Career Sphere

Create a great work culture

Today, nursing leaders face an aging work­force, pressure to streamline processes and reduce costs, and unprecedented complexity in patient care. Staff nurses face their own challenges, including increasing patient loads and administrative duties, reduced support services, and increased mandatory overtime. But despite these ever-increasing responsibilities, the most important challenge for nursing leaders isn’t introducing process efficiencies or lowering costs. It’s creating a superior work culture.

Understand the leader’s role

As a leader, you may think of yourself as a daily operations master or a long-term visionary—or both. If so, you need to change the way you think about your role. Your main responsibility is to be the Chief Retention Officer. The most successful leaders know that by focusing on employee satisfaction and professional growth, they’ll meet most operational challenges. A satisfied, motivated workforce will consistently deliver high-quality, patient-focused care. Front-line leaders exert the most influence over individual job duties and the work environment and commonly hold the key to retention. To change your work culture, first identify these front-line leaders. Typically, they are charge nurses, lead technologists, and those in similar roles. On the other hand, people with titles such as manager or director rarely are front-line leaders. Be sure to pay attention to and invest in the real front-line leaders.

A word about motivation

Leaders don’t motivate staff members. Motivation comes from within. Leaders can create conditions in which staff members motivate themselves for the team’s good. As a leader, you need to create a positive work culture and lead with care and compassion. To create such a culture, understand that creating conditions in which staff motivate themselves for the team’s good is integral to your job—not an add-on to your list of things to do. If you constantly focus on what’s important to the team, the team will focus on what’s important to the unit’s success.

Find and keep the right people

A positive work culture starts with having the right people. Develop a list of traits and behaviors team members should have. Many leaders look for people who can manage change, have a compelling vision, are willing to take risks, and can manage diversity. Your criteria may differ based on your needs, but these suggestions should help get you started. Next, look within to determine if you’re a role model of the traits and behaviors you seek in others. If not, you need to work on becoming a better role model before you can create a different culture. When you know the kinds of people you want and are sure your own behavior reflects the behavior you expect, conduct an internal team assessment. This step is about getting the right people on the right bus, in the right seats, and headed in the same direction. You’ll be making tough decisions about who should stay and who should go. Not everyone will fit in the new culture. When you have the right people, the job is easy. Together you create a shared vision and ensure that everyone understands your purpose, the reason your team exists. The right people and a shared vision and purpose set the foundation for a superior work culture. After you create your team with the right people, you have to believe in them. As author John Maxwell says, “Believing the best in people usually brings out the best in people.” Set clear expectations. Hold people accountable. Give them the tools they need to get the job done. And provide feedback and coaching along the way. ###Break###

Play favorites

For years, we’ve heard we should treat everyone the same. This may sound noble, but it’s a big mistake. A leader should play favorites and treat every employee differently. Suppose you’re a staff member who’s always on time and ready to go. You don’t call in sick. You meet deadlines. And you’re willing to go above and beyond. How would you feel if your boss didn’t seem to notice and instead spent most of her time focusing on team members who cause problems? That approach leaves top performers to fend for themselves without the support they need and the recognition they deserve. Playing favorites takes the opposite approach. You spend 80% of your time with the top 20% of performers. Remember—always treat people fairly, but never treat them all the same.

Recognize excellence

Many organizations now recognize superior work cultures by participating in the Magnet™ survey process. The Magnet Recognition Program® was developed by the American Nurses Credentialing Center to recognize healthcare organizations that provide nursing excellence. It also provides a vehicle for disseminating successful nursing practices and strategies. Research shows Magnet facilities have better outcomes in nurse-sensitive indicators, nursing satisfaction and retention, and nearly all measured quality indicators. During a validation survey, the work culture is the primary focus because it provides the foundation for attaining and maintaining the expected quality outcomes. Without a work culture that supports excellence, you may have the best strategy, but you’ll never realize success.


One last question

As a leader, I find nothing more motivating than people who come to work every day and leave knowing they made a difference. This is the hallmark of a superior work culture. If you’re a leader and you don’t work in such an environment, I have just one question: Why?


Jeffrey N. Doucette is Associate Operating Officer at Duke University Hospital in Durham, North Carolina.

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