Self-leadership requires commitment to self-care.
When she found herself struggling on her journey to resilience, wellness, and healthy work habits, she realized many employee programs put the proverbial cart before the horse.
As a nurse leader, I am always searching for ways to empower nurses and improve care delivery. For that reason, I often find myself asking, “What does a ‘healthy work environment’ really mean?” Is it achieving an ideal balance of positivity and resilience amidst the stresses of our workplace? Is it a broad perspective—the scope of a role or program—or more personal?
Every organization has a culture that reflects its values, attitudes, and beliefs. This culture serves as a standard—a guide—for employees to follow. A positive culture makes the work environment healthier and happier. Such a workplace helps employees become more resilient and develop skills that nurture wellness and relationships that are positive and meaningful.
Health risks reflect unhealthy culture
Traditionally, programs that focus on building healthy cultures seek to reverse health issues caused or made worse by workplace cultures that fail to consider and sometimes devalue the well-being of employees (Yang, Zhu, & Xie, 2016). When these issues manifest as health risks and chronic health conditions, they become costly reminders that the culture is unhealthy. One study found that 22.4 percent of annual costs for a group of employers came from 10 common health-risk factors. In the United States, these factors cost billions and are routinely cited as leading causes of death.
A workplace that provides a healthy culture for its employees motivates them to actively pursue improved health and address negative health conditions, both of which help mitigate health risks and their associated costs. These positive results should be sufficient motivation for creating a healthy work environment. Employees, after all, are an organization’s most important assets. Employee wellness, which starts with leadership wellness, encourages better teamwork, increased productivity, greater engagement, improved work quality, reduced sick leave, and fewer on-the-job accidents.
First things first
I struggled on my journey as a leader toward resilience, wellness, and healthy work habits. I found that many programs lacked employee input, and the values they held important were based on the latest trend or fad. That’s starting in the wrong place, putting the proverbial cart before the horse.
To achieve a healthy workplace, one must first define a wellness culture. To do that, you need to understand people—their needs, desires, and interests. Implementing a workplace wellness program without this information is counterproductive and may result in implementing an award-winning program better suited for a different organization.
Evidence shows that healthy work environments “are characterized by a high level of trust between management and employees; by employees who treat each other in a respectful manner; by an organizational culture that supports skilled communication and collaboration; and by a climate in which employees feel emotionally and physically safe.” Nurses are change leaders. They are in a position to lead change, and they inspire change. For 15 years in a row, from a wide spectrum of professions, nursing in the United States has been ranked the most trusted. As a nurse leader, it starts with you.
On the job training
On one occasion, I had an opportunity to work closely with nurses in a health system managed largely as a matrix organization. A communication consultant was temporarily housed in an office shared with advanced practice nurses who received frequent visits from nurses reporting on various study-related indicators. Each time the nurses reported back on progress related to clinical results, they sought guidance in conflict resolution from the consultant. This shared office was located one floor up from the ICU, next to the stairwell, so the nurses could easily check in during breaks, if desired.
When they experienced communication breakthroughs as a result of conferring with the consultant, they shared their successes with team members on the units. It wasn’t long before they asked for more formalized training so they, in turn, could help train their colleagues. So the consultant trained a few nurses who trained their co-workers who came up with the acronym CLEAR—Connect, Listen, Empathize, Acknowledge, Reframe—to describe what they had learned. The goal of the training was to help nurses see themselves and conflict situations through a different lens. The new framework was positive and empowering.
Here’s my card
Encouraged by these initial results, a small pocket card—a reference tool—was developed for use at a safety fair attended by more than 300 nurses. Three variations were tested. Based on feedback, the card design was expanded to include user tips on how to listen to and support their nurse peers. One thousand of the modified business cards were then printed and given away at shared leadership councils, unit councils, committee meetings, and educational venues. Unit champions took on the role of expanding awareness and use of the cards, and other nurses requested that CLEAR training be included in communication and RN-development courses. (Champions are nurses who develop expertise in certain areas such as pain, skin, Magnet certification, etc. and are identified as such.) Training was also included in quarterly wellness fairs and highlighted by the chief nursing officer in a monthly newsletter.
Empowered by their success with CLEAR, nurses wrote successful proposals asking that additional resources be allocated for more RN-designed solutions for burnout. You could say it was their first step on the path to finding their Zen zones. Other suggestions for promoting openness, transparency, and better communication with colleagues in a fun way soon followed.
With support from nursing leadership, this grassroots approach organically empowered nurses to own their communication and health practices. Recognizing the importance of nurses taking time to focus on themselves, sharing with and inspiring others has became the focus of a culture of caring at this organization. It’s now a healthy work environment that values wellness, fosters trusting relationships, and improves well-being.
Building on that success, I transitioned to helping startup organizations develop healthy working environments, and that led to the development of a peer-driven nursing wellness bundle. Drawing upon Watson’s Caring Science Theory (Watson & Sitzman, 2013), I begin by evaluating an organization’s current work environment and becoming acquainted with its goals as well as the nurses’ goals. Based on this information, I develop a nurse-driven wellness program built on the science of nursing. Watson’s Caring Science Theory is a natural fit for the wellness bundle because it aligns well with organizational values.
Several nurses who have attended a Caring Science conference or in-service training have become wellness champions who support the program’s interventions, activities, tools, and educational opportunities. Elements of the wellness bundle, which build on each other, include: 1) self-care; 2) self-awareness; 3) self-reflection; 4) self and the art of listening; 5) self and the art of communicating; and 6) self and the art of collaborating.
Work cultures improved
As these elements suggest, mastering self-leadership requires commitment to self-care, which focuses on mind, body, and spirit. By developing a self-care plan, keeping a critical eye on themselves (Dyess, Prestia, & Smith, 2015), and continuously integrating healthy practices into their lives, participants experience improved confidence and reduced stress. Nurses at each business site report an improved workplace culture that is healthier and more professional.
I am very proud of these nurses. Drawing upon the power they have within to improve themselves and support each other has led to healthier, happier, and safer care environments. Return on investment to the organization in terms of improved quality indicators and star ratings and lower sick hours is significant. Equally important is value of investment. You can’t overestimate the value of a nurse-implemented wellness program that empowers self-leadership and is dedicated to self-care though a focus on mind, body, and spirit.
Next step? With organizational backing and commitment, develop an interdisciplinary, multisite program that creates healthy working environments by first promoting development of self-leadership. RNL
Carole M. Kulik, DNP, RN, ACNP, HCIC, is an assistant professor at San Francisco State University School of Nursing, College of Health and Social Sciences, in San Francisco, California, USA.
Editor’s note: Carole Kulik presented Healthy Nurses Journey: An Innovative, Evidence-Based, Peer-Driven Wellness Bundle Supporting Professional Fulfillment and Wellness on Saturday, 23 February 2019, at Sigma’s Creating Healthy Work Environments conference in New Orleans, Louisiana, USA. See the Virginia Henderson Global Nursing e-Repository for additional information.
Check out these additional articles by presenters.
Dyess, S., Prestia, A., & Smith, M. (2015). Support for caring and resiliency among successful nurse leaders. Nursing Administration Quarterly, 39(2), 104–116.
Watson, J., & Sitzman, K. (2013). Caring science, mindful practice: Implementing Watson’s human caring theory. New York, NY: Springer Publishing Company.
Yang, T., Zhu, M., & Xie, X. (2016). The determinants of presenteeism: A comprehensive investigation of stress-related factors at work, health, and individual factors among the aging workforce. Journal of Occupational Health, 58(1), 25–35. doi:10.1539/joh.15-0114-OA