Meet Liam Caswell, a nurse leader who gives some great advice on workplace culture and leadership for nurses.

What makes a good nurse leader?

From my experience working as a CNC/NUM and my post-graduate leadership studies, I have noticed the following to indicate that you have a good leader:

  • They understand that we lead people & manage resources (stock/medications/equipment)
  • They have a true open door policy & get on the floor each day to help out and demonstrate recency of practice
  • They are authentic, kind, people focused and a staff advocate
  • They are open, honest and truthful in their communication
  • They have a communication strategy, focusing on positives (wins for the week) and areas for improvement
  • They conduct staff surveys about culture and implement strategic action plans, ensuring progress
  • They set ward realistic unti goals, in collaboration with the whole team, engagement is key!
  • They coach their staff, making time each week to learn what ideas staff have,
  • They have completed post graduate qualifications, preferably in leadership so they know they’re leadership style and understand the importance of culture
  • They don’t bad mouth anyone -ever!
  • They are a learner, not a knower
  • They are curious and get to know people on a deeper level
  • They follow up and keep their word
  • They actively succession plan, investing in their up and coming staff,
  • They admit mistake and encourage a culture of learning,
  • They do not waste time on low performers, who create problems in the workplace, they address them as per processes providing fair and equitable opportunity for growth without engaging in bullying/gossiping.
  • I could go on forever! Get curious and remember everyone is a leader, small steps create big change overtime.

At what stage in a nursing career should one be at before considering a nurse leader position?

I don’t think there is a specific time, I am very much anti the traditional “you need 20 year’s experience before applying”. Firstly, recognise that everyone is a leader in healthcare, the responsibility doesn’t lie with your manager/leader, it’s with everyone. If you have a passion to lead you should explore your leadership opportunities. Start leading on the floor or in your clinic. Do some reading around leadership styles and look at the styles which have the best culture outcomes.

Get self-aware and ask your peers for feedback about your leadership approach. Find a good leader, who you respect and does it well – ask them to mentor and coach you.  I think a lot of people think once you become a leader that you just sit back and enjoy the ride, it couldn’t be further from the truth. You must keep evolving, learning, reading the literature and thinking of innovative ways to lead the team! Top Tip, be the leader you always wanted but never had.

In your time nursing what organisational cultures have you seen? The good and the bad…

I have worked in a variety of organisational cultures and it’s worth noting that, good or bad, there are lessons to be learnt that shape you as a clinician and a leader.  Good organisational cultures really are people-focused, they don’t just claim it in their vision statement, they actively practice building a strong, learning, psychologically safe organisational culture. In my experience working across the globe, really good organisational cultures are far and few between- because its actually quite difficult to achieve.

With that said, all is not lost – we all are responsible for building culture and the culture is a result of our combined efforts. The organisational cultures that are more challenging are more prominent in my experience, with the original global nursing pandemic being the bullying and harassment pandemic that has plagued health for a long time. These cultures are consequences of poor investment in systems and processes, more management and less leadership, less people-focused and more business/budget driven.

“Bad” Cultures can be transformed but it takes a concerted effort amongst all staff in the organisation to help turn it around. Small steps that can be taken include revisiting the values of the organisation and thinking about how they apply locally within your team during a team meeting. Find common shared goals and understand how the values underpin your operational running of the unit. From there, hold each other to account and embed the values into your daily work. Everyone has a part to play.

Have you worked in toxic work environments?

Unfortunately, I think most nurses have experienced a “toxic person or workplace” during their training and practice. Firstly, its very important to note that “toxic people or places” will NEVER change unless we speak up and advocate. I want nurses to know that you should never have to compromise your own values, boundaries to stay in a job that’s not making you happy. You might not think so much about It at the time, but it will affect your confidence and general wellbeing moving forward. It shapes you as a clinician and as a person, do not tolerate it. 

Nurses are exceptionally good at advocating for our patients, but not so good at doing it for ourselves or each other.  Simply put, toxic places or people are symptoms of a broader dysfunctional organisation issues. That could include poor leadership, lack of governance structures, friends hiring friends, bullying and harassment, gaslighting, staffing shortages, low moral and culture, lack of flexible rostering, lack of team spirit and most concerning a lack of psychological safety among clinicians. As a nurse in such a situation, there are a few things you MUST be doing such as:

  • Escalate, report via internal mechanisms such as incident reporting or have a discussion with your line manager.
  • Document everything, keep your own records.
  • If someone (Your manager/leader/educator/peer) behaves in a manner not in accordance with the AHPRA code or organisational values, challenge it respectfully and document the event, sending an email account to your line manager.
  • If its in breach of the AHPRA code, report them immediately. We are obliged as nurses to report any form of bullying/harassment to AHPRA and could lose our registration if we stand and watch/walk by.
  • Look internally and re-assess whether this workplace/environment aligns with your core values and boundaries. If not, protect yourself and take action to explore new opportunities.
  • Speak to your union for support.
  • Contact the Nursing and Midwifery Support Helpline or seeking counselling/psychology support.
  • When on shift, try to positively contribute and not get caught up in the toxic culture.
  • Some organisations have confidential internal channels of communication, to let the CEO/Chief nurse know .
  • Try to be a change advocate, empowering your team to do their best, being mindful of your own energy and self protection.
  • Consider joining social media communities such as Australian Nurses and Midwives against bullying and harassment on Facebook to have peer support.
  • If all else fails, be kind to yourself, trust your gut, use your amazing assessment skills and review the situation and develop an exit plan.
  • What can make for a good organisation culture?

The literature is dense in this area and there are certainly lots of things that make for a good organisation culture. Here are a few I particularly have experienced:

It’s worth noting that organisations are large, complex entities with multiple moving parts. Some hospitals have over 10,000 staff to lead  and deliver a vast array of complex clinical and non-clinical services. Getting everyone on the same page is extremely challenging, not impossible but it’s a 24/7 job i.e. everyone’s responsibility.

Firstly, having a clear organisational strategic plan including staff-led values, where high-level staff consultation and engagement has been conducted to ensure the values are truly representative of all staff is a good starting point.

Next, Investing in the development of the organisation’s leaders, ensuring they are fully operational and are delivering services in accordance with the organisational plan, values and goals. This includes innovative, engaged and dynamic executive leaders who take the time to get to know the clinical staff delivering the services.

The creation of a learning and psychological safe working environment is critical for organisational success. When we create a learning environment, we acknowledge that no one has all the answers, we promote a culture of curiosity and encourage exploration and innovation. Furthermore, we must create a psychologically safe working environment for our teams and staff to operate.

Psychological safety, coined by Harvard Professor Amy Edmondson, effectively ensures that staff can show up as themselves, contribute fully, free from reprimand and humiliation. Basically, by creating a psychological safe environment, if something goes awry, staff are not humiliated, made to feel small, punished or penalised. Instead, it is seen as an opportunity to learn, grow and innovate our service delivery.

This doesn’t mean we just brush off critical incidents, we follow processes, but in doing so we are cognizant of the individuals involved and we seek opportunities for all to learn, grow to fill the gaps.  I always remind my staff when they say “I have failed” that FAIL stands for first attempt in learning. We dust ourselves off, we seek the support and guidance required and we try again with more knowledge and skill.

Last but certainly not least, we must focus on our people, our carers. Listening to our best assets – our staff and truly giving them a voice. Providing coaching opportunities to help staff grow and develop and innovate on the frontline. Without the frontline staff the hospitals are not operational, so many nurses and members of our MDT have fabulous ideas – we need to create space for them to come forward, express them, get curious and innovate! 

What do you hope for in terms of mentorship and leadership for future and upcoming generation of nurses?

I hope that the nursing profession catches up with our Allied Health peers who have been practicing clinical supervision as a mandatory requirement of their practice for years now. In order to sustain our workforce, we must invest in the coaching, mentorship and development of our nursing staff. We are the lifeblood of the health service and it’s time for nurses to be respected and acknowledged. We are at a point where chocolates and a card from an executive, no longer appease staff. Those days are gone.

We want change, we want action to implement nurse to patient ratios, we want internal high quality leadership programs, we want a national enquiry into the bullying and harassment culture in healthcare. Widespread, systemic change and upheaval is essential if we are to retain our current workforce and entice future nurses to join us.

Its predicted by Workforce Australia that by 2030 we can expect a national shortage of 85,000 nurses, this is not accounting for the post-pandemic nursing workforce challenges due to long COVID and career changers. We are at a breaking point whereby we absolutely must prioritise mentorship, coaching and support for nurses, because as it stands most do not desire to progress due to the huge workloads, off duty expectations and impact on their work/life balance.

What message do you hope that a future nurse leader takes away from you?

It’s my mission to show new and established nurses that they can create a unique career path and build a portfolio career by investing in your personal and professional growth, on your own terms! Build the life you want to live, if you want to apply for the job – do it!

Where can readers find and connect with you?

I really active on the below platforms and would love to invite you all to join the High Performance Nursing Community!

You can enquire about working with me @ Liam Caswell Career & Leadership Coaching

Instagram: @highperformancenursing


Listen to the The High Performance Nursing Podcast on Spotify/Google Podcasts/Apple Podcasts/Anchor