10 Leadership Strategies for Creating
Healthy Work Environments
Carol Huston, MSN, MPA,
DPA, FAAN
Director, School of Nursing,
California State University
Chico
Thank you for inviting me to be here!
Happy Nurse’s Week!
Healthy Work Cultures Don’t
Happen by Accident….
Changing unhealthy work
cultures can be very difficult.
An organizational culture is a system
of symbols and interactions unique to
each organization. It is the ways of
thinking, behaving, and believing that
members of a unit have in common.
Subcultures are common in nursing.
Ten Strategies Nurse Leaders
Can Use to Create Healthy
Work Environments
#1. Create a Culture of Civility and
Mutual Respect and Guard It
Judiciously
A recent survey of 2,100
Source: Johnson, C.
(Nov. 2009). Bad
blood: doctor-nurse
behavior problems
impact patient care.
Physician Executive,
35 (6), 6-11.
physicians and nurses by the
American College of Physician
Executives documented that
unprofessional conduct in the
workplace is increasing, with a
shocking 98% of those surveyed
reporting having witnessed
behavior problems in the
workplace in the past year. This
is referred to in the report as
“health care's dirty little secret.”
Bullying in the Workplace
Source: Roche, Diers, Duffield, and Catling-Pauli (2010)
Patients Also Inflict Violence On Nurses
Workplace Violence Statistics
• In 2009, more than 50% of emergency center nurses
experienced violence by patients on the job.
• There were 2,050 assaults and violent acts reported by RNs
requiring an average of four days away from work.
• Of these acts, 1,830 were inflicted with injuries by patients
or residents (Emergency Nurses Association).
Source: American Nurses Association (2014). Bullying and workplace violence.
Available at: http://www.nursingworld.org/Bullying-Workplace-Violence
In 2008, the Joint Commission
identified workplace bullying in a
sentinel event alert saying that it
threatened patient safety.
Is incivility “just part
of the job?”
Workplace Bullying is NEVER OK.
Courage to stand up for what is
morally right.
Obligation to adhere to the ANA
Code of Ethics.
Danger management by developing
strategies to avoid risk aversion.
Express your concerns effectively
and take action.
Source- Lachman, V. D. (Sept. 30, 2010). Strategies necessary
for moral courage. OJIN, 15 (3), manuscript 3.
Pitbulls On the Attack
Bullying
must always
be confronted
immediately.
Potshot Artists
Confronting
the Potshot
Artist….
The Clams
Getting the Clam to Talk….
#2. Find Someone Outside the
Organization to Vent To and
Maintain Appropriate Boundaries
Social media sites are
not an appropriate
place for venting.
#3. Stretch and Empower Workers
within Their Limits
#4. Avoid Micro-Managing.
(Get Out of the Way When You Can!
Encourage Innovation
Don’t be so quick to solve problems
for others or they’ll never try to do it
themselves.
Your way is not always
the “best way” or the “only way.”
#5. Make Sure that Assigned
Workload Is Reasonable So that
Success is Even Possible
Sometimes,
the problem is
that work load
expectations
are simply too
great.
New graduate nurses often need
some time to learn the complexities
of the nursing role. Our expectations
of them need to match this reality.
The need for graduates to 'hit the ground
running' has manifested into a
phenomenon coined 'Transition Shock'
where the fear of making a mistake and
feeling unsafe can be crippling to a new
graduate’s confidence and self-image.
Source- Harwood, M. (2011). Transition shock -- hitting the
ground running. Nuritinga, (10), 8-18.
That first step can be so hard….
Many staff nurses continue to report
unreasonable workloads.
A study comparing nurse staffing standards and
staffing levels in nursing home care in six counties
(the United States, Canada, England, Germany,
Norway, and Sweden) found that both the standards
and levels in most countries (except Norway and
Sweden) were lower than the recommended levels by
experts.
Source: Harrington, C., Choiniere, J.,
Goldmann, M., Jacobsen, F., Lloyd, L.,
McGregor, M., & ... Szebehely, M.
(2012). Nursing Home Staffing
Standards and Staffing Levels in Six
Countries. Journal Of Nursing
Scholarship, 44(1), 88-98.
Source: Gillen, S. (2012). Most nurses are struggling with
inadequate staffing, survey shows. Nursing Standard, 26(34), 9.
• Three in four respondents felt they did not
have enough time to spend with patients to
deliver dignified, safe and compassionate care.
•Nurses on early and late shifts were the most
likely to feel that the skill mix was inadequate.
•Almost 2/3 were being forced to work
overtime and only 1 in 13 were being paid for it.
#6. Keep Lines of Communication
Open and Deal with Problems As
Soon As They Occur!
Conflict in the organization
is inevitable and must be dealt with
before it becomes manifest.
Sources of Conflict
While diversity in the workplace is a
strength, it can also be a source of
conflict.
Rule setting and constructive
discipline are an essential part of
a healthy work environment.
Encourage
employees to
attempt to resolve
their own
interpersonal
conflicts
whenever
possible!
#7. Look to the Future
While Focusing On the Present!
Most 21st century healthcare
organizations find themselves
undergoing continual change directed at
organizational restructuring, quality
improvement, and employee retention.
Stages of Organizational Development
• Birth
• Youth
• Maturity
• Aging
Without
change,
organizations
stagnate and
die.
The Story of an
Aged
Organization
Contemporary nurse leaders then must be
visionary in identifying where change is needed
in the organization and be flexible in adapting
to change they have directly initiated or by
which they have been indirectly affected
(Marquis and Huston, 2015).
Malloch and Porter-O’Grady (2005) suggest
that the future will increasingly call for a
more fluid, flexible and mobile work
environment, which requires an entirely
innovative set of interactions and
relationships as well as the leadership
necessary to create them.
Thought leadership
refers to any
situation whereby
one individual
convinces another
to consider a new
idea, product, or
way of looking at
things.
Thought
Leadership
#8. Support and Recognize the
Challenges Workers Experience with
Constant Change in Healthcare
• Knowledge
information,
acquisition
and
distribution
will continue
to multiply
exponentially.
In a profession where knowledge doubles
every six years (Carroll, 2011), nurses can no
longer be the keeper of knowledge; instead
they must become the master of collecting and
sharing that knowledge with others.
The IOM (2010) suggests that the ways in which
nurses were educated during the 20th century are
no longer adequate for dealing with the realities
of health care in the 21st century.
Such profound change is not easy
since all major change brings
feelings of achievement and pride
as well as loss and stress.
Leaders must role-model positive
and adaptive responses to change.
Leaders
embrace
change and
new ways of
thinking.
#9. Be Authentic!
In 2005, the American Association of
Critical-Care Nurses released a landmark
publication identifying authentic
leadership as one of the six standards
necessary to establish and sustain healthy
work environments in healthcare.
• Becoming an
authentic leader
is a process that
occurs over time
and requires selfdiscovery, selfimprovement,
reflection and
renewal.
Leadership traits can either work as a
magnet or as a force that repels.
There is little doubt that nurse leaders experience
intrapersonal values conflicts between what they
believe to be morally appropriate and a need to
deliver results in a healthcare system,
increasingly characterized by pay for
performance and rewarded by cost containment.
#10. Don’t Take Leadership for
Granted
Remember that
followers are an
important part of
the leadership
equation.
Followers can stop
following at anytime…
Healthy work
environments
are all about
mutual respect
and groups
working
together to
achieve shared
goals.
Changing negative work
cultures is hard; it’s not impossible.
Leaders do make a difference in
creating healthy work environments.
10 Leadership Strategies for Creating
Healthy Workplaces
1.
2.
3.
4.
5.
Create a culture of civility and mutual respect
and guard it judiciously.
Find someone outside the organization to vent
to and maintain appropriate boundaries.
Stretch and empower workers within their
limits.
Avoid micro-managing and get out of the way
when you can!
Make sure that assigned workload is
reasonable so that success is even possible.
10 Leadership Strategies for Creating
Healthy Workplaces (cont.)
6. Keep lines of communication open and deal
with problems as soon as they occur!
7. Look to the future while focusing on the
present!
8. Support and recognize the challenges workers
experience with constant change in healthcare.
9. Be authentic!
10. Remember that followers can stop following
anytime, so don’t take leadership for granted.
Questions?/ Comments?