1. Section Editor(s): McGrath, Jacqueline M. PhD, RN, FNAP, FAAN
  2. Co-Editor
  3. Brandon, Debra PhD, RN, CCNS, FAAN
  4. Co-Editor

Article Content

Dear NANN Colleagues,


In 2017, the Institute for Healthcare Improvement published a white paper entitled, "The IHI Framework for Improving Joy in Work." This white paper outlines in detail why joy at work is important to healthcare delivery with strategies to improve Joy at Work.1 The crux of this publication is that compassion fatigue and burn-out take a toll not just on the individuals but on the organization as a whole such that institutional investment in Joy at Work matters. On average we spend more of our waking hours in the workplace than we do at home with our families, how we spend those hours matters. If we arrive home from work completely depleted by the work; it's unlikely we can recharge enough to continue to provide high quality care the next time we return to the work environment.


While caring for infants and their families in the neonatal intensive care unit (NICU) can seem joyful; we all know it can also be exhausting particularly, if the caring strategies used are not reinforced by others in the workplace. Joy at work can best be achieved by how we work together and how we support each other in the workplace. For example, the nurse who spends several hours working with a family preparing for a NICU discharge might find satisfaction and joy in those activities (a sense of achievement). However, if her/his co-workers believe this time could have been spent better in other ways that satisfaction (joy) could be lost and the nurse in question might become increasingly dissatisfied over time. Some would call the above scenario "joy stealing." This type of behavior could make the workplace dreary and no fun. It also increases the potential for a nurse to leave the organization, which is costly to all involved and could decrease the overall quality of care provided.


Dissatisfaction in the workplace is big business. Retention strategies are all about increasing satisfaction and although salary and raises matter they are not totally what keeps an employee in the workplace. How we support each other matters. How we engage in the workplace and work together to make it a better place, matters. Improving the places, we work within must come from within, it does not come from administration or a particular leader it must come from within each of us. If we are dissatisfied in our work, then it's likely to spread to others - almost like wildfire. So, what we do we when we are dissatisfied matters. Do we complain? Do we blame our co-workers? Our bosses? Or do we reflect and consider how we can make the workplace better.


Many would say that Joy at Work is about attitude. The attitude we each bring with us into the workplace. The saying "today is a good day to have a good day", reflects this belief. How we each decide to engage in the workplace matters. Many organizations are investing in values about workplace engagement. This may seem like just a benefit to the organization and that is true however, it is also a benefit to the employees that work there. A positive environment is one where there is more likely to be creativity, effectiveness, and overall positive outcomes. Risk-taking to generate new and more creative ideas to improve care are important to moving forward in a healthcare environment that is ever-changing. The NICU is a stressful environment. We tell families to expect the "roller coaster ride," but do we tell ourselves the same thing? Do we reflect on how to manage the ride or do we somehow get lost in the chaos and begin to burnout?


Be compassionate with yourself, there are strategies that you can build into your day to manage the stress and leave at the end of the day more satisfied. Reflect and discuss with your co-workers about, what makes for a good day in the NICU?1 What are the things you or your co-workers do for infants and families that make you proud? These are the things that provide you a sense of accomplishment at the end of the day. That feeling that you completed the tasks you set out to do and your team worked together to make it happen. During this discussion you could also consider what makes for a "Bad Day"? Items that could come out of that discussion might include feelings of isolation, unfairness or inequity, a lack of autonomy or even lack of psychological safety. Providing voice to these feelings is the first step in overcoming these barriers and increasing teamwork. The NICU is a busy environment and although there are a lot of people in the environment, if we are not a team we cannot provide the best care.


For example, the huddles that many units are using to begin their day are a way to highlight the team's efforts to provide high quality care. They are also a means for dividing and conquering a challenging staffing ratio or providing more creative discussions on ways to use the staff support that is available, or even a time to cheer each other on about accomplishments such as improving infection rates or increasing delivery of human milk. But even more importantly they are a time for each of us to remember we are all in this together and together we can make a difference for infants and families. We hope you begin today with a wonderful day - that you are grateful for your co-workers and that you know that without each of you high quality care cannot be delivered. Joy matters and we each have a piece in whether joy exists in our workplace or not.


Thank you to our readership and for your submissions to Advances in Neonatal Care,


Jacqueline M. McGrath, PhD, RN, FNAP, FAAN


Co-Editor; Advances in Neonatal Care


[email protected]


Debra Brandon, PhD, RN, CCNS, FAAN


Co-Editor; Advances in Neonatal Care


[email protected]




1. Perlo J, Balik B, Swensen S, Kabcenell A, Landsman J, Feeley D. IHI Framework for Improving Joy in Work. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2017. (Available at [Context Link]