As a nursing leader, there are times when we become frustrated with engaging direct care nurses. As healthcare continues to evolve, organizations consistently re-evaluate operations, and the direct care nurses’ viewpoint can be hindered by constant change. Currently, direct care nurses feel a high level of dissatisfaction due to lack of management support and failure to communicate why change occurs. Thus, I was inspired for my doctoral dissertation to understand how direct care nurses described nurse managers’ promotion of engagement to sustain a safe work environment within healthcare systems across the nation.

Encouraging collaboration to invite team to help build a safe environment

Direct care nurses would like nurse managers to receive training on how to include their team and learn how to build rapport to promote a culture of trust. When nurse managers understand their sole idea may not work, including direct care nurses would allow staff to see the bigger picture, thus increasing engagement and a feeling of being valued and part of the team. Nurses want to be able to understand why. According to Marques-Quintero and colleagues, nurses also want nursing leaders to evaluate their leadership style to effectively lead their team.

Delivering inspirational messages to create a culture of trust

Direct care nurses shared that nurse managers who don’t explain why a change was made, drive down their engagement within their workspace due to lack of details, which they need to do their job safely. It would be beneficial for nurse managers to receive training on message delivery and to be well versed in the message they’re giving, even if it’s not ideal news. Lack of communication leads to disengagement as participants feel unprepared for change. The findings also presented how nurse manager communication training is important to ensuring they develop their delivery to engage staff. According to Bakker and de Vries, positive communication creates a positive work environment even when sharing difficult news.

Advocating to organizational leadership how workflow change impacts nursing

Organizations would benefit by collaborating with the direct care nursing team to promote engagement. Some decisions didn’t make sense and nurses felt that no one took the time to evaluate the true impact. Each participant described understanding that their idea may not work, but they would appreciate having it considered. Penconek and colleagues describe how empowering the team to be a part of a change, support from leaders, and decreasing stress levels can increase job satisfaction.

Showing compassion and flexibility with staff to be present in their work space

Being visible offers a great opportunity for the nurse manager to get to know their team, understand their workflow, and help nurses become comfortable with their leader. Participants stated when their nurse manager was visible, especially on a challenging day, it led them to ultimately feel safe in their environment. Participants stated that they would like to see nurse managers receive training on how to be present for their team when they begin their role. They described it as a great opportunity for the nurse manager to get to know their team, help their team become comfortable with their leader, and for the nurse manager to understand the team’s workflow. According Kostich and colleagues, nurses want to feel cared for and describe how resulting emotions promote positive behaviors.

Decreasing team hostility through accountability

Participants expressed the need for leaders to be open to feedback. They described instances in which direct care nurses received punitive responses when they pointed out a nurse manager’s mistakes. Direct care nurses are reluctant to participate, which ultimately creates hostility as each team member lacks the essence of team. Nurse managers being accountable for their actions decreases hostility. Health workers’ job satisfaction reflects their attitude toward the work environment. Sihombing describe how leader interaction and work conditions play a factor in how employees react.

Heath care leadership providing adequate training and coaching for development

Participants described healthcare organizations providing training and a skill set for nurse managers to influence job satisfaction. Participants recommended organizations review how long nurse managers have been a nurse. Participants stated that it was nice to have a nurse leader who had leadership experience to answer questions and recommended a peer as a mentor. Examples included nurse managers being a bedside mentor prior to promotion to handle unit situations. Training would include how to build rapport and adjust leadership style. According to Lee and colleagues, rather than having a specific leadership behavior, nurse leaders are encouraged to have a combination of behaviors to adhere to the different personalities they may face.

Recommendations

Practical Implications for nurse managers.

• Encourage collaboration to build trust through understanding the why and feeling prepared for change.
• Deliver inspirational messages to create a culture of trust and collaboration while modeling behaviors to promote teamwork.
• Advocate to organizational leadership about how workflow change decisions impact nursing workflow.
• Show compassion and flexibility for direct care nurses to understand leader presence.
• Be accountable to minimize animosity from the team.
• Healthcare leadership should provide adequate training and coaching to develop nurse manager skills.

Future practice

• Encourage direct care nurse participation to aid in decisions with organizational change.
• Teach nurse managers how to strengthen work relationships with direct care nurses to build trust.
• Teach nurse managers how to deliver messages and be visible to promote staff engagement.

Future research

• This study didn’t specify the roles of informal leadership. Similar research identifying specific roles a charge nurse or nurse supervisor should be conducted.
• Similar research also should be conducted to include a balance of male and female nurses. This would aid in determining if the results are transferable to male nurses.
• The participants were recruited off of one Facebook page. Similar research should use additional sites or networks to capture more participation.
• Future research should recruit participants in person to create an open dialogue and more robust discussion within the focus group.

Conclusion

In the end, direct care nurses stated the need for nurse managers to communicate, be visible, and collaborate with change. Development of these practices promote engagement with direct care nurses and sustain a safe work environment. Thus, findings within this doctoral dissertation support advancing knowledge and practice to develop nurse managers. Organizations willing to focus on nurse manager development will promote nurse engagement to sustain a safe work environment as healthcare continues to evolve.

Priscilla Hill, Doctor of Education Organized Leadership Healthcare Administration EdD; Masters of Nursing Emphasis in Public Health, Bachelors of Nursing and Bachelors of Science Family and Human Development, is Director of Clinical Care Operations, BUMCT/S, at Banner Health, Banner University Medical Center, Tucson and South Campus.

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