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When staff disengage

When staff disengage

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By: Rose O. Sherman, EdD, RN, NEA-BC, FAAN, and Tanya M. Cohn, PhD, MEd, RN

Re-engagement is a two-way street.  

Takeaways:

  • Research indicates that pandemic experiences have led nurses to disengage at a rate twice that of other healthcare staff.
  • Current staffing challenges require that leaders take steps to keep nurses involved with shared governance and workforce planning issues.
  • Leaders must reinforce the need for professional engagement as a core team value.

Al has been a critical care manager since 2018. Before the COVID-19 pandemic, his staff enthusiastically participated in unit practice council activities and eagerly volunteered for unit projects. He now sees a profound change in many of the nurses. His unit endured three COVID surges, leaving his team exhausted and burned out. Just getting volunteers to serve as preceptors has become challenging. Today, Al overhears one of his staff refusing a charge nurse when asked to orient a new nurse. She says that she’s here to put in her 12 hours and go home. Al understands the trauma that the staff has been through. He wonders how he can get things back on track with shared governance and other professional activities when so many nurses have disengaged.  

Al isn’t alone in his struggle to keep his staff engaged while also dealing with their mental health and well-being challenges. Recent Press Ganey research indicates that nurses have disengaged at a rate twice that of other healthcare staff due to their pandemic experiences. Any of us may temporarily disengage from our work at different points in our lives and careers, but with the current staffing challenges, leaders need nurses involved with shared governance and workforce planning issues. The voice of the staff nurse is more critical than ever.

Work engagement is a two-way street. Nurse leaders can create environments that engage and empower staff, but they can’t force engagement. Al needs to take small steps to rebuild a climate that promotes and encourages staff inclusion in decision-making. He’ll also need to reinforce the need for professional engagement as a core value on his team.

What is engagement?

Team member engagement strongly predicts performance. Vicki Hess, MS, RN, an employee engagement expert, developed an engagement formula: Satisfied + Energized + Productive at Work = Employee Engagement.

You’re satisfied when you’re psychologically connected with the work, and you’re energized when you willingly put effort into your work. Productive means that your verifiable efforts contribute to the organization’s overall vision and bottom line. Engagement sometimes is described as a nurse’s commitment to and satisfaction with their job, but it involves more than that. Engaged nurses commit to the organization and the profession itself. (See Engagement factors.)

Engagement factors

Engagement factors The Gallup Corporation, which has studied engagement for over three decades, identified the following factors as having an impact on team engagement:

  • Staff turnover
  • Sick leave and Family and Medical Leave Act use
  • Medical error occurrence
  • Patient loyalty to a health system
  • Nurse well-being
  • Staff productivity

Health systems routinely track staff engagement (some do it quarterly) with assessments such as the Gallup Q12 Employee Engagement Survey, the Glint survey, or Press Ganey workforce engagement solutions. Engagement scores dropped during the pandemic, and some organizations suspended the surveys in 2020 and 2021. In their current engagement data, Glint researchers found four key drivers that might help Al and other nurse leaders re-engage nurses.

  1. A staff member’s ability to learn and grow in the work setting.
  2. A positive work culture with few or no toxic behaviors.
  3. Trust in leaders.
  4. Having a voice that’s heard.

Why do staff disengage?

Disengagement can stem from internal or external factors within the work environment. Internally, staff may feel a lack of purpose or meaning in their work. For the nurses on Al’s unit, this might result from the multiple COVID-19 surges that left them emotionally exhausted. Many critical care nurses fear that more patients will come to their unit to die, which directly impacts the role and meaning of being a nurse. In addition, staff will disengage when accomplishments go unnoticed and their professional growth feels stunted. This frequently occurs in a busy work environment where leadership may be focused on forward momentum and doesn’t take the time to highlight the great work of individual staff members.

External staff engagement factors come from the organization and direct leadership. Poor communication among the organization, direct leadership, and staff can hinder shared governance, which increases staff disengagement. Limited resources that leave nurses feeling that they can’t provide safe and effective care exacerbates this problem.

For the critical care nurses who work with Al, lack of personal protective equipment, personnel shortages, and limited equipment likely created an ongoing high-stress environment that left nurses disengaged. When leadership doesn’t prioritize employee well-being, nurses feel unappreciated and disconnected from their role.

Unfortunately for Al, COVID-19 created an environment where nurses didn’t participate in vital activities, such as preceptorship, professional development, and shared governance. To re-engage staff, Al must rebuild a culture of engagement.

How do you build a culture of engagement?

A culture of engagement requires a foundation built on the organization’s purpose and core values. This means developing a mission with a vision that recognizes employees as key stakeholders. Organizations that invest in their employees’ wellbeing, professional growth, and shared decision making directly increase engagement. With a well-established, positive, and employee-focused organizational culture, leaders at the unit level have the support to promote engagement. This includes providing team development, fostering peer-to-peer relationships, and promoting peer-to-peer recognition.

Team development starts with a shared governance approach. For Al, shared governance is already in place, but after three COVID-19 surges, the nurses feel so disengaged that Al must re-establish it. He can begin with a debriefing of the past 2 years where nurses have a safe place to discuss their emotional exhaustion and can participate in unit decisions. Al also will need to find creative ways to team-build. Considering the current high-stress environment of the critical care unit, he might need to start with small unit-based activities that don’t create a sense of burden. He can then introduce periodic out-of-unit activities focused on staff well-being, stress relief, and enjoyment.

These activities also can foster healthy peer-to-peer relationships, which may aid engagement by reminding staff that they’re members of a team. Cohesive teams have members who rely on and support each other, rather than putting in 12 hours while working in a silo. As the nurses begin to build back their team perspective and engage in peer-to-peer relationships, they’ll form a greater sense of community, which may lead to more interest in precepting new nurses.

Leaders also can strengthen the culture of engagement by promoting peer-to-peer recognition. Although leadership recognition is fundamental, peer-to-peer recognition creates an added benefit because direct patient care nurses rely on daily mutual support and informal leadership.

How do nurse leaders impact engagement?

Nurse leader engagement profoundly affects staff engagement. Al will need to reflect on his own level of engagement and the messages he sends to staff. The COVID-19 pandemic has been hard on many nurse leaders, who report challenges with their own well-being and trauma. Gallup research data indicate that managers account for 70% of the variance in employee engagement and that U.S. managers are only slightly more engaged in work than their staff.

Al must walk the talk of engagement, which requires positive energy and optimism. Positive energy is high-octane fuel for any team. The more positive you are, the more positive everything becomes. Leaders need to offer hope that the future will be better than the past. Al can implement some of the following leadership strategies:

Reconnect staff with their purpose. Al recognizes that COVID-19 has been challenging for his team. Many are so stressed and fearful that they forgot about what matters most to them in their work. He can encourage staff to share their stories and take pride in what they’ve accomplished.

Create psychological safety. In discussions with staff, Al understands that the pandemic has shaken some staff members’ core beliefs about work safety. He must work hard to keep his team within their circle of influence and talk about what’s in their control.

Rebuild trust. Many policy and practice changes enacted in response to the pandemic led staff to question whether their leaders knew what they were doing. Al can acknowledge these feelings and remind staff that the unique experience presented by COVID-19 proved challenging for everyone.

Reinvolve staff in unit governance. Staff participation in shared governance decreased during COVID-19. Al can restart the unit practice council with an initial project focused on nurse well-being.

Provide intentional recognition. Al understands why staff might feel unappreciated. The organization’s annual nurse recognition day was canceled in 2020 and conducted virtually in 2021. He can be more intentional in recognizing staff every day.

Offer development activities. During COVID-19, the organization suspended staff education programs. Professional development before the pandemic was robust, and the staff miss these educational opportunities. Al can plan development activities for the team and advocate for an organizational recommitment to staff development. On a unit level, he can schedule a coaching session with every staff member to determine their career goals.

Commit to re-engagement

Al is responsible for building a culture that promotes staff engagement, but it’s not his alone. No matter how big or small the commitment, every nurse should contribute to a unit’s shared governance. When staff re-engage, Al can empower them to drive change. Shared governance success in clinical settings hinges on the leader’s ability to effectively guide a collaborative decision-making environment. A path back to engaged nurses exists, but it requires committed nurse leaders.

Editor’s note: To learn more about active staff engage­ment, click here.

Rose O. Sherman is an adjunct professor at the Marian K. Shaughnessy Nurse Leadership Academy, Case Western Reserve University in Cleveland, Ohio, and author of The Nuts and Bolts of Nursing Leadership: Your Toolkit for Success and The Nurse Leader Coach: Become the Boss No One Wants to Leave. You can read her blog at emergingrnleader.com. Tanya M. Cohn, is an associate professor of practice and a consulting nurse scientist at Simmons University in Boston, Massachusetts.  

References:

American Nurses Foundation. Pulse of the Nation’s Nurses Survey Series: Mental Health and Wellness. October 13, 2021.

Davis C. Nearly 30% of RNs are at risk of leaving their organization, new analysis reveals. September 30, 2021.

Dempsey C, Reilly BA. Nurse engagement: What are the contributing factors for success? Online J Issues Nurs. 2016;21(1):2. doi:10.3912/OJIN.Vol21No01Man02

Gallup. The powerful relationship between employee engagement and team performance.

Hess V. 6 Shortcuts to Employee Engagement: Lead & Succeed in a Do-More-With-Less World. Morgantown, WV: Catalyst Consulting LLC; 2013.

HR Research Institute. The State of Employee Engagement and Experience 2020.

Key words: staff engagement, staff disengagement, unit governance, psychological safety

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