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6 Top Drivers of Nurse Engagement

Analysis  |  By Carol Davis  
   April 12, 2021

Autonomy, relationships, and development are among the keys to building a culture of engagement, American Organization for Nurse Leadership education director says.

Building a culture of engagement in a hospital or health system begins with recruiting and hiring nurses committed to the mission and then creating an environment where they can flourish personally and professionally, says a director with the American Organization for Nursing Leadership (AONL).

"Team member engagement is directly related to one's commitment and connection to their organization," says Crystal Lawson, DNP, RN, CENP, education director for AONL.

The growing number of studies on nurse engagement identify a number of outcomes, such as safety, decreased mortality rates, decreased falls, quality, and patient experience.

Engagement also affects a hospital or health system's bottom line. Fifteen of every 100 nurses are considered disengaged, with each disengaged nurse's lack of productivity costing an organization $22,200 in lost revenue annually, according to a 2016 study published in the American Nurses Association's Online Journal of Issues in Nursing. Consequently, a hospital with 100 nurses could potentially lose $333,000 annually, while a large system with 15,000 nurses could lost $50 million.

Building a culture of engagement is among the learning objectives of the Virtual Nurse Management Institute, a three-day virtual, interactive course being offered by AONL April 28-30.  

"[The course is] designed for current nurse managers looking to add the critical management tools necessary to be successful in their current role and take their career to the next level," Lawson says.

Lawson shared with HealthLeaders why engagement is crucial to both the organization and the individual nurse and how nurse leaders can build and cultivate a culture of engagement in their own organizations. 

This transcript has been edited for clarity and brevity.

HealthLeaders: What are the most important benefits of a culture of engagement to a hospital or health system?

Crystal Lawson: Highly engaged teams have better retention rates, higher patient satisfaction, and improved organizational performance. Ultimately, this affects patient outcomes, organization reputation, and healthier communities.

Organizations should also look at how they recruit new talent and the employee onboarding process. A culture of engagement can be cultivated by hiring the appropriate talent that are committed to the mission, vision, and values. Research shows Gen Z places value on culture fit over traditional benefits such as salary, insurance, and PTO, so it is important to clearly communicate your organization's mission and values, especially as they relate to diversity, equity, and inclusion. Clearly communicating this and empowering team members can significantly influence a culture of engagement. 

HL: What are the benefits of engagement for each nurse in that hospital or health system?

Lawson: Engaged nurses experience higher levels of happiness and in turn better health. Organizations with a culture of engagement demonstrate that people are valued. Employees feel rewarded and recognized. Nurses involved in professional governance have the opportunity to have their voices heard and impact outcomes. This allows the nurses to work smarter and produce better outcomes, which fosters innovation. Engaged nurses are dedicated to the mission and feel more energized and committed to their work.

As many areas across the country continue to experience a shortage of healthcare workers, these market forces allow new clinicians to be selective in choosing where and for what kind of organization they want to work. As younger generations value flexibility and work-life balance, organizations may consider offering clinicians the ability to tailor their schedules to provide time for innovation, as one example. Creating a career lattice that enables new clinicians the ability to move within the healthcare organization may also be attractive.

HL: What are the top drivers of engagement?


  1. Autonomy. This translates to being trusted to make decisions. Another way I like to put it, delegate the outcome and not the approach.
  1. Relationships. Positive relationships within teams and mutual respect are core to engagement. One question on a Gallup employee engagement survey asks, "Do you have a best friend at work?" There is concrete evidence that those who answer "yes" are twice as likely to be engaged.
  1. Development: Employees want to receive helpful feedback and support to help them achieve their personal and professional goals.
  1. Leadership: Are leaders role-modeling the way? Are they communicating a common language and committed to supporting a healthy practice environment? Are they visible and accessible? As the saying goes, "People don't quit a job, they quit their boss." The manager role is critical to engagement.
  1. Meaning: Are you able to find meaning in your work today? Connecting your work back to the purpose is a powerful way to create engagement. It is the leader's responsibility to bring purpose and meaning to the work, as well as setting clear goals and expectations for the team. Leaders must also inspire their team to the "why" behind their work. I personally believe demonstrating the “why” is one of the most powerful ways to drive employee engagement. Having purpose and meaning at work creates happier individuals and overall organizational success. Shared values make it easy to work toward a shared vision. It builds camaraderie and everyone is invested in success.
  2. Capitalizing on strengths: Last, but not least, I would add that an employee's ability to use their knowledge and skills is directly related to an employee's engagement. Being able to use your strengths makes the work more enjoyable and allows career growth. The quote that comes to mind: “Only do what only you can do.”


HL: Covid-19 has turned healthcare upside down and nurses are going to feel the effects of trauma and burnout for a while. How does a nurse leader build a culture of engagement in those circumstances?

Lawson: Engagement is reciprocal. One of the most powerful exercises is to connect to your purpose and find meaning in every day's work. There are best practices for resiliency. Individuals are responsible for identifying the practices that work best for them. Leaders should invest in their own resilience, role model how they find resiliency, and disseminate this to those they lead.

The foundational principles for engagement still apply during the COVID-19 pandemic. It is essential to set clear goals and expectations. Be intentional about choosing happiness, building positive relationships, and being present and fully engaged. These principles of engagement are true for nurse leaders and frontline nurses.

“I personally believe demonstrating the 'why' [behind their work] is one of the most powerful ways to drive employee engagement.”

Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.


A disengaged nurse's lack of productivity can cost an organization about $22,200 annually in lost revenue.

Gen Z places value on culture fit, so it is important to clearly communicate your organization's mission and values.

Building a culture of engagement will be part of the Virtual Nurse Management Institute, a three-day virtual course being offered by AONL.

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