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Developing Nurse Engagement Begins With Simply Listening, CNO Says

Analysis  |  By Carol Davis  
   November 22, 2021

An engaged nursing staff increases safety, decreases mortality rates, and saves money.

Cultivating strong engagement in a nursing staff requires nurse leaders to listen, ask questions, and walk in their nurses' shoes, says Heidi Clark, RN, BSN, chief nursing officer (CNO) at Cox Barton County Hospital, Lamar, Missouri.

The growing number of studies on nurse engagement identify several 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.

Drivers of engagement, Clark says, are independent to each employee.

"I've learned through the years that everybody has a purpose or a strong point. It may be their bedside manner, or for others it may be their path or skill level," she says. "You have to find out what their strong point or their passion is and then help them to build upon that."

"Once you tap into what's important to them, you need to get them to come forward to feel empowered—that what they're suggesting can make a difference and will be listened to," she says.

CNOs should start by being easily accessible to their nurses, she says.

"Be observant, and be out there [on the floor]," Clark says. "I still float out and provide patient care. Knowing firsthand what their challenges are allows me to connect to them when they come to me and they're complaining about something with the EHR being difficult or time-consuming or not having a supply or piece of equipment they need."

Nurse leaders who don't have time to work alongside their staff can show solidarity and support by attending morning shift huddles, rounding, including one-on-one rounding with staff members, and asking questions, she says, such as what equipment they need to do their job or what struggles they're having.

Caregivers will rarely readily provide a list of dissatisfactions, so asking questions is crucial, Clark says. Instead, nurses need to know that leaders are interested in what they think.

"Once you get them talking and they start to see the changes because of things they brought forward, you will see them coming forward with more things," she says.

Nurse leaders should also make sure nurses are aware of the changes they've created, Clark says.

"Whether it's in your weekly updates or in staff meeting minutes, make sure you let them know, 'These are the things that we've accomplished in the last month,' or 'These are the things you've brought forward and we're working on it.'  Or if we can't change something, they need to know why," she says. "You have to have momentum to show you're continuing to move forward, even if it's small steps."

'Fulfilled in what they're doing'

Besides benefiting the organization and patient, outcomes of nurse engagement benefit the individual nurse, as well, Clark says.

"It helps them to be fulfilled in what they're doing," she says. "We've seen several who are pursuing continuing education certifications because they are becoming more engaged, and they want to be able to improve or increase their educational abilities so that they can participate in programs like the clinical ladder or be able to move into another role."

Generally, some of a nurse's engagement is the responsibility of the individual—"I would like to say it's 50-50," Clark says—but the challenging circumstances of COVID-19 have tilted most of the responsibility to the hospital, she says.

"With our staff nurses, especially bedside staff, being so overworked through COVID, it has to be more upon the administrative and the supervisory level to get out there and really promote engagement," she says. "They are already giving 110%."

Encouraging engagement has "definitely" been made more difficult by the pandemic, particularly when they're given sicker patients, higher patient ratios, and the responsibility to help patients communicate with their families outside the hospital, along with the required charting and quality measures, she says.

But the nurses' commitment remains, she says.

"Many of them are very proud," Clark says, "of what they've been able to do."

“You have to find out what their strong point or their passion is and then help them to build upon that.”

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


Nurse leaders can cultivate strong nursing engagement by listening to, and asking questions of, their nurses.

Nurse engagement outcomes include better safety, decreased mortality rates, quality, and patient experience.

COVID-19 has tilted the responsibility of nurse engagement toward the hospital or health system.

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