The Nurse’s Role in Communicating Barriers to Patient Access

Nurses occupy a unique vantage point to spot patient access barriers, such as financial strain, cultural/language gaps, or system hurdles, through daily patient interactions. In direct patient care, nurses often notice when patients hesitate to fill prescriptions, miss appointments, or express worries about costs or care processes. By listening and using structured communication techniques, nurses can uncover hidden obstacles. For example, the BATHE interview method (asking about Background, Affect, Trouble, Handling, and providing Empathy) is a quick psychosocial checklist shown to surface patient stressors [1]. Similarly, communication models like RELATE (Reassure, Explain, Listen/Answer questions, Take action, Express appreciation) help elicit patient concerns. These tools encourage patients to share issues such as inability to afford medications or transportation difficulties. In practice, nurses routinely screen for social needs such as housing, food, and finances. For instance, one study noted that when pregnant patients were asked about social needs via a digital survey, 77.7% had at least one unmet need (vs 96.7% on a longer survey), and most felt it was important for their care team to know these needs. Patients in that study also reported comfort sharing needs through in-person or digital tools [2].

Nurses at the bedside often use structured questions and empathy to reveal barriers (e.g., a nurse documenting social or financial needs). Effective communication training improves this process.

Nurses’ observations are supported by research on communication barriers: nurses and patients alike cite patient-related factors (language/literacy gaps, socioeconomic status, health beliefs) and system factors (noisy wards, rushed care) as common hurdles. For example, a recent study found nurses perceived that patients’ limited English, low income, or lack of transportation often hindered understanding, while nurse workload or limited time also impeded patient dialogue [3]. These insights highlight that identifying access problems often starts with the nurse noticing a clue (e.g., a patient not refilling a drug due to cost) and gently probing with empathetic questions or screening checklists. Organizations encourage this approach: analysts of nurse–patient communication recommend training nurses in effective listening and interview skills to ensure such barriers are recognized and recorded.

Identifying Barriers at the Bedside

Nurses uncover access obstacles through observation and conversation. Key clues include patients mentioning unmet basic needs or showing confusion about care instructions. Common barriers include:

• Language and Cultural Gaps
• Transportation Issues
• Financial Hardships: Studies show many patients (e.g., ~33% of insured Americans in one survey) struggle with premiums or deductibles and may skip care [4].
• Insurance and Coverage Gaps
• Social Determinants

Nurses often use screening tools to systematically elicit these barriers. For instance, the Centers for Medicare & Medicaid Services (CMS) developed the Accountable Health Communities (AHC) Health-Related Social Needs (HRSN) screening tool: a 10-item questionnaire addressing food, housing, transportation, utilities, and interpersonal safety [5]. Such standardized forms (often integrated into the EHR) prompt nurses to ask about each domain. However, reviews find that primary care nurses rarely use formal SDOH screening tools routinely. In practice, much relies on a nurse’s clinical judgment and established rapport to surface issues. When a nurse suspects a problem (e.g., a patient seems anxious about affording care), they may use a mix of structured questions and empathetic dialogue to draw it out. By combining clinical interviews (BATHE, motivational interviewing, etc.) with targeted checklists, nurses can identify barriers that might otherwise remain hidden.

Communicating Barriers within the Care Team

Once a barrier is identified, nurses have a responsibility to communicate it clearly to the rest of the care team. Effective handoffs and interdisciplinary communication ensure that all providers – including physicians, social workers, case managers, pharmacists, and others – are aware of access issues. Structured handoff protocols are crucial. For example, the I-PASS or SBAR formats (Situation–Background–Assessment–Recommendation) are often adapted to include social needs and patient concerns.

Effective handoffs are essential: as one clinical review warns, “failure of communication of critical information during handoffs is one of the leading causes of medical errors,”. Incomplete handoffs can lead to care delays if the next provider is unaware of a patient’s situation. The handoff process, by definition, must transfer both information and responsibility for those issues [6]. Nurses should seize the opportunity to ask questions and confirm understanding at shift change. EHR flags or “problem lists” to tag SDOH issues so all providers see them. By integrating access concerns into standard communication channels, nurses help the care team plan appropriately (e.g., arranging translation services or home services).

Escalating Insights to Medical Affairs & Access Teams

Nurses’ real-world perspectives are invaluable not only at the bedside but also to organizational and industry stakeholders (such as Medical Affairs, Market Access, and patient support teams). They can convey patterns they observe to drive program improvements. For example, oncology and specialty clinic nurses often encounter many patients who cannot afford a new therapy. By compiling these cases, nurses can inform their health system’s access office or even the manufacturer’s medical affairs or patient services group. This can prompt efforts such as expanding patient assistance programs (PAPs), adjusting copay support, or working with payers on formulary exceptions.

Consider a scenario such as a community nurse documenting that many patients have high no-show rates due to transit issues might collaborate with hospital administration to fund transport services. In one example study, implementing a Financial Navigator intervention (often run by nursing or social work staff) significantly increased patient satisfaction with care and support for cost concerns [4]. The same study highlighted that, before intervention, physicians often discussed costs (80% did), but only 18% actually knew their patients’ financial situation [4], a gap nurses are well-placed to fill. By relaying such insights (e.g. “X% of our patients report being unable to afford meds” or “frequent denials of drug coverage”), nurses help medical affairs teams understand on-the-ground challenges.

Nurses also help drive programmatic feedback loops: they can report how existing support initiatives are working. For instance, data show that enrollment assistance in PAPs improves clinical outcomes (better glucose and lipid control in diabetes patients) [7]. Nurses overseeing patient enrollment into PAPs gather evidence on what helps or hinders access. For example, oncology nurses’ guidance on PAPs “can reduce the impact of financial toxicity” for eligible cancer patients. They inform colleagues about which programs have simple forms versus those burdensome to apply for. In short, by collaborating with access teams and advocating for patients’ needs, nurses turn individual patient stories into actionable insights that shape policy and support programs.

Best Practices & Tools

To systematize the nurse’s role in identifying and escalating access barriers, organizations are developing best practices and digital tools:

• Standardized Screening Protocols: Embedding SDOH screening into intake processes or nursing assessments ensures consistency. Tools like the AHC HRSN 10-question survey or PRAPARE (Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences) can be adopted. In practice, some clinics have checklists for nurses to check off issues like food insecurity or utility needs, generating automatic referrals.
• Digital SDOH Apps: New apps and EHR modules allow quick screening on tablets or patient portals. For example, a recent study validated a 3-question digital SDOH screener (derived from PRAPARE) for prenatal care: it showed high sensitivity for detecting social needs and was well accepted by patients [2]. Over half of the surveyed patients reported being comfortable sharing social needs electronically, suggesting mobile or digital screening can work even without face-to-face interaction.
• Partnerships with Community Health Workers (CHWs): CHWs are trained lay workers who share a cultural or linguistic background with patients. A systematic review describes CHWs’ roles as including care coordination, social support, and linking patients to resources [8]. For example, a CHW might join nurses on home visits to follow up on identified needs. These partnerships extend nurses’ reach: CHWs handle intensive outreach and follow-up, while nurses contribute clinical assessment and education.
• Interpreter and Cultural Services: Hospitals must provide professional interpreters when language barriers exist. Evidence shows that using professional in-person interpreters yields the highest patient satisfaction and communication quality.
• Financial Navigators and Social Work: Financial counselors or navigators (often nurses or social workers) help patients apply for benefits or assistance. One study found that patients paired with a financial navigator reported greater satisfaction with assistance on cost concerns [4].

By employing these tools and collaborations, healthcare teams turn nurse-identified issues into coordinated action. Systematic logging of barriers (via EHR templates or case logs) allows tracking of common problems, which can then inform quality improvement. Digital platforms (like health systems’ patient portals or integrated care management apps) can automate screening and referrals. Through these best practices, nurses ensure that communication of barriers leads not just to awareness, but to solutions.

Conclusion:

Nurses are at the frontline of recognizing the social, financial, and systemic challenges that hinder patient access to care. By skillfully eliciting patient concerns, consistently communicating them to the team, and collaborating with medical affairs and access experts, nurses transform individual patient experiences into data that improve care delivery. Real-world insights from nurses grounded in daily practice and shared across teams are essential for designing patient-centered access programs. As one study noted, empowering nurses with communication skills and formal support systems is key to removing access obstacles.

In this evolving healthcare environment, structured education can further enhance the nurse’s role in access strategy. Because they are experts in clinical communication and the patient's perspective, many nurses begin to explore roles where this expertise is valuable in non-direct patient care. These roles are typically in medical affairs or patient access. Certifications such as the Certified Nurse Medical Affairs Professional™ (CNMAP™) provide nurses with the required knowledge in medical affairs and access science, supporting nurses in bridging clinical care with broader system-level solutions. Ultimately, leveraging the nurse’s perspective, strengthened by both experience and targeted training, helps close the gap between bedside care and systemic change, improving outcomes for vulnerable patient populations.

References:

1. Joseph A Lieberman III, Marian R Stuart, The BATHE Method: Incorporating Counseling and Psychotherapy Into the Everyday Management of Patients https://pmc.ncbi.nlm.nih.gov/articles/PMC181054/#:~:text=Patients%20often%20expect%20help%20with,in%20a%20more%20constructive%20way
2. Peahl, A. F., Rubin‑Miller, S., Jahnke, E. J., Plough, A., Henrich, J., Moss, E., & Shah, N. T. (2023). Understanding social needs in pregnancy: Prospective validation of a digital short‑form screening tool and patient survey. AJOG Global Report https://pubmed.ncbi.nlm.nih.gov/36922957/
3. Reza Ghanei Gheshlagh, Syede Mona Nemati, Reza Negarandeh, Fatemeh Bahramnezhad, Pershang Sharifi Saqqezi, Hassan Mahmoodi (2024). Identifying communication barriers between nurses and patients from the perspective of Iranian nurses: a Q-methodology-based study https://pmc.ncbi.nlm.nih.gov/articles/PMC11225134/#:~:text=qualitative%20study%20identified%20multiple%20barriers,31
4. Matthew P Banegas 1,2,✉, John F Dickerson, Nicole L Friedman, David Mosen, Althea X Ender, T Ruth Chang, Tracy A Runge, Mark C Hornbrook(2019). Evaluation of a Novel Financial Navigator Pilot to Address Patient Concerns about Medical Care Costs https://pmc.ncbi.nlm.nih.gov/articles/PMC6380481/#:~:text=about%20not%20being%20able%20to,28%2C5
5. Tiase, Victoria MSN, RN-BC; Crookston, Cathryn Degraff BSN, RN; Schoenbaum, Anna DNP, MS, RN-BC; Valu, Madelynn MPH, RD (2022). Nurses' role in addressing social determinants of health https://journals.lww.com/nursing/fulltext/2022/04000/nurses__role_in_addressing_social_determinants
6. Mary Ann Friesen, Susan V. White, Jacqueline F. Byers. Patient Safety and Quality: An Evidence-Based Handbook for Nurses, Chapter 34Handoffs: Implications for Nurses. https://www.ncbi.nlm.nih.gov/books/NBK2649/#:~:text=%E2%80%9Chandoff%E2%80%9D%20will%20be%20used%20and,So%2C%20conceptually
7. Tisha M Felder, Nynikka R Palmer, Lincy S Lal, Patricia Dolan Mullen (2011). What is the Evidence for Pharmaceutical Patient Assistance Programs? A Systematic Review https://pmc.ncbi.nlm.nih.gov/articles/PMC3065996/#:~:text=significantly
8. Andrea L Hartzler, Leah Tuzzio, Clarissa Hsu, Edward H Wagner (2018). Roles and Functions of Community Health Workers in Primary Carehttps://pmc.ncbi.nlm.nih.gov/articles/PMC5951253/#:~:text=facing%20support%20and%20services%20in,Despite%20their