1. Macauley, Karen DHA, MEd, BSN, RN, CEN

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Employee engagement. Without question, a corporate buzz word. But, what does engaging employees mean? How can you do it? Does it matter to your bottom line? Why does it matter if you have engaged employees on your team?


Nursing leaders play an integral role in employee satisfaction, patient satisfaction, and employee productivity. Satisfied and engaged nurses provide safer and higher quality patient care. Engaged nurses strive for higher patient satisfaction. Engaged employees have more motivation and interest in participating in department activities and in improving patient safety and patient care initiatives. Employee engagement often starts with a nursing leader. Nursing leaders have significant impact on the way an employee feels about their career, their patients, and their organization.


Carnegie1 describes employee engagement as an emotional and functional commitment to the employee's organization. Leiter and Maslach2 note that engagement requires energy, involvement, and efficacy. Kahn3 adds 3 conditions of work associated with employee engagement: meaningfulness, safety, and availability. Engaged employees are committed to their organization. They are high performers who are enthusiastic, empowered, inspired, and confident.1 Engaged employees are emotionally and cognitively immersed in their job allowing a sense of meaningfulness and value in the work leading to higher sensitivity to the organization's mission and to organizational change.4


Engaged employees care about the future of their organization, have a strong emotional bond to their organization, are vested to ensure the success of their organization, and have both their hearts and heads engaged in their work.5 This commitment and bond with their organization leads to higher productivity, increased profits, improved safety, and lower absenteeism.5 In addition, organizations that have higher employee engagement have significantly less turnover. Carnegie1 notes that turnover alone costs organizations $11 billion annually and can be significantly lessened with an engaged and committed employee environment.


Disengaged employees, on the other hand, often do only as they are told, miss more work, and are more likely to leave an organization.5 Those who are actively disengaged are physically present but emotionally absent; they are unhappy and vocal in their unhappiness, speak poorly of their organization, and actually quit but physically stay in the environment causing significant morale issues for the others within the environment. These disengaged employees are extremely detrimental to the organization; yet these employees make up a majority of the corporate workforce. Carnegie1 notes that 71% of all employees are not fully engaged.


Why is employee engagement important? Carnegie1 notes that engaged employees are up to 202% more productive than unengaged employees. Higher employee engagement can lead to higher quality of individual and team work, which then can lead to higher growth, productivity, and revenue for an organization.4,6 Organizations with highly engaged employees have a 26% higher revenue per employee and these organizations are more likely to exceed the industry average for 1 year revenue growth. Finally, organizations with highly engaged employees and team members have safer organizations and have a 49% safer environment.6



Organizational commitment is allegiance to one's organization2 and is different than employee engagement and job satisfaction. Engagement refers, instead, to the employee's relationship with the work itself while job satisfaction is the degree to which the job itself is fulfilling. Engaged employees have organizational commitment and this commitment contributes to both the morale of the organization and to the loyalty the employee feels to their organization.


The Social Exchange Theory (SET) is one of the foundational theories for workplace behaviors.7 Review of the SET gives a theoretical foundation to understanding employee engagement. The SET states that relationships of trust develop over time and that these relationships are based on trust, loyalty, and mutual commitment.7 There are guidelines identified in the exchange and one of the most recognized exchange is reciprocity or repayment. Reciprocity exchange develops better work relationships than other forms of exchange.7


Social exchange relationships (interpersonal connections) can produce positive work behaviors and employee attitudes.7 Blau8 notes that most human pleasures derive from human interactions and that people will often get specific benefits from these social interactions and, in general, 1 good deed deserves another. This reciprocity theory lends itself to employee engagement in that the relationships across an organization build trust, loyalty, and enthusiasm for an employee's work within an organization. When an employee is happy and loyal, they will be more engaged and positive about their workplace and team.



According to Osmundson,9 motivation is defined as one's ability/energy to get excited or exert effort to complete a task. Motivation encompasses effort, persistence, direction, and goals. Effort refers to the amount of effort put forth in the attainment of a goal and persistence relates to the ability to stay the course until the task is completed. Direction is the effort related to the final goal and, finally, goals are both individual and organizational and must be aligned with the final product expected. These goals can be performance or learning goals. Performance goals are to gain favorable judgment from individuals with authority or influence and can include peers and supervisors. Learning goals, on the other hand, relate to an individual using feedback to increase individual competence.


Maslow is an early pioneer in the theory of motivation. He noted that individuals are motivated in a hierarchy of need and every person is both capable and has a desire to move up the hierarchy of need.10 Maslow identified 7 stages of motivation: biological and physiological, safety, love and belongingness, esteem, cognitive, aesthetic, and self-actualization and transcendence. Human motivation, according to Maslow, is based on personal growth and fulfillment. Growth along the continuum requires satisfaction of each level before movement to the next level and few people actually reach self-actualization and transcendence.


The Pathgoal theory of leadership relies on 2 theories of work motivation: goal setting and expectancy theory.11 Goal setting theory in effective methods to motivate teams is to set realistic but challenging goals and to offer rewards. In contrast, the expectancy theory explains why people would work hard for you and describes behaviors that lead to motivational goal attainment and include a personal belief that the attainment of the goal will lead to something of value to the individual (pay, recognition, status). Engagement in the required or expected behavior will lead to the accomplishment of the goal.11


Motivation is the ability and desire to get things done. Employee engagement, on the other hand, is a fulfillment of the heart and soul of the employee to be loyal to their position and organization. One could be motivated but not engaged although the terms are often used interchangeably. It is important to note that being motivated alone is not the same as being engaged.



A leader has a significant amount of influence on a team member's satisfaction, commitment, and engagement. Kaye and Jordan-Evans12 identify the most important factors for keeping employees: meaningful and challenging work, a chance to learn and grow, the sense of being part of a team, and good bosses. Perceived organizational support requires that an employee has the assurance that there is support and assistance available to them when needed to effectively do their job.4 In addition, psychological safety is a sense of self without consequence and is necessary for high engagement.


Leiter and Maslach2 identify several areas of work life that have an impact on an employee's engagement. Workload has an impact on employee engagement. When a person's workload exceeds their time and skill capability, an employee is at great risk for burnout and dissatisfaction. A sustainable workload, in contrast, allows opportunity for growth, which is an important component of employee engagement.


Reward and recognition is another component important to developing a high level of engagement. Consistent, sincere, and timely feedback and interaction with employees are a necessity within every team. Intrinsic and extrinsic rewards are both important components of rewards and recognition. Ram and Prabhaker2 note that pay is an important consideration at the time of employment but extrinsic rewards become less important as an employee settles into a position. At this point, the authors note that intrinsic rewards are a much greater motivator. Leaders need to take the time to find out what matters to their employees. Not all employees are motivated by the same reward and recognition of these differences is imperative for success and greater employee engagement.


A sense of community within the workplace will have a positive influence on the team level of engagement. Community includes social interaction, conflict resolution, support, and teamwork. According to Leiter and Maslach2(p98) a "lively, attentive, responsive community is incompatible with burnout."


Employees require a sense of self-worth, which influences their perception of fairness within the work environment and the respect afforded to them throughout their interactions at their job. Inequities in pay, responsibility, and workload can have a profound negative impact on an employee's engagement within their organization. An employee's values will also have influence on engagement. Values are the ideals and motivations that attract employees to their job and organization; it is the alignment with the organizational mission statement and the perception of meaningful work.



Does it matter if employees are engaged? It absolutely does. Can the nursing leader have a positive or negative impact on employee engagement, productivity, and job satisfaction? They absolutely can. Nursing leaders have a profound and important influence on employee engagement. Each leader must ensure that every employee clearly understands the organizational mission. Employees should work in an environment that supports their ideas and have the support and supplies needed to be effective within their position. In addition, the work environment must be safe so that employees are empowered to be successful without fear of retribution. It is imperative that employees are recognized and rewarded sincerely and that they know that the leader also believes that their work has meaning. Finally, and most importantly, employees must feel valued by their direct supervisor and by their organization. Employees that are engaged state that the relationship is what keeps them there, gives them courage, gives them motivation, and makes them want to come in and give their best every single day. This feeling of value should come directly from the nursing leadership.




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