Leading the Way

Promoting staff engagement

Jaime is a nurse manager in a busy emergency department. He’s been in the role for 1 year and was beginning to gain confidence in his leadership abilities. Last week, he received the results of the Gallup Q12® Employee Engagement Survey, which his staff had recently been asked to complete online. He was surprised to learn that the results showed his employees to be less engaged in their work than staff on other units. Of particular concern was the employees’ assessment that he didn’t recognize their work, care about them as people, or encourage their development. Initially, he was discouraged by these findings, but his director helped him see this as a leadership opportunity with the potential for substantial growth for both himself and the staff.

Jaime’s need to improve staff engagement isn’t uncommon, especially given the focus in many organizations on the triple aim of cost reduction, quality improvement, and patient centricity. But with employee engagement directly linked to quality of care, patient satisfaction, and safety, adding a fourth aim is important: Improving the work experience of clinical staff to build practice environments that promote joy and meaning in work.

Research indicates that most organizations have an employee engagement problem. The Gallup organization reports that only about 33% of the U.S. workforce are engaged in their work, and the Nursing Advisory Board noted in a recent study that only 32.8% of nurses reported being engaged, with 7.4% actively disengaged. The good news for Jaime is that there’s strong evidence that changing his leadership strategy and focusing on improvements in the work environment can make a difference.

Demystifying employee engagement

For leaders like Jaime, knowing where to start can be confusing, especially with no consensus about a definition for work engagement and how to best measure it. Conceptually, engagement is linked to empowerment, job satisfaction, job involvement, and organizational commitment. Staff engaged in their work exhibit passion, commitment, and a willingness to invest in them selves to help their organizations succeed.

Effectively engaging employees is an important business differentiator, but workplace cultures can be difficult to change. Leadership approach, workload, level of organizational change, decision latitude, and career development opportunities all affect engagement and job stress. For example, organizations that embrace the Magnet® culture of excellence or the American Association of Critical-Care Nurses’ healthy work environment standards have higher levels of staff engagement.

Leadership strategies

Gallup research indicates that managers account for 70% of the variance in employee engagement and that U.S. managers are only slightly more engaged in their work than their staff. Work engagement is higher among nurses who work for managers who practice authentic leadership and are themselves engaged in their work. As a relatively new leader, Jaime should reflect on his own level of engagement, build trust, and seek staff support. (See Taking action.)


However, you can’t simply declare that you practice authentic leadership. Your authenticity can be validated only by those you lead, so you must ask for and receive feedback. Jaime could start by sharing the results of the Gallup survey, noting that he’s disappointed and will be working hard to improve his leadership.

Many leaders think they need to have all the answers to be effective, but the interactions with leaders  is what makes or breaks employees’ connection with the organization. Every time you’re in front of an employee, whether one-on-one or in a group, take the opportunity to increase engagement through dialogue and inclusion in decision making. Start the conversation with an open-ended question, encouraging employees to express their opinions and ideas. Showing interest and respect for your employees’ input lets them know you care, helping them grow professionally and own their learning experiences.

A two-way street

While Jaime has a responsibility to build a culture that promotes staff engagement, the responsibility isn’t his alone. Work engagement is a two-way street. Vicki Hess, MS, RN, a nurse expert on employee engagement, contends that a key part of the puzzle frequently missed when evaluating work engagement is the employee, who may not know that he or she has a responsibility in the process.

To foster engagement, Jaime must promote the idea that it’s a shared responsibility. Marshall Goldsmith, in his book Triggers, observed that survey questions asked in a passive voice, such as those in Gallup Q12, promote the idea that employee engagement is an organizational responsibility. The variance sometimes seen in employee engagement may be because some individuals naturally accept their responsibility in the process. Goldsmith promotes the idea that leaders like Jaime should encourage staff to question not only the organization, but also themselves. (See Ask yourself.)

An ongoing journey

Change is a constant in the healthcare environment, and employees’ needs change as new generations with different attitudes, values, and beliefs join the workforce. Leaders must view employee engagement as an ongoing journey that demands intentional interventions. During the past decade, healthcare agencies have experienced unusually low turnover, but this is changing, and turnover rates are beginning to increase. Engaging and retaining staff will soon become a high priority.

Rose O. Sherman is a professor of nursing and director of the Nursing Leadership Institute at the Christine E. Lynn College of Nursing in Florida Atlantic University in Boca Raton. You can read her blog at www.emergingrnleader.com.

Selected references

Advisory Board. The national prescription for nurse engagement: Best practices for enfranchising frontline staff in organizational transformation. April 10, 2014.

GallupQ12 Index.

Goldsmith M. Triggers: Creating Behavior That Lasts—Becoming the Person You Want to Be. New York: Crown Business; 2015.

Hess V. 6 Shortcuts to Employee Engagement: Lead & Succeed in a Do-More-with-Less World (Healthcare Edition). Owings, MD: Catalyst Consulting LLC; 2013.

Hilton N, Sherman RO. Promoting work engagement: One medical center’s journey. Nurs Leader. 2015;13(6):52-7.

Rigoni B, Nelson B. Do employees really know what’s expected of them? Gallup Business Journal. September 27, 2016.

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