1. Section Editor(s): Raso, Rosanne DNP, RN, NEA-BC, FAAN, FAONL

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Do you remember learning about Maslow's hierarchy in Psychology 101? From the behavioral science perspective, the focus was on the priorities of human needs, starting from physiologic safety, then progressing to physical safety, love and belonging, esteem, and the pinnacle of self-actualization or fulfilling one's potential. There's a sequential and developmental order to the levels. I recently read an article calling Maslow's pyramid "one of the most cognitively contagious ideas," and indeed it has been. Let's revisit it from the perspective of our nursing workforce and the hierarchy of needs we should be addressing as leaders.

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Various health systems and recent nursing papers and presentations have invoked Maslow's theory in relationship to the practice environment. I've seen it as a model for joy in practice, a means of assessing COVID-19's impact on nurses, a conceptual framework for nurse retention, and a model for nurse manager competencies. It's all brilliant and makes so much sense. As we rebuild, we must start with the basics of safety and work our way up to each nurse's professional fulfillment and potential. Yes, that would be a healthy work environment, critical to retention and awesome nursing practice.


Physiologic safety includes taking breaks, having time to eat, and getting enough rest time between shifts. What about physical safety? Are we doing enough to protect our staff from harm in the workplace, both physical and verbal? Without these in place, you won't progress up the hierarchy, according to the theory. If you're struggling at the safety level, there's a long way to go. Zero tolerance for physical or psychological harm in the workplace is basic and a must.


When we reach the level of belonging, the focus shifts to connections, teamwork, relationships, and inclusivity. These are our support systems, both individually and as teams. Without them, there's no joy at work and, most likely, inadequate patient care. When asked, "Why do you stay?," most leaders talk about their teams, making teamwork a critical rung on the ladder. I recently read that belonging is a better motivator than money. Psychological safety comes into play here, too, which requires inclusion.


The esteem level relates to recognition and feeling valued, which are universally considered essential for a healthy work environment. Finally, with all this in place, fulfillment of one's potential is possible, where voices are heard, formal and informal structures allow and encourage professional growth and contributions, and extraordinary professional practice abounds.


These initiatives can happen at the same time. You can work on ensuring meal breaks, installing panic buttons, implementing shared governance structures, encouraging teamwork, showing appreciation, and giving recognition simultaneously. Don't let the hierarchy hold you back to tackling one step at a time. There's too much rebuilding to do. This also goes beyond well-being, which is foundational and related, but not enough.


The Nurse Staffing Think Tank, a task force sponsored by five professional organizations, issued recommendations recently to provide direction for national action. Not surprisingly, the priorities centered on healthy work environments, diversity and inclusion, well-being, schedule and compensation flexibility, and care delivery models. You can line them up on the hierarchy of needs rather easily.


When workplace culture and personal values coincide, magic happens. Let's make paying attention to human and staff needs "cognitively contagious." Maslow's hierarchy of needs gives us a blueprint for rebuilding so every staff member can be the best that they can be.



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