In a time of great competition in the post-pandemic healthcare marketplace, hospitals and other facilities are smart to find ways to differentiate themselves from the many choices consumers can access. We all vote with our feet and wallets when it comes to how we spend our healthcare dollars, and poor treatment at a hospital or clinic is a high likelihood that we’ll seek care elsewhere.
Likewise, employees also vote with their feet, and we can’t retain nurses when, despite special labels like Magnet, we allow bullying and other aberrant behaviors to thrive within a negative workplace culture.
Designations like Magnet status are ways healthcare organizations can demonstrate their striving for excellence. But what happens when an unhealthy or toxic organization hides behind something like a Magnet designation, ignoring systemic issues that fancy words, plaques, and awards won’t fix?
A Fox in the Magnet Henhouse
I recently spoke with a dedicated, well-educated, experienced, intelligent, and successful nurse who, up until earlier this year, worked for a Magnet facility somewhere in the U.S. The Magnet designation is designed to be a magnet for high-quality nurse clinicians, and this nurse is a person of great integrity and professionalism whom this employer was lucky to have on staff.
During her work on several hospital units, this individual was targeted by what we might call a “queen bully.” The bully nurse was highly experienced, had worked for the organization for many years, and was seen as a leader and an indispensable employee by the administration.
Tragically, the nurse I spoke with was psychologically traumatized by the bully and the other employees who colluded with her behavior. This nurse’s reports of being harassed were dismissed and ignored, and she eventually had to take a leave of absence to pursue psychological treatment for post-traumatic stress. Meanwhile, the bully kept her job and faced no consequences whatsoever.
Based on her egregious bullying behavior, this nurse bully should have been fired years ago. Still, managers and executives were likely scared to death of her, and if a union was involved, firing her might have proven a highly challenging avenue they were hesitant to pursue.
Sadly, this nurse was allowed to “rule the roost” for years as a frightening and controlling fox willingly set loose in the hen house, and the nurse whom I spoke with had been one of her main targets for months.
A bully can bring down the morale of an entire or multiple units. If bullies can thrive and spin their nasty webs throughout a facility or organization, the entire workplace ecosystem and culture can be poisoned.
Confronting the Shadows
In the final analysis, a Magnet designation doesn’t make an organization great. Magnet status is also not a magic bullet or blanket blessing from the authorities that deems a facility perfect and free from flaws.
Creating a just, civil, highly functional, and effective organization may be enhanced by designations or awards like Magnet status. Yet, the hard work of making a healthcare institution a safe and happy place to work doesn’t stop when the plaque goes on the wall.
When weeding out bad actors like bullies, the administration must have the will and the backbone to confront the issue head-on. Likewise, employees must feel safe to document and report such issues without fear of retaliation or having their complaints dismissed out of hand.
No matter if a bully is a great clinician with years of experience — there must be zero tolerance for aberrant behavior, and consequences must be swift, decisive, and universally applied.
Every employee deserves to feel supported in doing their best work. They likewise need to be able to trust that they will be protected from those who would do them harm. No staff member should live in fear of bullying, discrimination, harassment, or any other type of negative treatment, and it is the responsibility of the organization to create a culture that affirms positivity and trust and rejects anything less than perfect civility and kindness.
The work of achieving Magnet status is a lovely ideal with very real-world applications when truly operationalized. However, every workplace has a shadow, and it is from confronting that shadow and cleansing the organization’s darkest corners that a more civil, functional, and effective institution arises.
Magnet status is something to reach for, but only in the context of the hard work it takes to create a workplace to be proud of that is safe for all who walk through its doors.
We’ll be at the 2023 ANCC National Magnet Conference® October 12-14 at the at the McCormick Place Convention Center in Chicago, Illinois. Stop by booth #918. We look forward to seeing you there!
Nurses are invaluable members of the healthcare workforce, and when you’re proactively building a nursing career that you can fully embrace and be proud of, there are plenty of strategies and mindset hacks to consider.
One of the greatest assets you carry as a nurse is the many skills you’ve worked hard to acquire. So, if you want to boost your self-confidence and make the most of your nursing career, it’s wise to humbly take full ownership of the many things you know and the incredible skill sets that make you the outstanding nurse (and human being) you are.
Knowledge is Power
It’s been said since time immemorial that knowledge is power. The things you know — including how to leverage the soft and hard skills you have under your belt — are central to what makes your nursing mind tick, and articulating what those are is crucial.
In nursing school, you studied and read like a madperson, wrote care plans (sorry to bring that up), learned to apply the nursing process (you may be sorry I brought that up), and turned your non-nurses mind into a nurse’s mind. I bet there are things your professors said that you still hear in your head, and some of those may be helpful. “If it wasn’t documented, it never happened” was one truism I heard repeatedly during my nursing education, and I never forgot it. What sticks with you?
After the crazy nursing school journey, the rubber hits the proverbial road when you start working as a nurse out in the real world. Some skills and knowledge were entirely theoretical during school, of course. But when you’re working as a nurse and solely responsible for the care of your patients, you can bet that those wheels are turning, and the smoke is coming out of your ears as the pieces fall into your mind.
If you’re a generalist (e.g., med/surg, internal medicine, primary care), you may not delve deeply into cardiac arrhythmia, chemotherapy regimens, or other specialized areas of knowledge and practice. But you’ll need to know a little about everything since you never know what will walk through that door. A generalist may seem from the outside like a jack of all trades and master of none, but you can rest assured that these nurses know their stuff and have all sorts of knowledge that makes them amazing.
As for nurses who specialize in diabetes, stroke, cancer, labor and delivery, trauma, critical care, or other areas of hyper clinical focus, their knowledge is going to run deep about some very specialized concepts, treatment regimens, and diseases, and that knowledge is worth more than we can say.
Knowledge is power, so acknowledging and expressing what you know is a skill in and of itself. And if you’re job-hunting, being able to write and talk freely about why you’re fantastic is part of the sales pitch that will help you land the position of your dreams.
Your Multifaceted Skills
When we think of nursing skills, we often think of so-called hard skills like venipuncture, rhythm interpretation, wound debridement, or ventilator management. We also need to remember that the 21st-century nurse has computer skills, including using EMRs and other technologies.
In the interpersonal realm, there are skills related to communication, including emotional and relational intelligence, counseling, and active listening. We can also point to patient and family education or the education and training of other nurses (e.g., precepting or mentoring).
Meanwhile, we can’t forget all-important leadership skills, whether as a charge nurse, a director of nursing, or a chief nursing officer. Leadership can also be a skill we naturally demonstrate on the job, even if we don’t have a title beyond “staff nurse.”
You might also have skills in medical writing, grant writing, research, sales, case management, or other areas where you find yourself. Many nurses do important non-clinical work, and their knowledge and skills are equally valuable.
The list of skills and knowledge that a nurse’s mind holds is like an ever-expanding encyclopedia.
The Humble Brag
Whether you’re gunning for a promotion, interviewing for an awesome job, applying for a grant or fellowship, or being interviewed on a nursing podcast, your confidence comes from your ability to own what you know and what you can do, as well as the overall value of your “nurseness.”
If you’re feeling glum about your nursing career, pull out a sheet of paper and try to list every piece of helpful nursing and medical knowledge you have in your head. Chances are you’d need to fill page after page with every tidbit of knowledge you can claim as your own. And if you also included a list of your many skills, you’ll likely fill an entire notebook.
You can proclaim your value, assertively list your knowledge and skills, and still live and work in a place of humility. Being humble doesn’t mean you can’t take ownership of what makes you who you are. It means you don’t have to boast about it or lord it over others. The “humble brag” will serve you just fine: state it as a fact without emotion, and you can get your point across without fuss.
Rejoice in your nurse’s mind and everything it holds, and enjoy the clear knowledge of the value of your numerous skills. You’re a valuable member of the healthcare community, and owning your worth is a powerful place to be.
In the world of nursing, consistent rates of students graduating from nursing programs, becoming licensed, and successfully entering the workforce are critical to the long-term viability of the nursing profession and the healthcare system itself. As the true lifeblood of healthcare delivery, nurses are central to patient care, from long-term and public health to acute care and home health. In that regard, nursing education is a pipeline to the future.
Nursing School Capacity
In May 2023, the American Association of Colleges of Nursing (AACN) released data showing that student enrollment in entry-level baccalaureate nursing programs decreased by 1.4% in 2022, the first decrease in 20 years. Overall, 844 colleges and universities offer a BSN education, and many turned away thousands of qualified candidates due to a lack of clinical training sites and faculty. In 2022, 66,261 candidates were rejected, and in 2021 applications by 76,140 candidates were turned down.
Alongside these disappointing numbers in the entry-level BSN category, the AACN identified other factors:
Enrollment in RN to BSN bridge programs has been declining over the last 4 years.
Master’s programs have seen a 9.4% decrease since 2021.
Nursing PhD program enrollment shrank 4.1% from 2021 to 2022.
DNP program enrollment is at a virtual standstill.
When it comes to nursing school capacity, there’s plenty of evidence that something isn’t right. This statement from an October 2021 article by National Public Radio says a great deal about one major hurdle: “One of the biggest bottlenecks in the system is long-standing: There are not enough people who teach nursing. Educators in the field must have advanced degrees yet typically earn about half that of a nurse working the hospital floor.”
Becker’s Hospital Review reported in August 2023 that the California Hospital Association and the Service Employees International Union (SEIU) have teamed up to introduce a bill that would hold community colleges accountable for reserving 15% of enrollment slots for healthcare workers looking to advance their education and move into higher-paying career tracks like nursing. Whether this bill can make it through Congress and become law is unknown.
The U.S. Department of Labor has issued $78 million in grants to expand nursing school enrollment in 17 states. The state of Maryland has awarded its nursing program grants to boost schools and address the long-standing and worrisome nursing shortage. New Mexico is also expanding its nursing school capacity through support for increased enrollment.
While legislation, grants, and expanding nursing school capacity are all valuable strategies to increase the nursing workforce, we can also keep more grassroots efforts in our sights.
In families from many different backgrounds, a multigenerational tradition of service in the nursing profession is often the norm. Aunts, mothers, fathers, siblings, and others can profoundly influence younger generations’ career choices. When the value of being a nurse is communicated from generation to generation, a familial line of nurses can extend over many decades as additional family members join the profession.
As nurses, speaking proudly of the profession and our work can generate interest in those considering their options. While twenty-first-century nursing and healthcare have enormous challenges, we can also tell the story of how nursing provides endless opportunities and flexibility. Of course, there is the potential to travel and see other parts of the country and see one’s education through to a terminal degree such as a PhD or DNP.
In communicating about the possibilities to be found in nursing, we can point out that, contrary to what the public and the media might think, not all nurses work in the hospital. There are expanding opportunities in the pharmaceutical, biotech, and medical device industries; public health; informatics; nurse entrepreneurship; medical writing; legal nurse consulting; nurse coaching; research; and many other fascinating areas. In the interest of our profession’s growth, we paint an expansive picture for those who think of nursing as solely hospital based.
Pipeline to the Future
Whether a new graduate nurse eventually becomes an operating room nurse, a biotech research nurse, or a self-employed legal nurse consultant, the nursing school remains the pipeline through which that individual must pass to realize their dream. No matter how one person’s professional journey unfolds, it all begins with admission to an accredited nursing program, successfully graduating and passing the NCLEX®, and then receiving a license to practice. The nursing school is the funnel for future nurses of every stripe and interest.
When nursing school capacity is hobbled, our profession and society suffer. Decreased graduation rates translate to a shrinking nursing workforce, staffing shortages, nurses working under stress, and the potential for compromised patient safety and outcomes. Burned-out nurses are more likely to leave the profession and less likely to encourage younger generations to pursue the same career path.
Addressing decreased nursing school capacity is paramount, and we can use our collective genius to find solutions, whether through grants, legislation, and public relations or the direct recruitment of faculty through the offer of increased salaries and improved work conditions.
We must use every available means to secure the flow of fresh talent through the pipeline to the future. Our society and the lives of those within it depend on the quality and quantity of the nursing workforce, and it’s our responsibility to see that the pipeline remains filled with the talented nurses of tomorrow.
As a hard-working and successful nursing professional examining your career, you might reflect on your nurse mentor. The person who inspired, guided, advised, and kept you on the straight and narrow path, and ask yourself if you’ve ever been one yourself.
Was there someone who took you under their wing? Was there an individual who counseled you on your choice of master’s degree program? Did a colleague serve as an example of the kind of nurse you aspired to be? And if you’re a new nurse and can’t make heads or tails of this new career, where have you turned for guidance?
Sometimes, a mentor appears when you least expect it, and sometimes, you proactively go out and find one. Either way, the mentoring relationship can be life-changing, which sets you on the course of greater success, satisfaction, and confidence.
Mentors are Everywhere
Mentors are everywhere and can be sources of great inspiration who utilize their personal and professional experience as examples for others.
However, mentors are distinct from preceptors. A preceptor is a nurse you’re paired with to learn the ropes of a particular position or unit. Being precepted means that you’re being shown the ropes of where things are and how things are done. Mentors offer broader professional guidance; although they may be employed by the same institution where you work, that isn’t always the case.
According to Johnson and Johnson, where they match nurse mentees and mentors in hopes that these relationships will empower them to reach greater heights in their careers, “When you’re thinking about a potential mentor, you’ll obviously want someone you like and look up to. But it can be even better if they have skills that apply to your own career goals.”
And for the mentor, J&J states, “Sharing your experience with a new nurse can make all the difference to their career and help create a new generation of confident and well-prepared nurses.”
The American Nurses Association (ANA) is also a strong proponent of mentoring, outlining the many benefits of this special relationship for both the mentee and the mentor. Benefits may include:
Receiving honest feedback from a seasoned professional and role model.
Learning from generational differences.
Giving back to the next generation of nurses.
Gaining insight into a particular specialty or career path.
Finding a Mentor
Some institutions have official mentoring programs. While this may be rare, there are pros and cons to this type of situation. The required documentation can sometimes be so burdensome that it detracts from the creativity the pair could otherwise cultivate if left to their own devices.
Johnson and Johnson’s Nurse Innovation Fellowship matches teams of nurse fellows with successful nurse experts to solve real-world problems using human-centered design thinking principles. J&J’s Nurses Innovate QuickFire Challenge provides nurse innovators with grants and mentorship to bring their ideas to fruition.
The ANA offers a mentoring program that matches volunteer mentors with new nurse mentees seeking guidance and support as they launch their careers.
If joining an official mentoring program isn’t available to you or your cup of tea, there are plenty of ways to find one on your own.
There may be a nurse in your life whom you admire and would give anything to follow in their footsteps. You may be inspired by their work, accomplishments, and successes, or simply for the kind of person they are.
Aside from people you know, there’s also the riskier option: approaching someone you don’t know. You may encounter someone you admire at a conference, on LinkedIn, or through networking. While it may feel scarier to ask a stranger to be your mentor, taking that risk could lead to amazing things.
If you choose to approach someone about being your mentor, keep several things in mind:
Make sure they know that you greatly value their time and expertise
Come to them with a specific problem or issue that you’d like to tackle
Outline your initial goals for the relationship
Offer for the mentoring relationship to be time-limited (e.g., perhaps 3-6 months)
When you set parameters from the outset, the mentor knows you respect their time and expertise. And there’s always the possibility that the relationship may last much longer than initially proposed, including budding into a lifelong friendship.
The Magic of Mentoring
Mentoring can be magical for both the mentee and the mentor. Camaraderie, inspiration, friendship, professional connection, and mutual learning can all result.
While the relationship is by and large about the mentee learning from the mentor, there can be plenty in it for the mentor, too. After all, the mentee is human with their own experiences, skills, and knowledge, and the mentor may come out of the relationship equally enriched.
Every relationship has risks, advantages, and potential downsides, but the mentor-mentee relationship can be a highly inspiring experience for all involved.
If you’re interested in taking your nursing career to the next level, becoming professionally re-inspired, or launching a special project, engaging the support and guidance of a mentor may be just what the nurse ordered.
Every organization or workplace in healthcare or any other industry has a workplace culture, whether those working there are conscious of it or not. The best workplace cultures are consciously and proactively created by everyone involved, and the worst cultures exist without a shred of intention.
But what exactly is workplace culture, and how do you know your organization’s culture? This is a question worth pondering.
Workplace Culture in Plain Sight
According to the Harvard Business Review, workplace culture can be seen as “the ways people in the organization behave and the attitudes and beliefs that inform those behaviors (i.e., ‘the way we do things around here’) — including formal, stated norms as well as implicit ways people work and interact.”
“Work culture is a collection of attitudes, beliefs, and behaviors that make up the regular atmosphere in a work environment. Healthy workplace cultures align employee behaviors and company policies with the overall goals of the company while also considering the well-being of individuals. Work culture determines how well a person fits into their environment at a new job and their ability to build professional relationships with colleagues. Your attitude, work-life balance, growth opportunities, and job satisfaction all depend on the culture of your workplace.”
The culture at your workplace might be friendly, supportive, cold, cynical, laissez-faire, strict and controlled, or energetic and fun. As Indeed mentions above, healthy cultures align with what the company is trying to accomplish and how employees behave. However, how leadership behaves is a crucial factor that cannot be overlooked or overstated.
Whether you think about it or not, workplace culture exists and significantly impacts your workdays and how you feel about your work, colleagues, and even your patients.
Is there a nurse bully on your unit who makes everyone miserable, but the administration ignores that unhappy reality? The workplace culture is toxic and unhealthy, with weak leadership.
Dr. Renee Thompson, the CEO and founder of the Healthy Workforce Institute, states, “Numerous recent studies reveal the direct negative impact a negative culture and disruptive conduct have on employees and patients. One particular report from McKinsey sums it up nicely. Their research shows that toxic workplace behaviors are the #1 cause of burnout and intention to leave.”
Nurse attrition from either individual workplaces or the profession as a whole is often a cultural issue. Dr. Thompson continues, “Burnout and turnover result from bad behavior and a bad culture. Therefore, culture and conduct are more important than anything, especially now.”
Do the Chief Nursing Officer (CNO), Chief Executive Officer (CEO), and other leadership team members regularly participate in rounds, meet with staff to understand what is and isn’t working, and take proactive steps to address problem areas? The workplace culture is geared towards being open, communicative, and highly functional.
Do those same executive team members communicate organizational goals, praise employees’ hard work, offer financial bonuses, give generous stipends for CEUs, pay for employees’ education or certifications, or make sure that there are plenty of other amenities that employees appreciate and use? The culture is highly focused on employee well-being and retention.
Workplace culture can manifest in areas like:
Employee wellness
What types of behavior are encouraged, tolerated, or not at all welcome
The methods by which employee success is measured
The quality of communication and the company’s level of transparency
The values that inform the organization
How employees are kept engaged
Efforts related to employee satisfaction and retention
Teamwork
General morale
We’re All in it Together
Culture is an inside job, and no one who’s part of a workplace can escape the fact that they’re direct contributors to that culture. Everyone is always responsible, from the smallest interaction between two maintenance team members to the end-of-quarter email from the CEO that’s being sent to all employees. From the moment each person walks through the door until the moment they leave for home, they are in the mix when it comes to the culture of the work environment.
The Harvard Business Review states, “As employees engage with the culture as a resource to shape their skills and habits instead of a mandate decreed by top managers, culture becomes ‘expressed and reified through practice’.”
Both the individual and the collective create workplace culture. It is a dynamic force that must be fed, watered, and tended to so it can be a positive force that uplifts the majority whom it touches.
Examine your workplace for clues about its culture and your place within it. How does it feel? How do you contribute? And if it’s not a culture that fits you well, that is a sign that finding a new professional home may be in your best interest. After all, cultural fit is more than a buzzword. It’s a testament to whether a workplace and an employee truly belong together
