1. King, Lenetra MBA, MHA, FACHE
  2. Drake, Kirsten DNP, RN, OCN, NEA-BC

Article Content

No doubt you've heard the saying: "Employees don't leave organizations, they leave managers." In an age where employee engagement and turnover continue to be a challenge for many hospital systems across the country, we must have structures in place to create strong workforce cultures that lead to exceptional patient outcomes. Where does a culture of highly engaged employees begin? You guessed correctly-it all starts with leaders. Engaging your employees has to be a priority.1 There's a very clear link between high-performing and dynamic leaders and a positive impact on employee engagement, retention, and the patient and family experience. To succeed in an increasingly competitive healthcare space, it will take strong and competent leaders to create cultures in which frontline staff members are engaged, aligned, and committed to delivering excellent service to our patients and families while producing strong clinical outcomes.

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Five tricks of the trade

High-performing leaders cultivate environments in which employees feel valued and have a voice in decisions that impact their work. One of the end results is employees' ownership of what they can do to deliver on the organization's mission and vision. From an executive's vantage point, there are several key commitments that nurse leaders must make to drive employee engagement.


1. Grow yourself and your leaders

Have you measured the leadership competency of your nurse leadership team? If you haven't assessed your team's skill set in this manner, stop here and do so immediately. There are a number of assessment tools available; check with your nursing director first then your human resources department to find out about available resources. One resource that allows for self-assessment of competencies is the American Organization of Nurse Executives' nurse leader competencies, which are divided into three categories: the science, the art, and the leader within.2 Many hospitals have development programming for leaders to build and refine their leadership strengths, which may include comprehensive tools such as 360-degree assessments. It isn't enough to have the technical competency to perform the nurse manager role; the leadership component is becoming more significant to organizational priorities and results.


2. Set clear expectations and drive a culture of accountability

Leaders set the tone for cultures-on the unit, in the department, and throughout the rest of the hospital. Frontline staff members are watching you for reactions and responses, especially in times of turmoil. As leaders, it's up to us to ensure that we've set clear expectations for our teams so they know the metrics and how performance will be measured. Have routine conversations reinforcing expectations and the consequences for nonperformance. You've probably heard the saying "what you permit, you promote." This is the basis of accountability-the obligation to account for activities and accept responsibility for performance in a transparent manner.3 As leaders, we must continue to set the performance bar high, aligning expectations around goals, behaviors, and processes.4 How you manage low-performing or toxic employees determines how effective you are in meeting your departmental or organizational goals. Creating environments where highly engaged and high-performing staff members can thrive is critical and can mean the difference between barely meeting key performance indicators and exceeding your goals. In the world of performance management, acknowledging positive performance is equally as important as managing negative performance.5 The end game is to manage your culture so that your culture doesn't manage you.


3. Create solid structures for onboarding and orienting new employees

One absolute must-do is to make sure your department has a solid and organized onboarding approach for all new employees. More than just ensuring that a preceptor has been provided and a competency checklist is done at the end of orientation, the focus needs to be on integrating new team members into the department and the organization. A new employee's first 30/60/90 days to the end of the first year is critical, so set the stage for him or her to be welcomed into the environment. Also, connecting new employees with others to build relationships is integral to their success. Consider "stay" interview questions that charge nurses or nurse managers can ask new employees, such as why they come to work each day and how they prefer to be recognized.6 Again, the focus is to ensure that new staff members have the tools necessary to succeed within the first few months in their new role.


4. Communicate, communicate, and communicate even more

If you ask frontline nurses what can be improved in their workplaces, communication probably shows up on the list somewhere close to the top. Dynamic and high-performing nurse leaders must create multiple ways to communicate with frontline staff via huddles or department meetings and shift handoffs. Be visible, have communication touch points, and always challenge yourself to be creative in managing communication. It isn't enough to send an e-mail and expect that communication has occurred. Consider using communication boards, stoplight reports created from listening rounds, and department meetings across shifts as vehicles for communicating what's happening organization wide. Give employees the opportunity to share feedback about what's working well and not working, and talk through specific operational challenges impacting the unit. Adapt your communication style as necessary and always follow up to clarify and ensure alignment.


5. Create systems for reward and recognition

High-performing leaders create environments in which staff members are connected to purpose through meaningful work assignments. Ensure that your team is recognized and rewarded for exceptional service and care. After you've set clear expectations; created mechanisms for accountability; communicated all that can be communicated; and engaged, rounded, and connected with staff, have systems in place to recognize and reward teams for optimal performance. For example, celebrate quick wins for units that have patient satisfaction survey scores above a certain percentile. Celebrate exceptional performance on quality indicators; employees can easily see the data and know where performance needs to be improved. The energy and excitement when quick wins are celebrated can raise team morale. Recognition helps employees feel valued and encourages them to continue to work hard to meet goals. Take the time to brainstorm with your frontline staff members about how they want to be recognized. This can be a great source of options for you to consider if the ideas are inexpensive and can be executed with relative ease.


At the core

The work that it takes to truly be a high-performing leader, consistently building on the attributes that lead to outstanding performance, is no small feat. As healthcare organizations are forced to do more with less while at the same time delivering exceptional patient and family experiences, reliable and consistent care, and excellent clinical outcomes, dynamic leadership is at the core.


Bonus content

Head to for additional resources on stay interviews.


"Stay interviews" to improve retention




1. Barrington L. Who owns engagement: employees or leaders? [Context Link]


2. American Organization of Nurse Executives. Nurse leader competencies. [Context Link]


3. Business Dictionary. Accountability. [Context Link]


4. Murphy B. Ten questions to make excellence stick. [Context Link]


5. Studer Group. The Nurse Leader Handbook: The Art and Science of Nurse Leadership. Gulf Breeze, FL: Fire Starter Publishing; 2010. [Context Link]


6. Robeano K. Stay interviews to improve retention. Nurs Manage. 2017;48(9):7-8. [Context Link]