1. Doucette, Jeffrey N. DNP, RN, NEA-BC, FAAN, FACHE

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Q I'm overwhelmed with the challenges of staffing, engagement, turnover, and burnout as I try to lead my team back to some normalcy. Are things going to get worse before they get better?

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For almost a year and a half, we've been so focused on the pandemic we seem to have lost sight of the fact that we had a well-being and engagement crisis in nursing before anyone heard of COVID-19. Data from Press Ganey's 2019 workforce engagement survey of more than 1 million healthcare professionals show that nurses already had the lowest level of engagement pre-pandemic. The average national engagement score for all healthcare workers was 4.10 on a 5-point scale, with nurses scoring an average of 4.01.1 The pandemic took an already bad situation for nurses and made it much worse. Although disheartening, there's an imperative for hope rooted in an evidence-based approach to improving nurse engagement.


Among the top drivers of nurse engagement are a sense of belonging to the organization, the ability to do meaningful work, and being part of an organization that provides high-quality care and service. Stepping back from the daily crisis management we've all been in for the past 18 months and focusing on these drivers can provide a roadmap for leaders who want to lead their teams beyond the pandemic to a new level of performance and engagement.


Creating a sense of belonging starts at the unit level, and the responsibility for this goes far beyond the unit manager. Key actions to foster a sense of belonging include promoting psychological safety, checking in with employees on a regular basis, developing an identity for the unit and team, asking employees for input in decision-making, and encouraging high levels of involvement in shared governance activities. We must reset the focus on these critical and foundational elements to ensure we're creating a culture that supports optimal resilience, retention, and engagement.


Although most of us would agree that caring for others when they're sick is inherently meaningful, this isn't the case for many clinicians. The burden of administrative processes, lack of ability to practice at top of license, and constant interruptions in workflows are just a few of the common reasons that nurses cite when feeling burned out and less engaged. Reducing and/or eliminating these barriers to care, ensuring that nurses are focused on the practice of nursing, and removing unnecessary administrative work are ways to increase caregivers' perceptions that the work they do is meaningful and making a difference.


Nurses want to provide high-quality care; being armed with the appropriate data, resources, support, and leadership has been shown to make a difference in perceptions of quality, safety, and service. Of all the interventions, I believe this can be the most difficult area of alignment between frontline clinicians at the sharp edge of care and leadership team members. In part, this is a symptom of how data about quality and service are frequently shared. I've repeatedly seen performance data weaponized against clinicians. Rather than using the data to single out a particular caregiver or unit, data should guide changes, inform decision-making, and drive improvements. Frontline employees rarely respond to "your numbers need to improve," a frequent call of leaders and managers. Employees are more likely to be engaged in improvement activities when they understand how their role contributes to outcomes, which is something many leaders take for granted. Making the connection between data and the patient perspective presents a far more compelling case for clinicians than posting a graph on a bulletin board or sending spreadsheets to ever-growing email inboxes.


The short answer to your question is yes, thing have gotten worse during the pandemic and are poised to improve. One of the most important gifts we can give our teams is the ability to craft a vision beyond the daily crises and instill hope that things will get better, even when sometimes we can't clearly see it for ourselves. Get back to basics with these three interventions and you'll be on your way to resetting the culture and forging a new path forward.




1. Press Ganey. 2019 healthcare workforce special report: the state of engagement. [Context Link]