101 WAYS TO IMPROVE NURSING CULTURE
by Naomi Ervin, PhD, RN
During 2004 the Michigan Nurses Association Congress on Nursing
Practice focused part of its work on the nurse's practice environment
and the stressors that affect nurses and nursing. The patient care
environment contains a variety of stressors for nurses as well as
patients, e.g., physical demands, high noise levels. For nurses,
persistent problems such as unresolved issues with others, long
work hours, and shift rotations, contribute to stress and frustration.
Such conditions contribute to turnover and adverse outcomes for
nurses and other staff.
In an effort to address the nursing work culture, the Congress
on Nursing Practice developed 101 ways for nurses to improve the
nursing culture. Throughout the coming 101st year of MNA, the 101
ways will be published in installments.
In the following lists you may find several ideas about what you
can do to improve the nursing culture in your practice environment
as well as in your life.
Communication
Communication is a process with the basic purpose of effecting
change in ourselves, in others, and in our environment (Simms &
Ngin, 2000). One basis for effective communication is trust. Building
trust involves effective and honest communication (Covey, 1991).
The basis of interpersonal relationships is communication. There
are 10 ways for every nurse to use in improving the nursing culture
in the practice environment in relation to communication.
1.
Practice effective methods of communication.
2.
Clearly state what you are feeling (i.e. "I feel . . .").
3.
Communicate and integrate your contribution in improving nursing.
4.
Introduce yourself to your patients/clients as "the RN responsible
for your care."
5.
Give your input during committee meetings.
6.
Feel comfortable asking for feedback.
7.
Ask for help.
8.
Provide timely feedback, both positive and negative.
9.
Create a safe place to learn collectively - share thinking, listen
to the thinking of others.
10.
Greet your colleagues when you come to work.
Respect
The concept of respect is explicitly stated in the Code of Ethics
for Nurses with Interpretive Statements (American Nurses Association
(ANA), 2001). The first code statement is: "The nurse, in all
professional relationships, practices with compassion and respect
for the inherent dignity, wroth and uniqueness of every individual,
unrestricted by considerations of social or economic status, personal
attributes, or the nature of health problems" (ANA, 2001, p.
4).
The Code goes on to elaborate on this statement by pointing
out that the principle of respect for individuals extends to everyone
with whom the nurse interacts. Respect is demonstrated by valuing
the distinctive contributions of individuals and groups. "The
nurse establishes relationships and delivers nursing services with
respect for human needs and values, and without prejudice"
(ANA, 2001, p. 7). Although the nurse may not agree with all choices
made by individuals, the nurse respects the individual patient or
colleague as a person.
11. Honor the presence of each person's humanness.
12. Ask questions that dig deeper and uncover new
insights, a new learning by connecting differences and diversity.
13. Model unconditional respect.
14. Have zero tolerance for abuse and disrespect.
15. Expand thinking in diverse ways.
16. Believe colleagues.
17. Stand up for peers in their absence.
18. Avoid the three "B's": Bickering,
Back-biting, and B-ing.
19. Protect your colleagues from abuse from others.
20. Supporting the belief that every person has
a physical, psychosocial, sociocultural and spiritual dimension.
Support
In professional practice nurses are called upon to demonstrate
support to colleagues, patients, families, and the general public.
Support is demonstrated by a myriad of actions each day. Support
can range from providing encouraging words to someone in distress,
to providing directions to a lost visitor, to buying a cup of coffee
for a colleague who needs words of wisdom, or speaking up for others
who are less fortunate.
Support of patients and families may be likened to one of the six
essential features of professional nursing identified in Nursing’s
Social Policy Statement: "Provision of a caring relationship
that facilitates health and healing," (American Nurses Association,
2003). Research has demonstrated that support is instrumental in
producing better patient and client outcomes, e.g., higher birth
weights (Norbeck, DeJoseph, & Smith, 1996).
21. Align with and stand behind managers as they create an environment
that supports excellent patient care.
22. Encourage your manager to be supportive.
23. Have a way of showing other team members that they are valuable.
24. Support and acknowledge preceptors.
25. Provide praise and enhance self-confidence and self-esteem.
26. Empower colleagues.
27. When others perform a kind act, thank them in front of others.
28. Encourage new grads daily.
29. Set people up for success.
30. Share your wisdom.
Education
These are only a very few approaches that may be used to demonstrate
Standard 8. Education: "The registered nurse attains knowledge
and competency that reflects current nursing practice" (ANA,
2004, p. 35).
31. Recognize and verbalize your learning needs.
32. Be open to change.
33. Insist on orientation that evaluates competencies.
34. Find a mentor.
35. Be self aware and reflective.
36. Insist on adequate orientation.
37. Demonstrate competency prior to practice.
38. Be responsible for creating your future.
39. Maintain competency.
40. Take every opportunity to teach others.
Conflict management
Almost all work environments contain some stress and tension
for workers. Conflict may result from tension and is a natural part
of an individual’s personal and professional life. Conflict
cannot be totally avoided. It may be a result of differences of
opinion, incompatibility, erroneous information, or competition
for resources. Functional conflicts support the goals of the organization,
but dysfunctional conflicts prevent an organization from moving
forward (Robbins & Coulter, 1996).
For nurses working in conditions that may produce conflict, important
skills are recognizing and managing the conflict as well as possible.
Four strategies used in inter-group conflict are avoidance, diffusion,
containment and confrontation. Interpersonal conflict may be approached
by techniques such as lose-lose, win-lose, or win-win. The situation
and individuals involved should be considered when an approach is
chosen (Price, 2000).
The following suggestions may be useful to nurses to improve the
work culture in terms of recognizing and managing conflict, or even
avoiding dysfunctional conflict:
41. Engage in shared purposes.
42. Provide exit interviews with colleagues who leave.
43. Provide time management and stress reduction workshops.
44. Provide a process for referrals.
45. Provide colleagues at risk of failure with a progress improvement
plan.
46. Remain actively involved in the solutions until they are working.
47. Analyze your work culture.
48. Institute open, honest and supportive dialogue.
49. Use conflict management strategies.
50. Diffuse anger you feel by using relaxation techniques.
Collegiality
Collegiality is concerned with establishing and maintaining effective
working relationships. The American Nurses Association Standard
10, titled collegiality, addresses this important professional characteristic:
“The registered nurse interacts with and contributes to the
professional development of peers and colleagues.” One measurement
criterion is that the registered nurse “contributes to a supportive
and healthy work environment” (ANA, 2004, p. 37).
Other components of collegiality include sharing knowledge and skills,
providing feedback about performance, and maintaining caring relationships
with peers and colleagues. In an earlier article, the ethical code
that deals with respect was mentioned (American Nurses Association,
2001). Respect plays an important part of collegiality to promote
effective working relationships.
Nurses may use the following 10 specific ways to improve and/or
maintain collegiality in the work place:
51. Communicate to colleagues when they are at risk of failing.
52. Value and promote collaboration among nurses.
53. Promote collaboration between nurses and other health care professionals.
54. Provide relief for bedside nurses to attend conferences and
meetings.
55. Help new grad RNs to be successful.
56. Invite loners and newcomers to breaks and meals.
57. Help other colleagues with self care.
58. Provide collegial interaction outside of class and clinical
via personal, web or phone communication.
59. Get to know your colleagues in a social setting.
60. Help staff be efficient in their role when they are in charge.
Leadership
All nurses have contributions to make through leadership, whether
those contributions are through formal or informal activities. Leadership
is demonstrated by volunteering for committees, speaking up in situations
of ethical or social injustice, and supporting the nursing profession
to improve health care for all.
Leadership is formally defined as the ability to influence the actions
of others. Much has been written about theories and styles of leadership,
but current wisdom dictates that there is no one best leadership
style (Tomey, 2002). However, there is some agreement that the attributes
of an effective leader are enthusiasm, commitment, trustworthiness,
and effective communicator (Becker-Rems, 1994; Covey, 1991; Tomey,
2002).
Because nurses are required to be responsible for tasks delegated,
all nurses have some implicit, if not explicit, leadership authority.
Standard 15 is stated as: “The registered nurse provides leadership
in the professional practice setting and the profession” (American
Nurses Association, 2004, p. 44). One measurement criterion related
to this standard is: “Directs the coordination of care across
settings and among caregivers, including oversight of licensed and
unlicensed personnel in any assigned or delegated tasks.”
(ANA, 2004, p. 44).
Different situations call for different leadership skills. Effective
leadership calls for the individual nurse to develop an array of
skills that may be useful in a variety of practice situations. The
following suggested ways to improve nursing culture are provided
as ideas for your consideration.
61. Have professional autonomy and decision making authority regarding
patient care at all levels.
62. Face the challenges.
63. Provide experiences within the three roles of nursing: provider
of care, manager of care and member within the discipline.
64. Be a pace setter.
65. Foster staff coming to you with solutions rather than complaints.
66. Make sure staffing levels are appropriate for safe patient care.
67. Allow units to have a nurse-directed committee with rotating
members to address specific workload related problems with the opportunity
to solve some of their own
problems.
68. Ensure you are willing to engage in uncontaminated communication.
69. Support strong leadership.
70. Lead by example.
Diversity
Diversity applies to multiple aspects of nursing practice, such
as diversity in cultures and ethnic populations, diversity in lifestyles,
diversity in thinking, diversity in opinions, and diversity in competencies,
among many others. The first statement in the Code of Ethics for
Nurses (American Nurses Association (ANA), 2001) addresses the aspect
of diversity: “The nurse, in all professional relationships,
practices with compassion and respect for the inherent dignity,
worth and uniqueness of every individual, unrestricted by considerations
of social or economic status, personal attributes, or the nature
of health problems” (p. 7).
The standards of practice provide guidance for how respect for diversity
may be demonstrated in practice. The 4th standard is: “The
registered nurse develops a plan that prescribes strategies and
alternative to attain expected outcomes” (ANA, 2004, p. 24).
At least two of the measurement criteria provide examples of how
diversity is respected by the nurse. One criterion is stated that
the plan takes into consideration patient characteristics such as
age and culture. Another criterion is the expectation that the nurse
develops the plan with the patient, family and others. Working with
the patient and family demonstrates respect for the diversity brought
to any care setting by individuals.
Respecting the diversity of colleagues was addressed in an earlier
column on respect. The Code of Ethics for Nurses (ANA, 2001) includes
the interpretive statement that the code of conduct “precludes
any and all prejudicial actions, any form of harassment or threatening
behavior, or disregard for the effect of one’s actions on
others. The nurse values the distinctive contribution of individuals
or groups, and collaborates to meet the shared goal of providing
quality health services” (p. 9).
The following ways to improve nursing culture are a small sample
of what may be helpful in your practice setting.
71. Encourage learning and thinking in different ways.
72. Provide flexible scheduling.
73. Provide child care.
74. Develop a culture of inclusion.
75. Provide a learning styles inventory at beginning of all nursing
classes.
76. Promote the concept of parity in decision-making.
77. Accommodate diverse learning styles.
78. Get help for impaired professionals.
79. Provide opportunities for remediation for colleagues with competency
issues.
80. Teach the value of human resource at each level of institutional
hierarchy.
Development of Others
The obligation to assist others to develop knowledge, skills and
abilities has its roots in the very nature of nursing as a helping
profession and self-regulation. Nursing’s Social Policy
Statement (American Nurses Association, 2003) includes self-regulation
as one of three processes by which the nursing profession maintains
accountability to the public. The other two processes are professional
regulation and legal regulation. Self-regulation requires accountability
by each individual nurse as well participation in group activities
such as peer review. Assisting other nurses to maintain competency
for practice is also part of ethical behavior. For example, when
errors are made, nurses are expected to follow policy in reporting
the errors whether they are committed or observed. Contributing
to the development of others is an effective way for each of us
to also contribute to our own development.
The ten ways to improve nursing culture provided here emphasize
orientation and mentoring, but nurses use numerous other approaches
to contribute to the development of others. Some other approaches
may be clinical coaching, providing feedback on others’ work
when requested, assisting with accessing formal educational opportunities,
and providing positive feedback.
81. Apprise colleagues about scholarship information, web sites,
and write letters of recommendation for them.
82. Provide orientation programs.
83. Structure learning to include partnerships, self-work and systems
support.
84. Provide mentors.
85. Provide assistance to nurses in academic programs regarding
course content, clinical skills, and critical thinking.
86. Provide a mechanism for peer tutoring.
87. Provide positive and meaningful orientation experiences.
88. Mentor new nurses.
89. Encourage good leaders who foster the development of others.
90. Have a good welcoming and orientation program and provide mentors
for a year.
Professionalism
When it comes to professionalism, actions often speak as loud as
words. Professionalism is demonstrated by what nurses wear, how
they identify themselves, and how they interact with others. Displays
of professionalism are noted by others in written and spoken words.
Professionalism is on display for all to see in how we treat each
other and our patients.
In a formal sense, professionalism is viewed as involving autonomy,
mastery of a body of knowledge, and a community of colleagues. In
addition to these three characteristics, there are essential criteria
for a profession. Some of the criteria are providing practical services
that are vital to human and social welfare, having a code of ethics,
formulating and controlling its own policies and activities, attracting
people who emphasize service over self-interest, and having a professional
association that promotes and ensures quality of practice (Simms,
Price, & Ervin, 2000).
The Code of Ethics for Nurses emphasizes this last criterion with
the 9th provision: “The profession of nursing, as represented
by associations and their members, is responsible for articulating
nursing values, for maintaining the integrity of the profession
and its practice, and for shaping social policy” (American
Nurses Association, 2001, p. 24). Members of the Michigan Nurses
Association are fortunate to have a strong voice for nursing in
the State of Michigan.
The following eleven ways to improve nursing culture in the area
of professionalism are a few suggestions that each nurse can use
to contribute to the maintenance of a professional workforce in
each health care facility and for Michigan.
91. Invest and value nursing to improve patient safety and quality
of care.
92. Separate personal from professional problems.
93. Leave personal problems at home.
94. Present a positive image of the nursing profession.
95. Be a model for work ethics.
96. Model professionalism on and off the job.
97. Prohibit non-RNs from doing RN work.
98. Be a peace maker.
99. Create team spirit.
100. Be proud to be a Registered Nurse!
101. Participate in professional organizations.
4/4/07
|
