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How to Create a Welcoming On-Site Culture for Nurses

By Wei Deng, CEO of Clipboard Health

As healthcare facilities struggle with a nationwide talent shortage, many are rethinking how they attract, support, and retain nurses. Without question, better pay and benefits would go far towards winning over nurses. That said, scheduling administrators and nursing leaders may find that the most important lever is workplace experience and culture.

Researchers at University of Michigan have found that female nurses (85% of all U.S. nurses) are 90% more likely to experience “on-the-job problems” and 20% to 30% more likely to suffer from depression than the general female population. More disturbingly, they are twice as likely to commit suicide. Accordingly, 90% of RNs told a pollster they are considering leaving the profession within a year.  

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Running a talent marketplace that serves healthcare facilities means my team and I get to talk to many nurses. Our interviews show that “on-the-job problems” take many forms: difficult interactions with patients who resist care; colleagues who are hard to get along with; increasing demands to work extra hours; unpredictable scheduling; and high patient/nurse ratios that cause stress and raise the likelihood of mistakes and injuries. 

A few steps could produce a far more welcoming culture for nurses.

Provide nurses with channels to report and resolve on-the-job problems

Nurses often feel that they have no way to report and resolve serious issues. One nurse we interviewed mentioned that physicians can be especially unsympathetic to nurses’ mistreatment by patients. They expect nurses to simply bear the insults, food throwing, and worse. Contingent and traveling nurses also told us that full-time colleagues, maybe resenting their higher wages, will overload them with work and refuse to answer questions.

The common thread is a feeling of powerlessness in these situations. Nurses feel like there’s no point of contact nor any process for resolving issues that jeopardize their well-being and affect patient care.

Facilities can create and publicize quick, accessible procedures for reporting poor workplace conditions. This could be as simple as a digital form that gets communicated to nursing leadership. Nurses want the opportunity to voice their concerns—and they need proof that doing so can bring about change. While this places a burden on administrators to validate reports and have uncomfortable conversations, doing nothing is more costly, especially for facilities that experience understaffing. 

Rethink scheduling to provide more choice and flexibility   

Nurses often feel like they are forced into schedules that take a toll on their health and personal lives. For example, one ICU nurse was constantly swapped between daytime and NOC shifts. If she could have worked, say, three weeks in the daytime and then three weeks overnight, she might have adapted, but the facility didn’t allow that flexibility. Instead, she struggled with exhaustion and stress until she finally quit. 

Broadly, nurses want to pick a schedule that meets their needs. One interviewee, a CNA and single mother, needs to work overnight so that she can care for her daughter and attend LVN classes during the day. Inversely, an RN and new father, determined to work four ten-hour shifts from morning to early evening, made that schedule a precondition for taking any job offer (and he got it).

Whether they work full-time, part-time, or temporarily, nurses want more flexibility and control in how they are scheduled. At facilities where scheduling is entirely out of their hands, and unpredictable, morale suffers, and attracting talent is more challenging.

Build forums for listening—and show that management has listened 

Nurses who work in difficult cultures frequently report that they feel “unheard.” They don’t insist that administrators and management agree with their perspectives. They just want acknowledgement that their views on patient care and nursing-related decisions are heard. 

Without forums for listening—such as meetings where nurses can speak collectively to management—nurses are more likely to suppress their frustrations or channel them in less constructive ways. An us-versus-them mentality can emerge where nurses feel victimized by management. Well-meaning administrators and leaders may not be aware of this dynamic, especially in large, complex facilities. 

In a listening forum, though, nurses can express constructive feedback and concerns without fear of retribution. Having their peers as witnesses is important because, in private, one-on-one conversations, there tends to be a power imbalance between the nurse and their manager. That can lead nurses to withhold useful feedback. 

To be clear, these are not comprehensive solutions to the crisis in healthcare. Issues related to compensation, education, and patient-nurse ratios also need to be addressed. Still, facility administrators often have the influence to ignite cultural change. Getting permission to improve reporting processes, rethink scheduling, and create listening forums might be easier than expected. With understaffing as dire as it is, healthcare facilities might be ready to experiment. It’s worth finding out. 

Healthcare Business Today is a leading online publication that covers the business of healthcare. Our stories are written from those who are entrenched in this field and helping to shape the future of this industry. Healthcare Business Today offers readers access to fresh developments in health, medicine, science, and technology as well as the latest in patient news, with an emphasis on how these developments affect our lives.

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