We all have an interest in empowered nurses

Ann McRae a registered nurse at VCU Health System's new Critical Care Hospital takes the pulse of a patient.

It’s a fact: We nurses are masters of the work-around. Our near-universal penchant for hunting and gathering what we need to care for our patients means our pockets are full of tape and bandages, we have secret stashes of clean wash cloths, pillows and noninstitutional toothpaste, juice boxes and stickers for small fry.

But this benevolent hoarding speaks to a larger, darker truth about our workplaces — the nation’s hospitals and clinics — and offers a metaphor about the stress, lack of support, recognition and appreciation nurses, who at 3.1 million strong make up the largest portion of the health care workforce, may feel.

While many in the wider American workforce report disengagement at work — a recent and widely cited Gallup survey found that more than two-thirds of us are “just putting in our time” — health care is one profession where the consequence of disengaged, burned-out frontline caregivers is dire. And costly.

Nurse turnover — among the most expensive problems a hospital faces — stands at 20 percent, according to research published in the Journal of Nursing Administration. Retraining and replacing those who leave costs two and three times a nurse’s annual salary.

And it’s not just professional and financial jockeying. A U.S. Hospital Nursing Labor Costs study found that 14 percent of registered nurses abandon the field, while an American Journal of Nursing study reported that more than a third — 37 percent — want to after a single year. Among those who tough it out, “working wounded” nurses are at best demoralized and at worst error-prone.

Nobody goes into nursing to harden their heart; every nurse can recall the tidal wave of pure joy first experienced with a baby’s birth, a remission, a patient’s jubilant discharge. So what’s happening?

Turns out, a lot. Many nurses report feeling a lack of respect, support, collegiality and collaboration. Others feel devoured by the dissonance between patients’ complex medical problems and hospitals’ bottom lines. Still others find they’re not listened to, feel bent in half by needless and repetitive paperwork, computer screens and inflexible schedules. That health care is rife with fatigue-inducing layers doesn’t help, and we know from research that many nurses on the ground don’t feel empowered to make decisions.

While we nurses love our work, we often hate our jobs.

*** The two of us started learning nursing in the 1970s, a time in which nurses were instructed never to get attached to patients, never to cry, never to let the job own our emotions. But today, there’s a burgeoning understanding that it’s as critical to care for the care providers as it is to care for the patients.

Physically and emotionally strong nurses provide stellar care, and resilience in nursing and healthcare yields dividends by decreasing turnover, cultivating engagement and even boosting empathy and compassionate care. When nurses feel cared for, their own care improves. They’re also more loyal to institutions, colleagues and administrators when they feel valued. And when respect, empowerment and collaboration are the order of the day within the hospital corridors, patients benefit and safety metrics improve alongside, yes, the bottom line.

Sound basic? It really is. And yet, across the U.S. it’s not being done.

To get nurses where they need to be, we must teach resiliency in nursing school and beyond. It must be offered at hospitals through continuing education credits and workshops that give nurses a way to tap into methods for keeping their spirits buoyant through practices like yoga, meditation and mindfulness.

We must look at existing relationships and systems within our hospitals to intentionally foster healthy work environments that support a strong work-life balance, celebrate accomplishment, recognize and retain talent and link high expectations and performance with praise, incentives and financial rewards not just at the outset but throughout nurses’ careers.

We must insist on clinical collaboration that recognizes the value of each person’s role on the care team, and as health care leaders, find executives not solely driven by spreadsheets, ego and power but by a brand of servant leadership that is both humble and grateful.

When nurses feel supported, the burnout tide shifts. Retention improves, and so does patient care. One study found that a well-supported healthcare staff experienced 48 percent fewer adverse events. Another found that while hospitals with more stressed-out nurses had dramatically higher infection rates, even a 30 percent reduction in stress resulted in some 6,000 fewer infections at a single medical center.

In an era where nurses are even more central to care delivery, it’s never been more critical to look at how we frame our organizations’ support of nurses. Physicians and executives are no longer at an unquestionable, distant peak issuing edicts: healthcare must become a respectful conversation, with each participant playing an important, distinct role.

Servant leadership is hardly New Age hocus-pocus; it’s good, old-fashioned sense. Trust, respect and care well for those who are your primary caregivers — the core of your organization and the drivers of its safety metrics — and loyalty, retention, quality, safety and costs will fall into line.

Nursing is hard enough without combative, disrespectful relationships with colleagues on the inside. But if they are listened to and supported, if logistical roadblocks are removed by leaders not driven by ego or history or policy or why something can’t be done, nurses will be able to both love their work and their jobs.

And maybe when this happens, we’ll empty their pockets in favor of well-stocked supply closets everywhere.

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Dorrie K. Fontaine has been dean of the School of Nursing at the University of Virginia since 2008 and is the Sadie Heath Cabaniss Professor of Nursing and associate chief nursing officer at U.Va. Medical Center. Kenneth R. White is the Nursing School’s associate dean for strategic partnerships and innovation at U.Va. and holds the University of Virginia Medical Center Professorship in Nursing.

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