Active Listening Will Change Your Clinical Practice

When people think about important skills for an SLP working in skilled nursing, they often think of dysphagia management, dementia care, or instrumental assessments. While these clinical skills are essential, one of the skills that has had the biggest impact on my own clinical practice is active listening.

Active listening means making a real effort to understand what someone is really trying to communicate. It involves listening to understand rather than simply waiting for your turn to respond. It means asking thoughtful questions, reflecting back what you’ve heard, and remembering that information so you can use it later.

I’ve had countless treatment sessions over the years where I walked into a room planning to work on one thing, but after listening to my patient for five minutes, realized we needed to be working on something completely different that day. Those conversations have often led to far more meaningful therapy than whatever I originally had planned.

Good rapport is the foundation of every therapeutic relationship, and active listening is one of the fastest ways to build that rapport. More importantly, it allows us to create intervention plans that are meaningful to the individual rather than simply doing therapy and checking it off the to do list.

A Simple Example

Imagine you walk into a patient’s room for a treatment session and immediately notice they are upset. They tell you they “got in trouble” for going to the bathroom without using the call bell. There are two very different ways this interaction could unfold.

Scenario 1

The SLP allows the patient to vent and then responds: “Unfortunately, I don’t have anything to do with that. I’m here to work on your memory.” The conversation ends, therapy begins, and an opportunity is missed.

Scenario 2

The SLP listens carefully and recognizes that the patient’s frustration isn’t really about the call bell. It’s about losing independence.

Instead of redirecting the conversation, the SLP asks follow-up questions and learns that the patient’s primary goal is to transfer independently to the bathroom without needing assistance. This is what is most important to them at this time.

The SLP then collaborates with physical and occupational therapy to identify the barriers preventing that goal. The team determines that cognitive deficits are affecting the patient’s ability to sequence the transfer and remember to lock the wheelchair brakes.

Instead of working on a cognitive worksheet, the SLP practices the specific transfer sequence the patient wants to master. The patient learns to say each step out loud during the transfer to improve sequencing and recall, while the SLP collaborates with the rest of the team on strategies to improve carryover. The patient’s own goals are driving the treatment session.

Active Listening Doesn’t Stop with Patients

Active listening is just as important when working with colleagues. One of the most common frustrations I hear from SLPs is that their recommendations aren’t consistently carried over by nursing staff. When that happens, it’s easy to become frustrated or assume people simply don’t care.

Instead, ask one question:

“Can you help me understand what’s making this difficult?”

You may hear barriers you never considered.

“I didn’t know about the recommendation.” → The communication system needs improvement.

“There isn’t enough time in the morning.” → Identify another time in the daily routine when the task is more realistic.

“Oral care just isn’t a priority.” → An opportunity for education about the relationship between oral hygiene and aspiration pneumonia.

Sometimes the recommendation itself isn’t the problem. Once we understand why something isn’t happening, we can work with the team to find solutions that are actually realistic.

Listening Creates Change

Meaningful change in skilled nursing rarely happens because we tell people what to do. It happens because we understand what matters to them, what barriers they face, and what motivates them.

Whether you’re working with patients, families, nursing assistants, therapists, or administrators, active listening helps you find the information you need to create interventions that are realistic, collaborative, and person-centered.

Active listening is one of the most valuable skills we can develop as SLPs. It helps us build stronger relationships with our patients, collaborate more effectively with the interdisciplinary team, and create treatment plans that reflect what is truly meaningful to our patients. When we take the time to understand someone’s goals and barriers, they are much more likely to make meaningful progress.