Nurse Leaders Must Foster Change to Develop a Healthy Workplace Environment

Linda Laskowski-Jones, MS, APRN, ACNS-BC, CEN, NEA-BC, FAAN

Transformative solutions in nursing are ones that are sustainable, according to Linda Laskowski-Jones, MS, APRN, ACNS-BC, CEN, NEA-BC, FAAN. To come up with a transformative solution, leaders need to engage their employees and see how new strategies affect their working environment.

“Transformation oftentimes [is a] term bantered about and used freely in healthcare institutions today across the board but without understanding what it means, what it looks like, and how much time it takes—because it's not a short walk,” Laskowski-Jones said. She added, “as an oncology nurse, I think you can advocate best through helping to enable others to grow and when you do that you grow yourself and you also learn to take risks in your profession.”

In an interview with Oncology Nursing News®, Laskowski-Jones, who is editor-in-chief of Nursing2022 and president of the Delaware Emergency Nurses Association, and who has spent nearly 4 decades working in trauma and emergency nursing, as well as served as a manager, director and vice president in her hospital’s trauma and emergency departments, discussed how meeting problems with transformative solutions can help improve the working conditions of nurses across a unit.

Understanding the problem: Nursing Shortages

In her presentation, Laskowski-Jones highlighted that, although there are 4.3 million nurses in the US, because of new roles, more jobs, retirements, better staffing ratios, and RN’s leaving the profession, 11 million more nurses are needed to avoid shortages. Moreover, RN employment is projected to be the occupation requiring the most growth through 2026.

The effect of the COVID-19 pandemic on the nursing landscape paired with outside pressures as well as internal elements such as workloads, expectations, and patient factors, have left the field needing transformative solutions to address the causes of turnover along with burnout. Based on geography and specialty, the average turnover of nursing staff ranges from 8.8% to 37% and the American Nurses Association declared the nursing shortage a national crisis on September 1, 2021, to the Department of Health and Human Services.

In speaking about the nursing shortage, Laskowski-Jones noted that the “great resignation” had already begun in 2019, before the COVID-19 pandemic. “In 2019 there was this uptake of resignations across the board in all professions—not just in healthcare…. hospitals were starting to ratchet down on staffing. They were trying to cut corners and reduce resource utilization, [even though] we had organizations saying: we expect high patient experience scores.”

Laskowski-Jones noted that hospitals were being held to higher standards as the patient experience scores are publicly reported and with that came pressure. Additionally, an increase of violence in health care, and lawsuits piled on.

Of course, in 2020, the pandemic compounded these issues, and by 2021, many nurses were burnt out.

“In 2020, we had the pandemic, and everybody was engaged because nurses rise to the challenges, we always rise to the challenges, they’re all in; they’re being battered with what they’re dealing with between the personal protective equipment needs, the complex patients, potentially being pulled to a unit where they never worked before, having to learn new skills, and dealing with devastating situations in many cases,” Laskowski-Jones said.

“[However,] 2021 was a different story,” she said. “Even with vaccines, the pandemic had not ended. The biggest thing was that there was this latent demand in the community for services [because some patient’s] cancer wasn't diagnosed or their heart disease wasn't diagnosed and now they were all coming in where they had been too afraid to even use the hospital [before].”

With a large increase in patients coming to hospitals, nurses were working in environments that were at overcapacity and nurses “did not feel that they were being supported, they were valued, and they were starting to see shortages that weren't necessarily being addressed.”

While issues were still active, travel nurses had a large positive affect in care, but this impacted the dynamic in the hospital as travel nurses receive high contract pay which may have led some nurses who had been at institutions for a long time to feel undervalued and leave.

Transformative Solutions:

In her presentation, Laskowski-Jones noted that creating a healthy workplace environment is a crucial solution in beginning to rebuild the nursing field. The root causes for burnout, turnover and unhappiness must be addressed, and nurses should not be expected to be able to handle everything with a lack of support; psychological safety must be developed. Key points under that umbrella include developing non-defensive listening skills, promoting a clear vision with team alignment, innovation, respectful communication, and generating a culture across the organization of effective teamwork.

Transformative is a broad term, but it essentially refers to solutions that are sustainable, according to Laskowski-Jones. She highlighted some examples of unsustainable solutions vs sustainable ones.

“Transformation means going from this vision of what you think should be to sustainably getting there.” Laskowski-Jones gave the example, “let’s say there is a directive that when the patient comes in staff have only a specified amount of time to get a certain type of work done (eg, their admission process, or their discharge process, etc.).

In this hypothetical example, Laskowski-Jones said, someone looked at data and determined that all patients should be discharged in 6 hours. All nurses are trying to get patients discharged within a 6-hour time-frame. However, if they are struggling to do it, are exhausted, and are consequently cutting corners, that would be an unsustainable goal as currently performed.

Sustainable solutions should make work easier and more effective, Laskowski-Jones noted. This means that when new strategies are implemented, leaders should be asking employees how they feel about the change, and whether it is making things better.

Meeting Problems with Solutions

Laskowski-Jones’s presentation emphasized the importance of creating a healthy work culture and assessing one’s own style and reputation to encourage positive change in the environment. Emotional intelligence is key in the workplace and establishing trust to build relationships with coworkers and teams is crucial while being mindful of short- and long-term goals that are set.

When discussing issues in the workplace, Laskowski-Jones said that she encourages nurses to come-up with solutions to the problems that they pose to her.

“If you bring me a problem,” she said, “and I don’t care what it is, you need to bring me your idea of what the solution is... If we make this change that you recommend, how is that going to affect other people?”

Lastly, Laskowski-Jones emphasized that leadership must value their staff.

“You have to show empathy,” she said. “Value is not just giving somebody a little gift… or some sort of recognition day, value is being able to have a conversation where you witnessed someone having a difficult day or a challenging patient,” she said. “It’s when a manager says ‘I was impressed with how you handled that.’ Or that must have been difficult for you, do you want to talk about it? I am here to listen, I’ve been there, and I know how hard this is.”

Reference

Laskowski-Jones L. Finding your voice: how nurses can create a healthy work culture to enhance a thriving work environment. Presented at: ONS Bridge; September 13-15, 2022; virtual.