.001), nursing years (F = 56.212, P < 0.001), professional titles (F = 40.879, P < 0.001), and department (F = 10.151, P < 0.001).

Table 3 Univariate analysis of NCCCS in relation to variables (N = 1977).
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The relationship between NCCCS and CAI among 1977 staff nurses

The study revealed a statistically significant correlation between the examined NCCCS and CAI scales (P < 0.001), as detailed in Table 4. All subdimensions had significant correlations except for the courage dimension (P < 0.001), and the courage dimension only had a significant correlation with team communication competency (P < 0.05). The specific results are shown in Table 4.

Table 4 The results of correlation analysis between NCCCS and CAI (N = 1977).
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Multiple linear regression analysis predicting nurses’ clinic communication competency

Using NCCCS as the dependent variable, multiple linear regression analysis was conducted with statistically significant variables including department, gender, nursing years, professional titles, age, CAI (β[95%CI] = 0.464 [0.622 ~ 0.735], P < 0.001) as independent variables in univariate analysis and correlation analysis. The results showed that department, nursing years, and CAI were the influencing factors of NCCCS, which could explain 30.2% of the variance in nurses’ clinic communication competency (F = 41.687, P < 0.001), as shown in Table 5.

Table 5 Multiple linear regression analysis predicting NCCCS (N = 1977).
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 Discussion

Nurses from different departments were included in this study, and their overall clinical communication competency was above average. Compared with two studies involving 254 ICU nurses28 and 539 mental health nurses29 in general hospitals, the participants in these two studies scored (3.94 ± 0.69 points) and (4.31 ± 0.60 points) on NCCCS, respectively. In this study, the participants had a higher level of clinical communication competency (4.47 ± 0.56 points). This discrepancy may be related to the specific populations of the compared studies: ICU nurses often communicate with mechanically ventilated patients, who face physiological limitations (e.g., intubation) that hinder expression of needs or discomfort, creating significant communication barriers30,31; mental health nurses interact with psychiatric patients, who may be unwilling to communicate due to emotions like anxiety or paranoia, or societal stigmatization of mental illness that leads to caution and defensiveness in communication32,33. Among the 1977 nurses in this study, team communication competency scored the highest, while communication competency in difficult clinical scenes scored the lowest. Team communication refers to information exchange between nurses and other healthcare team members, and its competence is critical for improving work efficiency, service quality, patient recovery, and team collaboration34,35. In contrast, communication competency in difficult clinical scenes involves using appropriate strategies to communicate effectively in challenging situations36. Potential reasons for the low score in this dimension include nurses’ insufficient communication skills, lack of focused listening, and obstacles in healthcare services37. Additionally, nursing work in China faces complex challenges—such as nurse shortages, high workloads, and tense doctor-patient relationships38. This study’s participants were from top-tier hospitals, where nurses often care for multiple patients simultaneously, limiting time and energy for communication and reducing effectiveness in difficult scenes. Research has shown that nurses’ cognitive and physical overload can lead to ineffective information transmission, poor emotional communication with patients, and even occupational burnout39. Thus, adopting effective communication methods in high-stress contexts, remaining calm, listening carefully, and mastering nonverbal communication are particularly important for nurses40,41. The score of CAI in this study was relatively low (192.21 ± 22.23 points), consistent with He’s multicenter cross-sectional study on nurses’ caring ability in 27 Chinese provinces (192.16 ± 24.94 points)42. Nurses scored lowest in the “courage” dimension of CAI, which may be because courage—defined as the ability to handle unknown situations and actively implement caring11—requires high standards and is difficult to practice, making it a challenging quality to develop.

Student’s t-test and analysis of variance revealed significant differences in clinical communication competency among nurses of different ages, genders, nursing years, professional titles, and departments. Women showed better communication competence than men, consistent with previous studies: women are often more patient, better at listening, and more empathetic in communication, enabling them to understand others’ needs and express themselves effectively43,44,45,46. Junior nurses generally had weaker communication skills due to limited experience47 while older nurses with longer tenure had stronger competence, as they accumulate medical knowledge, nursing skills, and practical communication experience48. Nurses with higher professional titles demonstrated higher resilience, enabling faster responses to pressure and stronger problem-solving abilities, which help build patient trust49.

Correlation analysis indicated that better clinical communication competency was associated with stronger caring ability. Caring ability—encompassing empathy, understanding, and support—helps nurses establish trusting relationships with patients, laying the foundation for effective communication50,51,52. Through active listening, nonverbal communication, and emotional support, nurses can better interpret patients’ signals, reducing misunderstandings. Notably, the “courage” dimension of caring ability was only proportional to team communication competency, with no significant correlation with other subdimensions of clinical communication. This may be because in interprofessional team collaboration, especially during critical moments involving patient safety and rights, overcoming significant internal and external resistance is a direct manifestation of courage. Other core success factors in clinical communication subdimensions focus more on empathy, communication skills, knowledge transfer, and relationship building. While these abilities may occasionally require courage, courage does not play as universal, central, or decisive a role in them. Additionally, organizational power culture and pressure-filled environmental factors may suppress nurses’ expression of courage, leading them to use it selectively in team communication (e.g., reporting safety incidents) but avoid it in daily patient interactions. Further research is needed to verify this and explore the complex interaction between courage and communication.

Multiple linear regression analysis identified department, nursing years, and CAI as influencing factors of NCCCS. Using the emergency department as the reference group, several departments (surgery, gynecology and obstetrics, pediatrics, Gaogan department, infectious diseases department, E.N.T. department) showed statistical significance, and the emergency department had the lowest NCCCS score. This may be related to the fact that emergency department patients often experience physical discomfort or psychological tension when seeking medical care, leading to anxiety or non-cooperation during communication53,54 as well as nurses’ time constraints, which require them to make quick decisions and treat patients promptly, resulting in simplified communication and even the omission of important information exchange55. Longer nursing years were associated with better communication, possibly because nurses’ emotional intelligence improves over time56 enhancing their ability to handle patient emotions and build trust. This study newly confirmed that nurses’ caring ability impacts their communication competence: caring ability—emphasizing attention to patients’ emotions, needs, and happiness, and requiring knowledge, courage, and patience57,58—enables nurses to better understand patients and establish good nurse-patient relationships59,60. Despite the recognized importance of caring ability, medical education still struggles to cultivate it61. Thus, future research should focus on cultivating caring ability (e.g., integrating training into novice nurse development, designing theory-practice curricula, and implementing senior nurse mentorship) to improve nurses’ communication competence and nursing quality.

Limitations

This study has several limitations. First, the sample lacked diversity: it was single-center, predominantly female, and geographically limited to urban areas, failing to account for gender and regional differences in culture, economy, and society. This may limit the generalizability of results. Future research should adopt multi-center collaboration or stratified sampling to increase diversity and validate findings. Second, self-report measures may introduce bias; future studies could supplement quantitative results with qualitative methods. Finally, as a cross-sectional study, it cannot confirm a causal relationship between caring ability and clinical communication competence. Longitudinal studies are needed to further explore the strength of associations between variables.

Conclusions

The research results of this study indicated that the stronger the caring ability, the stronger their clinical communication competency of nurses. Multiple linear regression found that department, nursing years, and caring ability were influencing factors for nurses’ clinical communication competency. First, given the varying demands on nurses’ communication skills across different departments, hospitals should develop department-specific communication enhancement strategies. For example, given the fast-paced and complex nature of the emergency department, specific clinical communication training programs must be developed. Virtual reality technology can be utilized to simulate various emergency scenarios, enhancing nurses’ ability to adapt and communicate effectively in high-pressure environments. For specialized departments such as pediatrics and geriatrics, targeted communication skills training should be conducted. For instance, pediatric nurses should be trained in effective communication methods with children and their parents, while geriatric nurses should focus on developing the ability to listen and understand the needs of elderly patients. Second, communication and caring ability training must be incorporated into the foundational training of new nurses from the outset of their employment. Professional caring ability courses should be implemented, and a mentor framework should be established, with experienced nurses providing personalized guidance and timely feedback to less experienced nurses. Additionally, course designs should be optimized to emphasize the integration of theoretical and practical courses, increasing the proportion of practical instruction, such as clinical communication case analyses, patient-physician conflict simulation exercises, and caring ability enhancement workshops. Finally, in terms of policy formulation, caring ability and communication competence should be incorporated into performance evaluations. Regular excellence in communication case sharing sessions should be held to foster a departmental culture that values humanistic care through role model demonstrations, and rewards should be provided to model nurses.