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There is growing evidence in the nursing literature regarding the positive impact of healthy work environments on staff satisfaction, retention, improved patient outcomes, and organizational performance. Although much work has been done to identify what needs to happen in practice environments to maximize the health and well being of nurses, the achievement of these key elements has proved challenging for many organizations in today’s turbulent healthcare environment (Laschinger, 2007; Ulrich et al, 2009).
If a healthy work environment is to be achieved at the unit level, current and future nurses in these unit-level roles and the nurse manager role will need development and mentoring to develop the leadership skills needed to support the development of healthy work places. Leaders can help create a deeply satisfying organizational culture at the unit level by engaging staff in the development of shared values in their work. A failure to take steps to build cultures of engagement can lead staff to feel that they are not supported in their work. Research with Magnet-designated hospitals continues to identify important aspects of healthy practice environments (Drenkard, 2009).
Another innovative leadership approach to promote healthy work environments at the unit level has been the utilization of the Clinical Nurse LeaderSM (CNL)® role. Interest in the CNL role continues to build nationwide as nurse leaders face a healthcare environment where retention of the workforce is critical, reimbursement is based on indicators sensitive to nursing care, and patient safety is a growing concern. Unfortunately, many organizations are not investing resources in the development of both current and future nurse leaders, helping them to build the skills needed to promote healthy work environments (Sherman, Bishop, Eggenberger, & Karden, 2007). It is challenging for today’s leaders to predict what knowledge, skills, and abilities will be needed to lead in the future healthcare delivery system.
Kate will read Marshall Goldman’s (2007) best selling book “What Got You Here Won’t Get You There.” Goldman pinpoints 20 bad habits that stifle successful careers and what leaders need to do to change them. Emerging leaders must be taught that relationships live within the context of conversations that individuals have, or don’t have, with one another. Often with novice leaders, structured techniques can help to promote better team relations by providing them with a shared simple set of words that describes critical communication behaviors.
The Two-Challenge Rule requires communicators to voice their concern at least twice to receive acknowledgment by the receiver. Call-Outs are a strategy that emerging leaders can be encouraged to use to inform all team members of crucial information during emergencies. Check-Backs require the sender of the communication to verify the information that is being received by the other team member. Leaders are also encouraged to use briefings, debriefings, and huddles to keep communication lines open throughout a shift. Agree to ground rules for discussion that are acceptable to all parties, (examples of these rules might include one person talking at a time and length of meeting times). Highlight an overall goal that all team members value, such as providing the best care possible to our patients.
Keep the lines of communication open and respect differences in attitudes, values, and behaviors. Acknowledging the work and contributions of other staff members is a key leadership responsibility.
Although healthcare is built around relationships, it is also a business that needs to be managed. A self-rating on the Science of Leadership competencies in the Nurse Manager Inventory (NMLC, 2004) is a good place for emerging leaders to begin to identify their strengths and weaknesses.
Dr Elizabeth (Beth) Pross is an Assistant Professor in the Christine E Lynn College of Nursing at the FAU.
Related ArticlesGrowing Nurse Leaders: Their Perspectives on Nursing Leadership and Today’s Practice EnvironmentSusan M.
We recently had a call with some of the individuals who are partnering with us to develop the Leadership and Networks publication, which is part of the Leadership for a New Era Series. The network leadership conversation is overlapping with the network capacity-building conversation. How do we make the case for using network leadership for leadership programs who are on the fence and unsure about the importance of this approach?
We invite you to join the conversation and share your ideas and questions about network leadership. English Language Learners in the Super ELL course received 44% more Aa€™s and 41% fewer Fa€™s compared to their ELL peers from the previous year. One of the ways where leaders can be trained to become more self-directed is through project management.
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At Leadership Horsepower we pride ourselves in being a leader in developing and harnessing the power of emotional intelligence. Completing the personal horsepower course has been a massive leap forward for me in my own personal development and effectiveness. The establishment of a healthy work environment requires strong nursing leadership at all levels of the organization, but especially at the point of care or unit level where most front line staff work and patient care is delivered. It can be challenging for today’s leaders to predict what knowledge, skills, and abilities will be needed to lead in the future. 31, 2010) "Growing Future Nurse Leaders to Build and Sustain Healthy Work Environments at the Unit Level" OJIN: The Online Journal of Issues in Nursing Vol. Many organizations, including the American Association of Critical Care Nurses (2005), the American Nurses Credentialing Center (2008), the Institute of Medicine (2004), the International Council of Nurses (2007), and the American Association of Colleges of Nursing (2002), have outlined criteria that characterize a healthy work environment. The establishment of a healthy work environment requires strong nursing leadership at all levels of the organization, but especially at the point of care or unit level where most front line staff work and where patient care is delivered. In this article the authors will present a review of the literature addressing the importance of healthy work environments in healthcare organizations and the significant role of nurse leaders in building and sustaining these healthy environments.
A healthy work environment cannot occur without nurse leaders who support its importance, authentically live it, and engage others in its achievement (AACN, 2005). O’Neil, Morjikian, Cherner, Hirschkorn, & West (2008) found in their research that the greatest single barrier to nurses accessing leadership and professional development opportunities was the inability to get time off the unit to invest in the acquisition of new skills. A competency model that is now widely used for nursing leadership development at the unit level is the Nurse Manager Leadership Collaborative (NMLC) Learning Domain Framework (NMLC, 2006) presented in the Figure. Ideally, this development would take place as part of an emerging leaders program that could include self-assessment tools, presentations, group discussions, reading assignments, journal reflections, experiential activities, and application exercises.
She and her manager will have a short session each week to discuss her progress in being more inclusive. TeamSTEPPS TM is an evidence-based teamwork system aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
Emerging leaders can be encouraged to assertively practice this technique when they observe a deviation from standards of practice or witness unprofessional behavior.


Emerging leaders can be encouraged to use check-backs to follow up on responsibilities that they delegate to others. These tools and other information in the TeamSTEPPS program can be used to help emerging leaders improve their communication skills (Sherman & Eggenberger, 2009). Even in the most ideal of environments, communication breakdowns and conflict are inevitable on teams.
Real-time conflict situations offer excellent coaching opportunities for experienced leaders to work with novices. Managing conflict well in an environment helps to create a culture where staff feel valued.
It is difficult to build healthy work environments in healthcare settings that are not financially stable.
Nurse managers are in a unique position to involve emerging leaders in the development and monitoring of a unit budget.
The Healthcare Financial Management Association (HFMA) and the American Organization of Nurse Executives (AONE) co-publish a nursing-business newsletter, The Business of Caring. It is important to ensure that they develop the skills and competencies that will be needed for them to be successful.
Beth has had 28 years of experience as a registered nurse, the last 11 years of which were in nursing education and administration. Students will be taught on how to generate new ideas through the design thinking methodology. In this phase, students will be taught how to manage and account for the resources given to them in the project. Students are taught how to be flexible in managing the different changes during the execution of projects and how they can manage both people n tasks in these situations.
Students are taught how to use new media (For example, Facebook, Google Docs, Emails, WhatsApp, etc) to help in the facilitation and smooth running of the project.
Students can also be guided along their projects through coaching sessions with certified coaches from Lifeskills Enrichment. We value each participants experience and input and we support them through our programs with follow-up business coaching to ensure that change and action happens.
This article presents a review of the literature regarding the importance of healthy work environments in healthcare organizations and the significant role of nurse leaders in building and sustaining these healthy environments.
They will  also discusses the development of leadership skills, presenting a widely used competency model for nursing leadership development, namely, the Nurse Manager Leadership Collaborative Learning Domain Framework, a useful resource in the development of unit leaders. Kramer and Schmalenberg (2008) observed that only staff nurses can confirm whether initiatives planned and designed to improve the health of a work environment are successful. There is evidence in the literature that work environments are evaluated as being more healthy and staff retention is better when staff feel supported by their nurse manager (Kramer et al. Achievement of Magnet recognition through the American Nurses Credentialing Center (ANCC) Magnet Recognition Program® is considered in nursing to be the gold standard for hospitals seeking to build professional practice environments that are healthy and support the work of nurses. The effects of the Magnet professional practice environments on patient care were reported in several studies. This role evolved in 2004 as an outcome of meetings that the American Association of Colleges of Nursing had held with stakeholders to discuss what changes were needed in nursing education for the future. They help to reduce the contentious relationships and communication problems that AACN (2005) described in the healthy work environment standards document. In many organizations, very little attention is being paid to succession planning and the development of emerging nurse leaders at the point of care (Stichler, 2008). Many current leaders in healthcare today were selected for their roles because of their clinical and technical proficiency (Sherman, Bishop, Eggenberger, & Karden, 2007).
Nurse-manager leadership is necessary to support the development of healthy work environments. Strong coaching from an experienced and respected nursing leader who helps an emerging leader with self-development plans can be equally powerful when formal programs are not in place.
She acknowledges that she is not inclusive in her decision making and is often judgmental about the viewpoints and contributions of others. The art of leadership involves managing relationships with others and influencing their behaviors. It was developed for use in clinical practice with funding from the Agency for Healthcare Research and Quality. If managed effectively by emerging leaders, these breakdowns can be viewed as an opportunity for team growth.
It can be helpful to present a structured approach to resolving conflict among team members. AACN (2005) noted that recognition of the value and meaningfulness of one’s contribution to an organization’s work is a fundamental need and important for both professional and personal development.
This newsletter can be downloaded for free and serves as an excellent resource to educate emerging leaders about business and finance. The development of healthy work places that are responsive to the ever-changing healthcare environment will be in their hands.
Lynn College of Nursing at the Florida Atlantic University (FAU) where she is also an Associate Professor and Program Director of the Nursing Administration and new Clinical Nurse Leader tracks in the graduate nursing program. She currently serves as an appraiser for the American Nurses’ Credentialing Center Magnet Recognition Program® which she has done for the past 6 years. The magnet nursing services recognition program: A comparison of two groups of magnet hospitals. AACN standards for establishing and sustaining healthy work environments: A journey to excellence.
Workplace empowerment and magnet hospital characteristics as predictors of patient safety climate. Connecting the dots: Responding to the challenges of budget and finance education for nurse leaders.
Context matters: The impact of unit leadership and empowerment on nurses' organizational commitment. Healthy workplaces for health workers in Canada: Knowledge transfer and uptake in policy and practice. This was a unique opportunity to engage such a diverse group of thought leaders in reflecting about the most crucial questions and ideas related to network leadership.
It also discusses the development of leadership skills by presenting the Nurse Manager Leadership Collaborative Learning Domain Framework, a widely used competency model for nursing leadership development that can serve as a useful resource in the development of leaders at the unit level.
Accessible nursing leaders play a key role in helping to give nurses a voice in the improvement of patient care environments (AACN, 2005). Participating nursing leaders were urged to think completely out of the box as they looked at the issues and challenges of today’s healthcare delivery system. These problems can occur between nurses and administrators when nurse managers have responsibilities and spans of control that make it difficult both to track and monitor patient outcomes as well as to assume responsibilities for coaching the staff. The attributes and behaviors that leaders need to support the development of healthy work environments are often identified as the “soft skills” (Shirey, 2006).
To address this need for leadership development, the American Organization of Nurse Executives, the Association of periOperative Registered Nurses, and the American Association of Critical Care Nurses worked collaboratively to develop a model that would identify competency domains needed by current and future nurse leaders. Emerging leaders can be asked to do a self-rating using the competencies in the Nurse Manager Inventory (NMLC,2004). Kate’s nurse manager views Kate as having high potential for a more significant leadership role. Casey Stengel, the beloved manager of many major league baseball teams, noted, from his own leadership career, that “Finding good players is easy.


Left unresolved, conflict can cause a loss of productive work time, medical errors, decreased patient satisfaction, staff turnover, and the development of an unhealthy work culture (Manion, 2005). Kouzes and Posner (2006), two well known leadership experts in the field of business, have noted that the most significant contribution today’s leaders can make for the future is develop their successors so that they will adapt, prosper, and grow. Prior to joining the faculty at FAU, Rose had a 25-year nursing leadership career with the Department of Veterans Affairs.
Her research interests include transforming health organizations through caring values and transformational leadership. The American Association of Critical Care Nurses has worked collaboratively with the Gannett Healthcare Group and the Bernard Hodes group to conduct national surveys of critical care nurses to assess the progress and impact of their healthy work environment standards. These components or forces of magnetism have evolved since the early 1980s when the American Academy of Nurses (AAN) first commissioned a study to determine why, during a competitive time, certain hospitals did not experience a shortage of nurses.
Ulrich’s study further concluded that even hospitals “in the process” of Magnet designation showed significant improvements in their nurse and patient outcomes because of the improved practice environments. Their discussions led to the design of the CNL role and the initiation of the CNL pilot project (American Association of Colleges of Nursing, 2007).
In addition to the model, a Nurse Manager Inventory (NMLC,2004) was developed which outlines key skills needed by nurse managers in each competency domain area. They know how their communication and actions impact others and are sensitive to watching the cues in an environment when things are not going well. She is concerned, however, about Kate’s lack of tolerance of others and agrees that it could negatively impact Kate’s career if she does not commit to personal transformation. Getting them to play as a team is another story.” The same could be said of teams in healthcare settings. Emerging leaders can be coached to develop intentional behaviors that help to recognize the staff in their environments. Golden (2008) noted that despite the need to become more financially savvy, current and emerging nurse leaders often gravitate to what they do best; and rarely does that include fiscal responsibilities.
They can be given assignments to review staffing variances and create staffing alternatives.
The Business of Caring features a Business School for Nurses as a regular educational section of the newsletter. She is widely published and speaks nationally on the topic of nursing leadership development. Their findings from the 2006 and 2008 studies indicate that issues still remain in the work environment that can impede the quality of care, safety of patients, and RN job satisfaction.
What was found were elements of healthy practice environments, environments where nurses were respected, valued, and had a “voice.” Forty-one of the hospitals studied were identified as Magnet organizations. The evidence clearly supports that Magnet practice environments are exemplars of healthy care environments that support professional nurse practice and quality patient care.
In her role as a CNL project consultant, Tornabeni (2006) noted that the context of how nurses practice has changed and the work of nursing and patient care environments needed to be realigned to reflect this. CNLs are expected to guide the clinical team by encouraging professional development, providing continuing education, and promoting clinical excellence and collegiality. Jack Welch (2001), the former Chairman of General Electric, noted that he spent a great deal of resources on leadership development because “Giving people self-confidence is by far the most important thing that I can do. The inventory can be used to develop charge nurses, unit facilitators, and emerging leaders.
A gap analysis on a particular skill could lead to the development of an action plan to develop that needed competency.
Both she and Kate are also aware that such behaviors do not support the development of a healthy work environment.
Guiding team members to get past their day-to-day problems, conflicts, and communication issues and more toward a goal of working as a high performance work team is a significant leadership challenge for emerging leaders. This recognition could be as simple as a thank you at the end of a shift, or it might involve having the emerging leader nominate staff for organizational awards. Novice leaders often fail to understand the impact of nursing activities and staffing on the revenue of a healthcare agency. They can also be assigned to projects to elevate staff awareness about the costs of supplies and equipment. Examples of recent topics include the following: reducing hospital readmissions, evaluating staffing costs, determining return on investment, business writing tips, medical variation, and the cost of care. These emerging leaders will ultimately replace them and continue the very important work that is being done to improve nursing work environments and most importantly patient outcomes.
This entails a paradigm shift from a more traditional command-and-control style of staff supervision toward a transformational style of leadership in which leaders enhance the motivation, morale, and performance of their follower groups. They cite a need for improved leadership to improve staff perceptions of leadership support and reduce turnover in critical care units (Ulrich et al. Currently there are 340 ANCC-designated Magnet hospitals and another 199 hospitals in the application process (C. CNLs are in a unique position to promote a healthy work environment at the unit level because their practice is at the point of care.
It is available at no cost and allows nurses to use Benner’s novice-to-expert scale to rate themselves on a variety of key leadership skills (Shirey, 2007).
Yet the need to do this is critical in healthcare environments where team synergy and interdependence are required for high quality patient care. If nurses are unable to see the financial ramifications and costs of decisions, they will be less successful in advocating for the resources needed to successfully staff and operate units. With the trend toward hospital reimbursement for performance measures that are nursing sensitive, emerging leaders need to understand how nursing care outcomes impact the financial bottom line of their institutions.
This newsletter is a very rich source of business information and practical strategies that can be easily used by nursing leaders. The positive relationship between this type of transformational leadership and satisfaction of staff is supported by research (Faila & Stichler, 2008). They also have a strong academic preparation designed to build key leadership skills to support staff. The three domains in the framework (see Figure below) also provide a useful structure to plan leadership development activities targeted to growing current and future nurse leaders at the unit level. This authenticity in nursing leadership is often described as the glue needed to hold together a healthy work environment.
Equally important in this turbulent healthcare environment is understanding the science of leadership as described below. The overall goal of all the activities described above should be to help emerging leaders develop confidence in their ability to build a business case to support their decisions.
Self assessment instruments and 360 degree evaluations can be very powerful tools to help current and emerging nurse leaders assess their current strengths and weaknesses in the different dimensions of leadership. Shirey (2006) has proposed that becoming an authentic leader requires self-discovery, self improvement, reflection, and renewal. When developing emerging leaders, a self-rating on the Art of Leadership competencies in the Nurse Manager Inventory (NMLC,2004) is a good place to begin to identify strengths and weaknesses.



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