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Nurse leader talks about respectful, healthy work environments

By: Ric Cuming,EdD, RN, NEA-BC, FAAN

Find an opportunity to address workplace civility.

Ric Cuming,EdD, RN, NEA-BC, FAAN, is senior vice president and chief nurse executive at the twice Magnet®-recognized Christiana Care Health System in Wilmington, Delaware, and a Delaware Nurses Association member.

Among his passions is promoting respectful, healthy work environments. An alumnus of the prestigious Robert Wood Johnson Foundation (RWJF) Nurse Executive Fellows program, he codeveloped the Civility Tool-kit: Resources to Empower Healthcare Leaders to Identify, Intervene, and Prevent Workplace Bullying.

As a nurse leader, do you face consistent challenges?

nurse leader respect healthy work environment ric cumingChallenges are really opportunities in disguise. One of the biggest is the pace of change in healthcare, which is exponential. Another is having sufficient resources—staff and supplies—so we can provide the safest, highest quality patient care. What really keeps me up at night is recruitment. We have nurses who have been with us for decades who are retiring. I can replace the individual, but I can’t replace all that knowledge and depth of clinical experience. We place high value on our clinical ladder and nursing tuition-assistance program to advance our nurses and continue to develop our extraordinary nursing workforce.

Can you describe your work around the Civility Tool-kit and its importance?

We wanted to provide a resource for nursing and healthcare leaders that focused on creating and sustaining healthy work environments that staff, educators, and others can access free online.

The American Nurses Association also has done important work addressing workplace incivility, bullying, and violence, which has become a national epidemic in healthcare. For the tool-kit (with tip sheets, assessments, and strategies), we defined workplace incivility broadly to include any negative behavior that demonstrates a lack of regard for other workers. We’ve reached a very wide audience locally, nationally, and internationally through ongoing presentations.

Healthcare is a team sport. At Christiana Care, our values statement supports this from the top: “We serve together, guided by our values of excellence and love.” We continue to implement and innovate with the full support of our leadership.

We’ve started using aspects of the tool-kit and established a task force to promote a healthy, respectful workplace. Our “Heavenly Seven” survey assesses the experiences of our float pool and nurses required to float from their units—whether they felt welcomed on the unit, if they were offered help when needed.

What are key strategies to build civil workplaces?

Healthcare leaders need to shine a light on the importance of a healthy, respectful workplace and model those behaviors, including the following:

  • Empower staff to safely respond to uncivil behavior when they see or hear it.
  • Train supervisors, managers, and faculty to recognize the signs of bullying and emotional distress.
  • Refuse to be a silent bystander; take a stand.
  • Create a mechanism for staff to confidentially report issues in the workplace without fear of retaliation.
  • What’s happened recently in Hollywood and the political world is extremely empowering to others who may be suffering in silence.

What are pressing issues that nurses should be leading on or advocating for?

Appropriate nurse staffing is the number-one issue. Advocating for healthy work environments, governance structures, patient safety, quality indicators, and the ability for nurses to practice to the top of their license in all settings leads to appropriate staffing.

Final comments?

I encourage nurses to embrace lifelong learning, become certified in their specialty, lean in to new opportunities, and get involved in professional practice issues. I also believe we must be courageous, perhaps even more today, to speak truth to power.


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