The 'secret sauce' to a great nurse work culture

The "secret sauce" to creating a great work culture is having nurse leaders who embrace a primary role as retention officers and putting values into action, nursing leaders told Becker's.

In August, Nurse Journal, a career and education resource website, ranked 15 hospitals as the top 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 break down their "secret sauce" for creating a great work culture for nurses:

Margarita Baggett, MSN, RN. Chief Clinical Officer for UC San Diego Health: I believe the secret sauce is having exceptional nurse leaders who embrace a primary role as chief retention officers. These nurse leaders ensure that their nurses and team members feel cared for and belong. Most importantly, they recognize nurses for their contributions in achieving department and organizational strategic goals. This brings meaning, purpose and joy to their work.

Nurses are offered a multitude of professional development programs to ensure engagement and to provide opportunities for advancement. The Clinical Nurse Advancement Council developed and supports a robust clinical advancement program, which includes the completion of a quality improvement project. To support nurses who are novice in quality improvement, evidence-based practice or research, we have developed programs such as the Research Immersion Program to support nurses in learning these processes and concepts. 

Nursing and the transformational healthcare department partner to provide Lean Six Sigma training to team members, which empowers all nurses to be problem solvers. UC San Diego Health nursing has also partnered with other local hospitals and schools of nursing to support the Evidence Based Practice Institute, where nurses from across San Diego County come together to learn EBP skills and implement those projects in their department.

We are also fortunate to have a nurse retention specialist, Laura Rossi, who ensures nurses are recognized for their work and achievements. Ms. Rossi coordinates a variety of recognition events throughout the year, including Nurses' Week, Certified Nurses Days, Rookie of the Year Awards, Preceptor Awards, Daisy Awards, etc. She also offers individualized support to nurse leaders and clinical nurses to provide guidance and connect them to needed resources.

A great work culture cannot flourish without support for new nurses and nurses transitioning to new roles. As such, UC San Diego Health was the first nurse residency program accredited with distinction by the American Nurses Credentialing Center's Commission on Accreditation in Practice Transition Programs in the region! This program ensures nurses new to the profession are supported and mentored through this critical transition in their career and buttresses our low nurse turnover rates.

Dina Dent, DNP, RN. Vice President and Chief Nursing Officer at Inova Health System (Falls Church, Va.): Empower 180: A systemwide weekly three-hour, meeting-free block of time for all Inova team members (including nurses and nurse leaders) to focus on things conducive to their work needs instead of attending meetings. Nurse leaders use this time to round on their direct reports, to strengthen relationships and fuel team member engagement.

Team member recognition: We emphasize recognitions such as monthly Daisy Awards (for nurses) and Peach Awards (for any team member, including nurses) to recognize exceptional performance. These are attended by not only nursing leaders but the entire hospital senior leadership team whenever possible. We have found this boosts morale and encourages a culture of excellence and continuous improvement.

Town hall meetings: Our Inova Fairfax Medical Campus town halls are a bit unique because they're much more than report-outs by leaders. The bulk of our time and attention is spent directly answering team member questions (sometimes tough ones) in real time as they come into us via the Zoom chat feature. If we don't know the answer, we say that, but we always follow up. Then we publish the full list of team member questions and answers on our intranet (along with the town hall video itself) so any team member can participate, whether they attended live or not.

Leader rounding: Our leadership team emphasizes the importance of direct rounding on our areas. This means regular rounding with the team at night and on weekends, not just during core working hours. This can take the form of weekly mission rounds (to celebrate a team's recent achievements), listening sessions (to find out "what's really going on" and how leadership can help) and even through daily leader informal shout outs on our hospital safety huddle calls to highlight team members who are doing great things.

Donuts with Dina: These are regularly scheduled breakfast sessions, strategically hosted during shift turnover, for me to informally meet and greet nursing team members on the units. You simply can't replace the personal touch in relation-based leadership. This is just one example of the kind of extra outreach each of our senior leaders are committed to.

Brandee Fetherman, MSN, RN. Chief Nursing Officer at Morristown (N.J.) Medical Center: 

We are fortunate to have a culture that supports an open, transparent environment that actively encourages teamwork, mentorship and professional development. We have a clinical ladder program for nurses and support staff, as well as certification pay and preceptor pay for our nurses. We offer weekend work programs and new nurse graduate residency programs, including specialties such as critical care, operating room, perinatal, emergency department and neonatal intensive care unit.  

We pride ourselves on being highly innovative and have ongoing projects such as virtual nursing and digital whiteboards, which are available in a variety of environments. We are about to launch a pilot program implementing robot technology to assist with non-clinical functions giving our team members more time at the bedside. One of the great things about our organization is that we're not afraid to try new things, in fact, we're always looking to find new and highly innovative ways to improve. We look to each other to help strive for ongoing improvements, we help and support one another, which I think enhances our culture as an organization.

We instituted a nurse navigator role in the emergency department, as well as patient mobility technicians, which really go a long way to support the bedside nurses and clinical teams. We also have healthy relationships with our physicians across the board. That mutual respect and open communication among the team is exceptional and shows in the care we provide, as well as patient outcomes.

Ryannon Frederick, MSN, RN. Chief Nursing Officer at Mayo Clinic (Rochester, Minn.): At Mayo Clinic, our values drive everything we do. That is evidenced in our decisions, words and actions from every leadership layer down to our front lines. That's our secret sauce — we put our values into action.

We're a learning organization, and that's embedded in our culture. We work hard to provide significant development opportunities, and we put tremendous focus on developing our leaders because we know that for our staff, their direct supervisor makes the biggest impression on how they feel about the organization. We teach our leaders about communication, support and demonstrating respect. Our values are fundamental to developing that work culture for our staff.

We also learn from our successes and failures and use those learnings to improve our processes and care. We encourage our staff to be part of this, to have a voice in driving our future and collaborative decision-making.

Joye Gingrich, BSN, RN. Chief Nursing Officer and Vice President of Patient Care Services at UPMC Harrisburg (Pa.): UPMC Harrisburg promotes involvement of the clinical bedside nurse in Professional Governance Councils as a shared voice and promotes evidenced-based best practices to care for our unique patient population. The council structure allows for a shared voice in the decision-making process where the clinical nurse is involved in 90 percent of the decision-making at the unit level and hospital level. Nursing leadership serves as an adviser for the unit and hospital-based councils.  

We also focus on nurse leadership development, which includes professional development opportunities, a monthly elite clinician meeting, succession planning, better consistency in leadership orientation, and increased engagement in key quality and safety initiatives.  

Shannon Pengel, MSN, RN. Chief Nursing Officer of Cleveland Clinic: A great work culture begins with strong retention and recognition efforts. Flexible schedules are critically important to our caregivers, so many programs have been initiated to allow for this such as a weekender program and robust night shift incentive. Our caregiver office under the leadership of Kelly Hancock, DNP, our chief caregiver officer, has advocated for significant investments in our caregivers, including market adjustments, merit increases and premium dollars for difficult-to-fill shifts. 

Another important aspect of creating a great work culture is supporting caregiver wellness and resiliency. Toolkits have been developed so that these services are easily available for our caregivers focusing on all aspects of caregiver well-being, including physical, emotional, financial and wellness activities to participate in. 

Finally, our professional practice model embodies a nurses' role in speaking up, empowerment, collaboration and embracing a culture of safety in a high reliability organization.

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