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Staff who do not feel part of an organization are more likely to leave in search for one that makes them feel valuable. Employee engagement is one tool; however, organization engagement is necessary. This course for nursing leadership and management will outline ways that they can improve their staff engagement in a healthcare facility.  

Introduction

Merriam-Webster defines engagement as an arrangement to meet or be present at a specified time and place (4). When you think of the word ‘engagement,’ it may bring thoughts of a bond you have between individuals and others. This bond could be described as trusting, respectful, caring, or enthusiastic. A bond is created by mutual work within a relationship and is not easily broken but sustained through good and bad experiences.  

For a healthcare facility to thrive, leadership must create conditions that empower nurses in autonomy and agency. This can lead to greater job satisfaction, long-term retention, safety, and quality of care improvement, and thus, the overall success of the healthcare organization (2). 

Case Study on Nursing Leadership and Management

Judy is a night shift RN in a community hospital. She has worked there for over two years and is learning to triage patients and becoming a preceptor for newer nurses; she is a valuable night shift asset.  

Judy has just finished a stretch of four 12-hour nights, and it is time to give a shift report; however, no relief nurse has arrived. At this point, Judy has been waiting for 30 minutes. She finally spoke to the long-time day shift charge nurse, John, and asked where her relief nurse was. He replied, “Oh, I thought you were days.” Judy has always been on the night shift. After this interaction, Judy felt that no one at her workplace knew who she was. Despite being a staff member for over two years, she is now beginning to look for jobs elsewhere.  

• Did John, the nurse leader, and the organization fail to be engaged with Judy? 
• After reading Judy’s experience, you or a colleague you know might have shared a similar interaction within your facility, and now, you might be wondering: 
• What change is required to be part of an engaged organization? What does an engaged employee look like?  

Do You Feel Engaged? 

Nurses may feel happy to come in on their day off to assist when understaffing occurs. This may not be for the money but for being an engaged team member. As a healthcare leader, supporting this sense of engagement from caregivers is essential. However, ensuring this engagement is genuine rather than for the “look” of being a team player is necessary.  

Engaged employees are happy at work, problem solvers, not just there for monetary compensation, and are genuinely concerned for the welfare of their patients, families, and coworkers (2). 

Utilizing Engagement through Nursing Leadership and Management 

There are many essential functions of nursing leadership and management where engagement is central. Engaging leaders can create favorable work environments by addressing these essential functions of the workplace (5): 

 Job Benefits 

In the hiring process, care must be taken to ensure that the employment “perks” are a reality and that benefits are correctly processed. Depending on the healthcare organization, various job benefits may include childcare, time off, healthcare benefits, retirement portfolios, and staff schedules. If these items are not processed appropriately, employee trust may be broken early on, ultimately impacting short—and long-term employee engagement. 

Pay Equity 

Pay Equity is equal pay for work completed rather than race, gender, ethnicity, age, religion, or other non-job-related factors (9). Compensation may initially attract staff members to a healthcare organization, but a sense of fair pay and transparency can promote employee loyalty. This transparency is essential, as staff may discuss their hourly or salaried wages and ultimately negatively impact employee engagement if individuals feel others are getting paid more fairly than they are without clear reasons, such as years of experience, education, or credentialing. Fair and equitable compensation is an impactful way to meet an organization’s diversity, Equity, and Inclusion goals (7). 

Scheduling 

Staff scheduling can be challenging and disastrous and present ethical concerns for employee engagement. Self-scheduling can favor specific individuals through seniority, title, culture, or workplace bullying. In an engaged organization, the staff has a significant say in their schedule and is cognizant of the unit’s and its members’ needs. Finding a balance between these two and implementing a structure and process to achieve these items in scheduling will improve employee engagement. 

Time Keeping

Payroll mistakes can cause staff complaints. Ensuring that everyone’s time is inputted accurately and that mistakes are addressed and corrected with payroll logbooks will engage staff members and improve employee workplace satisfaction.  

Patient Satisfaction Surveys. 

Healthcare organizations often use the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys to assess patient satisfaction (3). As indicated in the name, this survey assesses more than just the floor nurses, nursing assistants, and other healthcare professionals. These surveys report items continually beyond a nurse, unit, or organization’s control, which is disheartening. Staff members work hard to treat patients fairly, compassionately, and with dignity.

Whether measured through HCAHPS or other surveys, patient satisfaction scores often point out what the healthcare organization is doing wrong rather than highlighting the “wins” of the department or organization. Patient satisfaction should celebrate that level of service, rewarding those who engage with others throughout the care process. The organization should consider how to inform the public about various media changes to policies or procedures that affect the public. 

Budgeting.  

There is limited research to show that financial rewards improve employee engagement. However, other ways to improve overall employees include involvement in budgeting discussions. Though employees may not have the final say regarding the budget, staff members should be included in conversations about supply and staffing costs and capital and annual budgets. They will be more engaged if they feel involved in the organizational budgeting. The majority of Product Review Committee members should be end-users. (3).

Patient Care Coordination. 

Leadership rounding is a term used to describe a leader who interacts directly with staff and residents about care and services (2). This cannot happen from within an office. Managing by ‘walking around’ will allow the unit manager to engage staff as they work. If a staff member is making a bed, go to the other side and make the bed with them; take that time to ask how they manage their tasks, their work-life/home-life balance, etc. It matters.  

Standards Compliance. 

Compliance with healthcare standards takes proactive action to prevent fraud and waste of abuse within the healthcare entity (1). Standards compliance is the responsibility of all staff. Training to maintain compliance should be more than just an annual management. Engaged staff members should be aware of standards, how to incorporate them into their daily care, and how to solve barriers to excellence. 

Incorporating Engagement of Night Shift and Weekend Staff 

Shift-to-shift report attendance is a chance to provide coaching. Asking discerning questions about care issues allows staff to reflect, problem solve, and then take ownership of the situation. This will not only help with patient care coordination but also with staff engagement. 

Weekend attendance may not be expected but is unbelievably valuable in nursing leadership and management. 

If you are a part of nursing leadership and management, your attendance not only shows your staff members that you care enough to be there, but it also allows them an opportunity to voice any concerns they have and a chance to get to know you. 

Preceptor substitution presents an opportunity for you to engage with new staff, allow them to see your style of nursing leadership and management, and keep your clinical skills sharp.  

Peer-to-Peer Engagement 

“Getting to know you” opportunities are needed to humanize the workplace. Mingling, get togethers, and fun activities allow staff members to open up and express themselves on or off-campus. As a part of nursing leadership and management, it is important that you ensure activities are scheduled and that they include as many staff members as possible.    

Unit committee appointments present opportunities for staff members to brainstorm ideas for needed change with those in other units; when scheduling these meetings, ensure that the time is convenient for night shifters to participate as well.  

Case Study on Nursing Leadership and Management (cont.)

Donna works with Judy (from Case Study above) in the ER.  

Donna has been there for three years after working at an affiliate hospital for 6 years. When she joined her current hospital, there was a push for more BSN-prepared nurses as part of Magnet status; she agreed to join the hospital-sponsored RN to BSN transition class. This class required Donna to be off every Wednesday night. To accommodate this, the nursing leadership and management at the facility scheduled her to work weekends, and a pattern of working one night on, one night off developed.  

After 18 months, Donna graduated with honors; however, her schedule remained the same despite no longer needing Wednesday night off.  After numerous requests to the scheduler to correct this, Donna seemed to be ignored. She took her scheduling concern to the CNO. 

Ways to Improve Morale through Engagement 

If you have a position in nursing leadership and management, there are many ways that you can work to improve morale and staff engagement. Here are just a few examples: 

Bring in a homecooked meal or baked goods 

In my years of experience, I have found that baking cookies for my staff members is an easy way to thank them for their hard work and dedication and show them that I care.  

Staff challenges 

Whether it’s a “Guess Your Coworker’s Pet” or something you create on the spot, staff challenges are a fantastic way to de-stress and allow everyone to get to know each other better; don’t forget to incorporate prizes!  

Greetings and Thanks Staff 

This should be something you implement into your daily workday. A smile, wave, or a simple, “Hi *name*, how are you doing today?” can go a long way in making your staff feel human and appreciated. 

Clinical Ladders  

Employees want room for growth, and as a part of nursing leadership and management, you have the power (or at least a little say) to make this happen. 

Small Acts of Kindness 

These do not always have to be work-related. When I was a part of nursing leadership and management, I would come in early when it snowed through the night and clear the snow off my night shift nurses’ cars. Simple acts of kindness show that you care about your staff personally, and they should never be done solely for recognition or your reputation.  ​

Summary of Nursing Leadership and Management

As a part of nursing leadership and management, you must take the reins and ensure that there is engagement among you and your staff members throughout the day. It will increase morale, which in turn, improves the quality of patient care given as well as patient outcomes.  

Improving employee engagement cannot happen with just a survey. An engaged organization will actively reward those that embody the institution’s values as well as engage all staff towards that goal. 

Do you want to work where trust, care, and enthusiasm go into every decision?  

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