Healthy work environments change—and save—lives

Cynthia "Cindy" Clark | 11/01/2016

Wanted: More civility champions!​​


I was recently traveling home to Boise, Idaho [USA], on a long flight from Florida. Throughout the trip, the flight attendants kept us entertained with their witty retorts and humorous comments. After we landed, one of them issued the usual “Welcome to Boise” and then said: “If you are in a negative relationship or working at a job you don’t enjoy, remember, life’s too short, so it may be time for a change. Take it from me, a 20-something who clearly understands the way the world works and has the infinite wisdom to advise you on these important matters."

Cynthia Clark

The comment was intended to elicit a chuckle, and I found myself grinning along with most of the other passengers. But later, as I reflected upon his remark, I realized I often meet people who don’t like what they are doing for a living. In fact, many express deep displeasure with their current work conditions, often disclosing that they can hardly wait for retirement or a new experience. Many say they are keeping their heads down, flying under the radar, doing the least amount possible, or waiting for the next best thing to come along. This, clearly, is a sad state of affairs.

I am blessed!
I count myself among those truly fortunate individuals who genuinely enjoy their work. I’m convinced I have one of the best jobs in the world. My work as a strategic nursing adviser and consultant takes me to schools and practice settings across the country. I am blessed to meet faculty members, practice-based nurses, and other healthcare professionals, as well as students, in just about every nook and cranny of the United States. Meeting people and listening to their stories energize me and remind me that my work is not only important, but I am making a difference.

Clark's daughter promoted to lieutenant.This was recently pointed out to me by our daughter, Molly, a lieutenant in the U.S. Navy Nurse Corps stationed in Guantánamo Bay, Cuba. [Lt. Molly Clark, BSN, RN, is the author of a 2014 RNL article in which she describes what she learned in her first job after nursing school.] Prior to her deployment to Cuba, she sailed on the USNS Comfort as part of a healthcare team on a humanitarian mission. I was praising her for the awesome work she and her team accomplish every day and how they are saving and changing lives around the world. She was pensive for a moment and then said, “Yes, the work we do is important, but your work is important, too. You’re also changing lives, only in a different way."

I was a bit taken aback at first, then realized that perhaps she was right. When people make changes to their work environments by transforming the culture and dedicating themselves to deliver safe patient care, it’s pretty amazing. My work matters, and I am deeply affected by the people I meet on my travels.

Negative work environment: All hands on deck!
I recently facilitated, for a group of nurse executives and managers, a workshop on evidence-based strategies to foster positive, healthy work environments. Toward the end of the day, a nurse manager of a busy ED stood to address the group. She said she had been frustrated with unsupportive people who contributed to a negative work environment where teamwork and relationships were second-rate, and, as a consequence, patient care had suffered. As the leader of her department, she decided to do something about it.

She began the process by supervising—individually and deliberately—each offending nurse. Over the course of a 12-month period, 11 nurses were removed from their positions and asked to leave the organization. One by one, she replaced each negative worker with a carefully vetted nurse committed to teamwork, collegiality, and collaboration as part of a high performing team dedicated to delivering the best and safest patient care possible. Life today in that ED, she enthused, is extraordinary! While the work continues to be challenging and demanding, every day is now an energizing experience as the team works together in a highly functional, united, and mutually satisfying way.

Talk about a civility champion! Her bold declaration motivated others in the room to agree that now is the time to lead a coalition for change and mobilize teams to create and sustain healthy, positive work environments where civility flourishes and where workers band together to fulfill a collective and unequivocal commitment to safe patient care.

Road to civility
This dedication to civility—and ultimately patient care—requires principled, ethical, and authentic leadership, as well as unambiguous adherence to nursing’s responsibility to fulfill the obligations set forth in our code of ethics and other professional statements. To hold employees accountable, managers must first establish clear, specific expectations for acceptable work performance and desired behaviors. Next, managers need to discuss each employee’s commitment to fulfilling those expectations and secure his or her assurance that achievement of the desired behaviors will be supported.

It is imperative for managers to provide necessary resources for each employee to meet work-performance expectations and offer ongoing feedback regarding employee performance. Setting clear expectations coupled with quality feedback are hallmarks of holding someone accountable. Although providing constructive feedback about areas of strength and improvement isn’t foolproof, it opens the door for problem-solving and follow-up action. In many cases, giving objective, sincere feedback while expressing desire to support the employee are sufficient to change behavior. When employees meet work-performance expectations, their actions should be rewarded and celebrated.

If employees do not meet performance goals, they require additional education and training. If it is a motivation problem or refusal to comply with a performance-improvement plan, imposing a fair and appropriate consequence might be in order. This should not be viewed as a punitive measure, but an approach to encourage employees to take commitments seriously and focus on delivering safe patient care.

Remember: While managers play an important role in fostering healthy work environments, it is ultimately everyone’s responsibility to model the way and be civility champions!

Editor’s note: Cindy Clark will be presenting at the Creating Healthy Work Environments conference, slated for 17-19 March 2017 at the JW Marriott in Indianapolis, Indiana, USA. The theme of the conference is “Building a Healthy Workplace: Best Practices in Clinical and Academic Settings,” and Clark’s Plenary 1 presentation is titled “Creating Healthy Work Environments: Powered by Civility, Leadership, and Ethical Practice.” The early registration deadline is 25 January! To learn more and to register.

Cynthia “Cindy” Clark, PhD, RN, ANEF, FAAN, nurse consultant for ATI Nursing Education, founder of Civility Matters, and author of Creating & Sustaining Civility in Nursing Education, is a psychiatric nurse/therapist and an expert in fostering civility and healthy workplaces.

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