Just imagine: It is Monday morning, the sun is shining, and today is starting off great. Yet in this profession, surprises abound, and the good morning ends abruptly.

Over the weekend, two staff nurses have left letters of resignation under the door; three other staff members have left voicemails reporting that they cannot handle the workload and demanding something be done; and, reviewing weekend staffing, there were several staff who called in sick over the weekend.

Staff are unhappy, and turnover and call-offs are increasing. The great day just turned into grim reality.

Commit to Correction

It is frustrating for the nurse leader to feel like he or she is doing so much for the team, only for everything to go downhill. But what to do? A good place to start in turning the team around is for the nurse leader to first commit to correcting problems.

This can be a challenging step to follow through on, as a necessary next step is for the nurse leader to evaluate his or her own behavior. Equipped with a commitment to resolve issues, no matter their source, the nurse leader must uncover why staff are disengaged. Then, develop an action plan to change the work environment.

Leader Attitude Check

To create a more positive work environment, nurse leaders may need to check their own perception and behaviors. Staff can pick up on negative vibes from leadership.

For example, if the leader believes that the workload is unmanageable, staff will too. Many leaders might say that the workload is tough, and it may be, but wallowing in those thoughts around the team doesn’t help to make the changes necessary to improve the environment. Leaders need to examine how they feel about the organization, the work, and their employees. 

A few good questions to ask are:
  • Is the leader’s perception of the work and actions affecting how the team performs on a daily basis?
  • What does the leader say that might be considered negative or disempowering?
  • How does a leader’s body language affect others’ perception of the leader?
  • Do staff members find it easy to come and talk to the leader?
  • Is the leader doing or saying anything to erode trust amongst team members?
Once leaders understand how their behavior and actions affect the team, they can work toward changing those things, so that they can achieve the desired outcome of a more positive work environment. Leaders earn respect from staff based on their behaviors. So, the leader should model behaviors that are expected of others.

Identify Concerns Through Satisfaction Surveys 

Like most efforts at problem solving, it can be a productive early step to gather some information. 
Employee satisfaction surveys are a great way to learn and address employee concerns while demonstrating respect for the staff’s opinion. These surveys also provide insight into how staff view the facility work environment and its leadership. Analyzing survey responses can provide vital information on the staff’s perception of their work environment.

For example, if the survey indicates that 50 percent of staff are not satisfied with their current employer due to an unsafe work environment, facility leaders can now delve into why staff feel the work environment is unsafe.

This may require a follow-up survey regarding safety, or the nurse leader may decide to try a team meeting covering the topic and the staff’s concerns. Once the leader knows why employees are flagging a concern, he or she can use that information to help build a plan toward improving employee satisfaction.

It might also be helpful to ask them: How do they think the facility leaders or the team might improve or fix the issue? Wherever feasible, incorporate staff’s input on how to best address workplace concerns, and publicly applaud the contribution of ideas.

Tapping Employee Rounds

If the facility does not conduct employee satisfaction surveys, nurse leaders can solicit staff input during rounds. A few simple questions can provide a wealth of information. When rounding with employees, ask the following:
  • How can leadership help them to better perform and succeed in their jobs?
  • What tools or resources do they need to do their job properly that might be missing from what is currently available to them?
  • What’s not working well?
Framing these questions as open-ended, rather than simple yes-no questions, can prompt more substantive, actionable responses. Furthermore, assuming that areas for improvement within the question exist can help motivate employees to share candid feedback, rather than unfounded reassurances.

Whenever an employee raises an issue, always probe for further information. The more information available to work with, the more likely the leader will be able to effectively resolve the problem.

Searching for Themes

After gathering a list of staff concerns and analyzing the information, look for common themes. These may be overall, facility-wide concerns or unit-specific ones. Next, prioritize the list of concerns and select one or two issues for improvement. Select at least one issue that can be addressed within a relatively short period of time; “quick win” improvements in the work environment show staff that the leader is working to address their concerns and may also change how employees see some of the other issues not yet resolved.

For example, staff may indicate that their workload is overwhelming and that facility leaders do not appreciate the work staff do. Implementing a plan to address staff appreciation may be more easily and readily achieved than reducing workload. Although the workload issue still needs to be addressed, seeing progress on their concerns may improve how staff view their workload.

There may be situations when staff concerns cannot be addressed quickly, or staff disagree with the outcome. In these situations, it is best to acknowledge the concerns, thank staff for their input, and let them know why their preferred approach cannot be adopted. This lets staff know that their opinions count, but that there are factors preventing the change.

Just as staff will take note of efforts to act on issues they have raised, they will likewise notice if their concerns are ignored. This can compound employee frustration, which further erodes staff morale. 
Following through is critical.

Ongoing Efforts

Addressing staff concerns isn’t a one-and-done effort. Leaders must continually monitor for issues that impact the staff’s view of the work environment. This may mean introducing annual employee satisfaction surveys, regularly soliciting feedback during employee rounding, or simply monitoring for changes in the staff’s behavior.

Leaders who understand their own impact, make their team’s satisfaction a priority, follow through on their commitment to improve conditions, and continue to monitor for areas of improvement in the work environment and staff morale will have many more good days to come.
Amy Stewart, MSN, RN, DNS-MT, is vice president of curriculum development for the American Association of Nurse Assessment Coordination. She can be reached at astewart@AAPACN.org.