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CNO Exchange: 3 Behaviors Make Life Better for Nurses

Analysis  |  By Jim Molpus  
   November 16, 2018

Without an investment in improving nurse culture, hospitals will struggle to recruit and retain from an increasingly competitive pool of candidates.

Nurses need to start taking better care of themselves and each other. That's the only proven, cost-effective way that nurses will thrive through the generational, technological, and market changes that are coming to nursing, said the chief nursing officers gathered for the annual HealthLeaders CNO Exchange this week in Charleston, South Carolina.

Hospital and health system leaders recognize that nursing remains healthcare's largest workforce, and without an investment in improving nurse culture, hospitals will struggle to recruit and retain from an increasingly competitive pool of candidates.

The CNO Exchange members emphasized in a series of roundtable discussions that nurse executives must take some easily ignored workplace truisms—like "improve communications"—and make them urgent and real.

1. Emphasize actual human interaction

The modern hospital is a disconnected workplace like any other, where managers and coworkers try to communicate via text or workflow tools. In healthcare, that can create misinterpretation, which can lead to resentment at a time when teams need to work close together.

Many of the health systems represented at the CNO Exchange have created "tiered huddles," a series of daily or regular groups calls where challenges are presented to the group. A "unit huddle" of a floor or department might be followed by a managerial huddle where the concerns raised are elevated.

Linda Hofler, PhD, RN, chief nursing officer for Vidant Health in Greenville, North Carolina, says that calls instead of emails literally give a voice to concerns so that nurses know that their concerns are not going into a file to be ignored.

"Nothing can replace good human conversation," Hofler says. "Technology can be a blessing and a curse."

One of the care team goals is to "get the doctor and nurse to have a conversation, and then engage the patient."

2. Be nice and mean it

The stress on the nursing environment in enormous. Staffing ratios and workplace issues create a hectic pace. Increasing numbers of patients with behavioral issues can create a volatile environment. And hospitals still suffer from tension between doctors and nurses. Being "nice," in the face of tension or disagreement is a coping skill that can solve a lot of problems.

"I think the biggest part of enhancing the environment is civility," Tammy Daniel, DNP, MA, RN, NEA-BC, vice president, patient care services at Baptist Medical Center in Jacksonville, Florida.

For example, Daniel says, de-escalation training for medical center staff gives them the tools to help manage tense situations before they become dangerous.

3. Support the types of leaders you want

Nurses face a fundamental shift in the healthcare teamwork paradigm. Nurses are now expected to lead complex care teams, often with members of the medical staff included. Beth Houlahan, DNP, RB, senior vice president and chief nurse executive of UW Health in Madison, WI, says she will be leading a retreat of nurse managers with one theme: "The leadership behaviors that got us to where we are today will not sustain us in the future," Houlahan says.

"We need for them to be leading us toward success, so we're covering attributes that will move us forward: emotional intelligence, creating a sense of urgency, leading with optimism, being vulnerable and working out a solution together, and creating good teams that are focused on the patient experience."

The nurses won't just be listening to each other, Houlahan says. It's important that nurse leaders listen to a variety of stakeholders, most critically the patient.

"We have over 100 patient/family advisors on councils in our system," Houlahan says. "That's helped with our communications and process improvement. We learn what their expectations are and how can we address those."

HealthLeaders team members Jennifer Thew, Julie Auton, and Jim Molpus contributed to this story. For more information about membership in the 2019 CNO Exchange, Nov. 13-15 in Ojai, CA., please email

Jim Molpus is the director of the HealthLeaders Exchange.

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