1. Pappas, Sharon PhD, RN, NEA-BC, FAAN


This column reviews the concept of humanism in leadership. After surviving a year perceived by many healthcare professionals as the most challenging of a generation, the author reflects on leadership essentials for rebuilding our nursing workforce.


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The year 2020 had a profound impact on many aspects of healthcare. For many clinicians, it resurfaced the importance of humanism, systems or actions in which common human value and goodness dominate, a core purpose for many clinicians. For some, an anchor in humanism brought pride and heroism, whereas for others, moral distress. Clinicians hold responsibility to patients and, sometimes forgotten, responsibility to collaboratively improve their work systems so humanism is reinforced. Stronger connections to each other facilitate this because, at its core, healthcare "is fundamentally a relational endeavor."1(p2) As compassionate professionals, we are accountable for how we behave and interact, make decisions, and lead. All of these relational factors influence clinician well-being. Clinicians are subject to joy and emotional pain associated with their work. The inability to rebound from pain can no longer be singularly attributed to a fault of individual clinicians; it is important to consider how the work systems make that worse[horizontal ellipsis] or better.

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The health of the workforce is a function of both physical safety and the clinicians' individual level of well-being. Before the pandemic, clinician burnout, an occupational syndrome that evolves from the work environment, affected between 35% and 54% of US nurses and physicians.2 After a year of managing the COVID-19 pandemic killing half million Americans by February 2021, the grief, fear, and anger felt by clinicians caused or exacerbated burnout and the deleterious effects on their mental health.3 In one study, nurses had the largest psychological distress among other providers.4


Organizational leadership is accountable for clinician well-being and is now tasked with rebuilding a compassionate workforce. The challenge ahead is to make the individual clinician more resilient, but also to make the workplace a contributor to well-being. Three key concepts, relationships, accountability, and community, fall within the scope and talent of nurse leaders to accelerate the path forward. It is essential we master our situation or be mastered by it.


The original Magnet(R) research identified leadership as one of the core elements of a positive work environment. Decision-making, autonomy, professionalism, and outcomes accompany leadership as essential interacting forces that when present in hospitals, nurses are less likely to have burnout.5 Leadership styles, transformational, servant, authentic, appreciative, and others, are important to sustaining positive work environments and systems. The leadership characteristics within these styles emphasize relationships with and within teams. Patients benefit from relational caring. Peer support benefits clinicians. The leader does not accomplish this alone; the relational value must permeate the organization through all leaders. Although there are multiple successful blueprints to achieving cultural well-being, progress accelerates when leaders exhibit relational competencies. Published 4 decades ago, the 1st studies on nursing burnout reported that relationships expressed as peer support, collegiality, and effective teams were significant to ensure a positive culture. How would care look different if we prioritized relationships?1


The NASEM (National Academies of Sciences, Engineering, and Medicine) consensus study2 summarized the evidence about the role of the leader in creating well-being. The study, grounded in research, reported evidence that contrasted leaders who valued and focused on developing relationships with people, exhibited hopefulness, had high ethical standards and transparent values to leaders who focused on tasks, or were abusive and found leader behaviors to be a strong predictor of employee burnout. When the leader sets a positive context for the work, leader behaviors influence individuals, and the work system are interactive and adaptable.


Healthcare organizations, as living cultural environments, hold the accountability for the effectiveness of leadership, the work system, and for the well-being of its people. Concurrent measurement of individual well-being and work system effectiveness is required to make improvements. Employee satisfaction is not the same as individual well-being. Work system metrics include resource availability, both human and material; employee data, such as injuries and retention rates; and quality indicators related to patient outcomes. We cannot consider it a victory when organizations achieve positive patient outcomes on the backs of the heroic clinician effort. Clinicians have to compensate for the many unresolved fissures in healthcare organizations6 to manage ineffective systems and prevent negative impact on patient care. Such management consumes clinician resilience. Accountability for the effectiveness of the organization's work systems requires leaders to facilitate conversations to listen, learn, and respond and resist transactional approaches to improvement. How would systems change if clinician well-being were a leader accountability?


The leader creates the context for relational work and facilitates community. Community is a descriptor of a work system that represents the interrelationships that exist as the individuals perform the patient care. Throughout the pandemic, the way nurse leaders had to manage the rapidly increasing numbers of patients communicated a message that nurses are interchangeable. Clinical roles blurred across disciplines when care was bundled to address the lack of available personnel and/or limitations imposed to reduce exposure to the virus. This contributed to the loss of personal connection to patients and families and fellow clinicians. In some cases, these practices resulted in loss of clarity of professional purpose and personal value and contribution.


There are many examples of solid leadership that worked to counter the above by actions that improved social support among healthcare professionals that cultivated community and enhanced camaraderie. Clinicians thrive when they are part of a supportive community of colleagues.7 Highlighting the focus of cultivating community, consider routine patient care practices. Shift huddles that begin with a patient story or recognition celebrates the importance and impact of clinical care. This use of the narrative helps augment resilience and restore purpose through the realization of the profoundness of the nurse-patient bond. In addition, consider how bedside shift report or patient rounds could improve community. What if, in addition to the transactional practice of relaying patient information, the rounds connected colleagues on a personal level? The restoration of individual clarity on their value and connection to purpose must occur as we emerge from the pandemic-induced isolation and solo activities of patient care. Is your team a community?


The causes of burnout across disciplines and clinicians vary, and both individual and system approaches are required. This happens when individuals support each other and together improve the systems in which they practice transforming mechanized processes of patient care through meaningful colleagial relationships and with patients. Few longitudinal or experimental studies describe correlations of variables and burnout. We must build on the variables that contribute to clinician well-being, experiment with them, and learn their impact over time. Nurse leaders understand the pandemic's damage to the spirit of the nursing workforce and must restore it. How will you lead to restore the humanism in care?




1. Sinsky CA, Bavafa H, Roberts RG, Beasley JW. Standardization vs customization: finding the right balance. Ann Fam Med. 2021;19:171-177. [Context Link]


2. National Academies of Sciences, Engineering, and Medicine. 2019. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-being. Washington, DC: The National Academies Press. . [Context Link]


3. Dzau VJ, Kirch D, Nasca T. Preventing a parallel pandemic-a national strategy to protect clinicians' well-being. N Engl J Med. 2020;383(6):513-515. [Context Link]


4. Shechter A, Diaz F, Moise N, et al. Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. Gen Hosp Psychiatry. 2020;66:1-8. [Context Link]


5. Kelly LA, McHugh MD, Aiken LH. Nurse outcomes in Magnet(R) and non-Magnet hospitals. J Nurs Adm. 2011;13(5):428-433. [Context Link]


6. Rushton CH, Pappas S. Systems to address burnout and support well-being: implications for intensive care unit nurses. AACN Adv Crit Care. 2020;31:141-145. Accessed January 10, 2021. [Context Link]


7. Swensen SJ, Shanafelt TD. Strategies to Reduce Burnout 12 Actions to Create the Ideal Workplace. New York: Mayo Clinic Scientific Press; 2020. [Context Link]