With front-line providers experiencing an epidemic of burnout and compassion fatigue in the era of value-based care, it's critical for hospital and health system leaders to create a cultural environment where nurses are set up to thrive.
Nurses spend more time with patients than any other provider, meaning they have considerable influence on care outcomes. With nurses working long shifts amid a nationwide nurse shortage, leaders must make the extra effort to keep nurses engaged in their work.
"At the executive level, organizations have to acknowledge that employee engagement is a fundamental part of the culture... this work cannot just be seen as another program," says Martie Moore, RN, CNO at Medline who has more than three decades of industry experience.
Here are three areas of focus for nurse engagement.
Nurse empowerment
Nursing literature is replete with studies suggesting an empowered nurse is more likely to trust the organization, stay on with their current employer, have high levels of productivity and beneficially influence care quality.
In a 2014 article for American Nurse Today, Shelley Moore, PhD, MSN, RN, wrote, "To truly embrace healthcare reform in creative ways, they [healthcare leaders] also must foster a certain degree of controlled destabilization that births new ideas and innovations. People (not only staff but also patients and families) should feel comfortable asking questions. A structurally empowered nurse is best equipped to protect patients' rights."
According to Dr. Moore's article, elements of structural employee empowerment include:
• Workplace culture that supports a non-punitive professional accountability and error reporting system designed to improve patient safety rather than ostracize employees
• Performance evaluations conducted by peers who are knowledgeable about the intricacies of the work environment
• Decision-making policies that are recognizably influenced by the philosophy of shared governance
Embracing humanness
Due to the high-pressure demands of the healthcare work environment, stoicism can become a kind of default setting for providers, which can be detrimental to morale and ultimately the quality of care being delivered.
Ms. Moore, Medline's CNO, references Don Berwick, MD, Institute for Healthcare Improvement president emeritus and senior fellow, who often speaks on bringing joy to the workplace.
"When people are joyous in their work...they are more alert, they are more curious, they can learn, they're not scared of data, they're not scared to ask a question, they're not scared to ask 'how am I doing?'" said Dr. Berwick in an IHI video.
Building on the idea of joy, Ms. Moore describes the importance of having a work environment that embraces the humanness of the nursing vocation — which is more calling than it is profession. Those who step into these roles are driven by the innate drive to help others, she says.
Ms. Moore encourages the regular acknowledgment of the inspirational things nurses do on a daily basis. To embrace and amplify the humanness of the workplace, she suggests after witnessing an inspirational act, leaders should "just call it out and say 'you just took my breath away'... people need that, employees need that."
Fostering resilience
The word resilience has become a buzzword of sorts in recent years, entering the lexicons of psychology, the global development sector, economics and healthcare. Resilience by definition is the ability to withstand or recover quickly from difficult conditions. This is an essential quality for nurses as these front-line providers regularly confront life or death scenarios.
The American Psychological Association provides several tips to build resilience, including these that can be applied to the healthcare workplace environment:
• Set goals: Establish achievable team goals that can be improved upon daily.
• Promote wellness: A healthy mind and body are more apt to meet adversity head on.
• Make connections: Promote a culture of support and caring in which colleagues can confidently rely upon one another when the road ahead seems perilous.
"Nurses make a difference every day," says Ms. Moore. "Their vision for betterment of those they serve keeps their spirit alive and touches the heart and soul of many. Nursing is not about a stethoscope and scrubs. It is about the people who wear them — genuine, incredible people who are the heart and soul of healthcare. We have to create environments that foster their ability to be resilient, authentic and engaged."