The power of visibility for nursing leaders

Creating a top-ranking nurse culture comes down to a few things, but the No. 1 recommendation is leader visibility and availability, nursing leaders told Becker's.

In August, Nurse Journal, a career and education resource website, ranked 15 hospitals as the best for nurses to work at. They determined the top 15 hospitals by using rankings from CMS, the American Nurses Credentialing Center Magnet Recognition Program, and the Hospital Consumer Assessment of Healthcare Providers and Systems Patient Survey, as well as the following criteria: patient satisfaction scores, safe staffing levels, hospital safety measures, nursing career opportunities, benefits, workplace environment and ratings from nurse reviewers.

Here, six leaders from some of the recognized hospitals and health systems give advice on how to build a great workplace for nurses:

Margarita Baggett, MSN, RN. Chief Clinical Officer for UC San Diego Health: One key factor is to ensure a strong professional governance structure is in place. These structures ensure nurses across the healthcare spectrum are empowered to make meaningful change at all levels of the organization. It starts at the department level with nurses and nurse leaders working together to advocate and enact change in their environment. Nurses are also leading and participating in committees at all levels within the organization, where advocacy for nursing practice and safe patient care occurs.

As a CNO, supporting innovations through research and quality improvement in nursing, as well as dissemination has led to 47 podium presentations, 48 poster presentations and 57 publications! There are also 65 doctoral prepared nurses working at UC San Diego Health, which include a nurse scientist to support project development. Enabling nurses to participate in research and quality improvement reinvigorates and restores a passion for the profession and helps support a great place to work.

Dina Dent, DNP, RN. Vice President and Chief Nursing Officer at Inova Health System (Falls Church, Va.): My first advice is this: "You can't pour from an empty cup." By that I mean, when we talk about the importance of "work-life harmony" we as leaders need to walk the talk. This involves more than being flexible and understanding when others' personal emergencies come up or plans change. It also means demonstrating this concept working in our own personal lives. Many studies have shown that workaholics aren't more productive at all, they just miss out on the other important things in their lives.

I encourage CNOs and other nursing leaders to maximize personal interactions, even if only brief. For me, I always tell my team to "pick up the phone" and "my door is open." Technology is great and exceptionally useful, but remember to appreciate the value of face-to-face communication.

Lead with compassion. People come first. Ultimately the quality and safety of the care our patients receive is always reflective of the care and support our teams give, and receive, from each other.

Embrace and encourage innovation. Remember to ask the follow-up question, the "why." No one has a monopoly on great ideas; many of our best ideas come from our front-line staff nurses who perform direct patient care every day. Tap into that amazing reservoir of knowledge and experience.

To be a problem solver, you need to be a problem seeker. Cultivate a mindset of listening deeper, staying curious and being truly present in every encounter. By engaging your teams, the problems will arise, but so will the solutions.

Brandee Fetherman, MSN, RN. Chief Nursing Officer at Morristown (N.J.) Medical Center: Strive to have an open and transparent environment — listen to your team, and purposefully engage them in the process. Be flexible and open minded. Remember that what worked well in the past may no longer continue to be a best practice — look at all we learned during the COVID-19 pandemic, for example. Some things may never go back to the way we used to do them, which is good — we learned a lot and instituted new processes and practices that have proven to be successful. There really needs to be a continuous and creative effort to find and develop new solutions together as a team. 

Ryannon Frederick, MSN, RN. Chief Nursing Officer at Mayo Clinic (Rochester, Minn.): The number one piece of advice I can share is to listen to the voice of your staff and act on what you hear them say. This doesn't mean that they will always get every desire they have. However, staff will notice when you understand the challenges they point out and when you work with them to co-develop solutions to those challenges.

Second, recognize your staff. They have hard jobs and don't seek recognition, but they appreciate it when leaders recognize how they support peers, make tangible changes for patient care and feel valued for their contribution.

Joye Gingrich, BSN, RN. Chief Nursing Officer and Vice President of Patient Care Services at UPMC Harrisburg (Pa.): CNO visibility and availability to the staff is important to creating a positive culture. Leader rounding provides the opportunity for the CNO to connect and build relationships with the bedside nurse. On hire, UPMC Harrisburg nurses meet with and are provided my cell phone number, and I am available to the nursing staff should they ever need to contact me. Recognizing the positive contributions of the bedside nurse is my priority. Sending a personalized thank you cards to nurses' homes shows nurses the value of their work. Celebrating unit accomplishments, such as days free of falls or infections, promotes a positive culture that can instill unit pride and encourage continued quality work. Nurses every day go above and beyond to not only provide patients and families with excellence in clinical care but also compassion. UPMC Harrisburg partners with the Daisy Foundation, to honor nurses with profound gratitude for all that they do with the Daisy award quarterly. 

Shannon Pengel, MSN, RN. Chief Nursing Officer of Cleveland Clinic: One of the roles of a CNO is to remove barriers for their caregivers, and this starts with active listening to the concerns they face. Communication in today's environment must be more transparent than ever before sharing data and plans clearly and concisely.

One current key strategy is to meet regularly with our frontline caregivers to discuss issues impacting their day-to-day work. Sharing challenges with them and asking for their assistance with strategies to overcome our current workforce challenges. We all must work together to reimagine our nursing workforce to safely provide exceptional care to our patients. Using new models of care or onboarding strategies is best defined by our own caregivers. In addition, CNO's must advocate for their caregivers and develop a collaborative partnership with key stakeholders to accomplish their goals. Barriers are frequently outside of nursing such as patient support services, throughput or technology. Solutions to these barriers take collaboration and innovative problem-solving.

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