Being positive in a negative situation is not naïve. It’s leadership. — Ralph S. Marston, Jr., author and publisher of The Daily Motivator website
Nurses may encounter many challenges and stressors in the workplace—long hours, rotating shifts, inadequate staffing, poor teamwork, and pressure to achieve higher performance levels in an emotionally
and physically demanding field. The American Nurses Association found that the effects of stress and overwork are nurses’ top health and safety concerns, ranking higher than suffering a disabling physical injury or catching an infectious disease.
But hope exists. Positive psychology uses scientific understanding and interventions to help people achieve a more satisfactory life. Positive psychologists have shown that building positive emotions can change the way we approach and view our environment, helping us become healthier, happier, and more resilient and helping employees and teams become more productive and engaged.
Research on positive emotion over the last 15 years focuses on using positivity to build resources and resilience. A leading researcher in this area is Barbara Fredrickson, who developed the “broaden and build” theory. This theory describes how accumulating positive emotions broadens our minds and awareness, enabling us to develop new thoughts, activities, and relationships and to gain lasting personal resources that persist even after the emotion passes. We become better, more able versions of ourselves, in turn creating more positive emotions and an upward spiral of positivity. Leaders have a unique opportunity to apply this research to build positivity in their teams using simple interventions.
Overcoming negative tendencies
As humans, we’re wired to focus on the negative. Our basic negative emotions evolved from our ancestors’ fight-or-flight instinct—the physiologic response to a perceived threat to survival. While fight-or-flight is important in emergencies, too much exposure to long-term negative emotions can heighten our cardiovascular response and cause additional stress.
In nurses, a negative tendency may be intensified because we’re trained to look for the negative: crackles in a patient’s lungs, ST elevation on an electrocardiogram, an elevated potassium level, a high white blood cell count. Fortunately, research shows that accumulating positive emotions enables us to overcome the effects of the negative and realize the power of the positive.
Positivity in action
Applying the “broaden and build” theory to teams can result in positive emotions that lead to a positive emotional climate, which stimulates organizational growth and performance. Positive emotions also can improve relationships among coworkers and cooperation within teams. Using positive psychology in healthcare settings is a relatively new concept but has endless potential for healthcare workers and the patients in our care.
Our unit has a blended acuity of patients and a high daily patient turnover rate—up to 50% in a day. We turned to positivity research to find ways to inspire staff to move past a survival state and motivate them to achieve new levels of resilience and satisfaction. We tailored seven evidence-based interventions to apply to building positivity in teams rather than just individuals.
Three good things
Writing down three good things each day for 2 weeks helps those good things become more visible, even during the most challenging situations. Researchers found that doing this every day for 2 weeks increased happiness for up to 6 months.
To adapt this practice to a clinical environment and a focus on teamwork, we developed a “three good things” sheet that gets passed around at the end of the shift. Every staff member writes down a good thing that happened that day, and the charge nurse presents three of these things to the oncoming-shift nurses to help them start their shift in a positive light. “Three good things” was an encouraged practice for 2 weeks, but staff continued to practice it consistently throughout the next year—and beyond.
Increasing social connections
Social connections have been correlated with happiness and are considered necessary for people to flourish. It’s important not only to increase the number of social connections, but also to make each connection a high-quality one. (See Not just happiness and smiles.)
To improve the quality of our connections with patients, we place “Getting to know you” boards in each patient room. On admission, the RN or nursing assistant explains to patients that this board is a place to share something about themselves, not their illness and hospitalization. They ask patients, “Is there anything you’d like to share?” Patients post information about their hobbies, families, jobs—things they may not otherwise share with us.
Encouraging random acts of kindness
Acts of kindness and altruism have been shown to improve mental health and reduce stress levels. We challenged staff to perform random acts of kindness over a 2-month period and report any acts performed, received, or witnessed. This practice spread throughout the hospital, with patients performing acts of kindness for other patients and ancillary staff and doctors getting in on the action. At the end of the 2 months, we celebrated at our staff meeting, where we showed a video of all of the acts of kindness. (Visit www.youtube.com/watch?v=VV9Fzdqoy20 to watch the video.)
We’ve also worked on increasing gratitude through a staff peer recognition board, increasing our awareness of the positivity in our lives through a “loving kindness meditation” at a staff meeting, and using the Signature Strengths survey (available at www.viame.org) to discover each other’s strengths. Engaging in enjoyable activities, such as getting dinner together after a long shift or going out as a group to a baseball game, also has been shown to increase positive emotions and happiness.
Just do it!
Any positive emotion can start the upward spiral, so the most important thing you can do to increase positivity in your team is to get started. Pick the intervention that most appeals to you, adapt it to your environment, and commit to implementing it within the next week. Keep at it—and watch the upward spiral of positive emotions grow.
Achor S. The Happiness Advantage: The Seven Principles of Positive Psychology That Fuel Success and Performance at Work. New York: Random House; 2010.
Achor S. Positive Intelligence. Harvard Business Review. January 2012. https://hbr.org/2012/01/positive-intelligence
American Nurses Association. 2011 ANA Health and Safety Survey: Hazards of the RN Work Environment. 2011. nursingworld.org/FunctionalMenuCategories/MediaResources/MediaBackgrounders/The-Nurse-Work-Environment-2011-Health-Safety-Survey.pdf
Fredrickson BL. Positive Emotions Broaden and Build. In: Devine P, Plant A, eds. Advances in Experimental Social Psychology. Vol. 47. San Diego, CA: Academic Press; 2013; 1-54.
Seligman ME, Steen TA, Park N, Peterson C. Positive psychology progress: empirical validation of interventions. Am Psychol. 2005;60(5):410-21.
Tugade MM, Shiota MN, Kirby LD, Frederickson BL, eds. Handbook of Positive Emotions. New York: Guilford Press; 2014.
Vacharkulksemsuk T, Sekerka LE, Fredrickson BL. Establishing a Positive Emotional Climate to Create 21st-Century Organizational Change. In: Ashkanasy NM, Wilderom CPM, Peterson MF, eds. The Handbook of Organizational Culture and Climate. 2nd ed. New York, NY: Sage Publications; 2010:101-118.
The authors are Clinical Nurse IVs at UNC Hospitals in Chapel Hill, North Carolina.
July 26, 2015
Lillee Smith Gelinas, Editor-in-Chief
Cynthia Saver, HealthCom Media
American Nurse Today
Dear Nursing Colleagues,
I am a nurse on a twenty-two bed pediatric intensive care unit. I have been in this specialty for seven years. This environment is very stressful and at times can be very negative. Nurse leaders need to take a positive approach to leadership to increase nurse job satisfaction and patient satisfaction. In the article The Power of the Positive, the American Nurses Association discovered that nurses rank stress and being over- worked as a high threat to their health (Roberts, 2015). Long hours and staff shortages lead nurses to have a negative outlook on their jobs.
Leadership plays a huge impact on nurse job satisfaction and patient outcomes. Wong and Cummings (2007), states that positive leadership practices reduces the prevalence of adverse effects in patients and increases nurse retention. How full is your Bucket? (Rath & Clifton, 2004), is a book that investigates the influence of positive interactions between people. There are techniques in positive leadership that can enhance a team’s success.
There were several techniques that can be successful, increasing social connections, encouraging random acts of kindness, and rewarding staff (Roberts, 2015). The rewarding of staff is a positive leadership technique that allows employees to know that they are essential to the goals and success of the company. Rath and Clifton (2004), surveyed 15 million people and of those the employees that received regular recognition were more likely to increase personal productivity and pass on the positivity to other co-workers. These employees also had high retention and high satisfaction scores from their consumers (Rath & Clifton, 2004). They were also more likely to have fewer accidents on the job (Rath & Clifton, 2004).
In the future, more studies are needed to look at the effects of positive leadership and nursing in regards to patient satisfaction and productivity. It would also be pertinent to examine which techniques work the best to increases positivity. A positive environment increases growth and production and should be a priority for all nurse leaders (Roberts, 2015).
Amy Silva, RN- BSN
Rath, T. & Clifton, D. (2004). How full is your bucket? New York. Gallup Press.
Roberts, P. (2015). The power of the positive. American Nurse Today 10(7). 13-14.
Wong, C., A. & Cummings, G. G.(2007). The relationship between nursing leadership and patient outcomes: A systematic review. Journal of Nursing Management, 15(5), 508-521. doi:10.1111/jonm.12116