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I am penning this thought piece while in Darwin at the Australian College of Nursing (ACN) annual nursing conference with over 700 nurses from across Australia. While a wonderful week of inspiring nurse leadership conversations (from many fabulous nurse leaders), hearing about some wonderful initiatives and sharing a glass or two of wine between friends in some cases we haven’t seen for almost 2 years there is an underlying tension and distress I sense in many of the nurses I am chatting with.

The last 2 years have been hard for so many of our front line clinicians, many expressed their frustrations, anger and distress for a number of the decisions or potential lack of decisions made around a number of policies, pay, working conditions and medicare review outcomes. Many were burnt out and in some cases on the verge of tears at times for what they have seen, witnessed, experienced and continue to experience in both ICU and Emergency and across the system.

In many cases they have expressed an “us vs them” culture where they felt executive and leadership just expected them to come to the table and continue to give when they had nothing left to give. They felt their leadership was unapproachable, didn’t listen, wasn’t supportive and in many cases they had reached out with concerns via emails which were never replied to.

I kept hearing a common theme that “I don’t feel heard by my leaders”

Now culture and leadership isn’t something that is easy at the best of times in health, and I’m not going to pretend its been an easy road for anyone, anywhere over the last few years.

But as I have said before in other thought pieces, lets not kid ourselves that it was rosy pre-COVID.

COVID is the straw that broken the camels back, but these issues around culture and leadership have plagued the industry of healthcare for a long time and even pre-COVID the need for excellent nursing leadership across our health system was imperative to high quality care, reduced adverse event and retention of staff pre-covid.

study in 2021 concluded:

“Nurses who experience working under a nurse manager exhibiting toxic behaviours reported an increased frequency of nurse-reported adverse events and poorer quality of care in the unit.”

And a cross sectional study in early 2022 concluded that:

“when nurses are exposed to workplace bullying, they are more likely to demonstrate an increased intention for turnover.”

Now hardly groundbreaking in its conclusion the real concern to me is that Meissiner coined the now infamous phrase of “nurse eat their young” back in 1986 and a quick search of google scholar of this phrase results in 370,000 results. So it appears the issue that was apparent in 1986 still resonates across the sector and this is now compounded by an industry facing incredible workforce stress and shortages.

But rather than focus on this negative, lets focus on the real opportunity for Nurse leaders to step up and lead in a new way, for health organisations to become the employer the choice and succeed, attract and retain staff and do this in the face of health services and nurse leaders that continue to do what they have always done.

In a previous life I worked in recruitment and I still remember a high-performing consultant uttering these words to me very early on:

“Ben, employers are either clients I want to work with or employers I will poach from. I will make this decision based on the leaders/managers I meet from these organisations as I know my placements are more likely to stay depending on leadership.”

And in the same breath, health services and leaders can either become employers that clinicians want to work with or employers that clinicians will leave. The other factor to consider here which is actually worse than them leaving for the safety and quality of outcomes of our patients is they stay and are either completely disengaged or reciprocate toxic behaviours to new staff.

There is a complexity to this and I will also admit this isn’t going to be easy but those leaders and organisations who embrace and lead in this space will attract talent and will benefit from the outcomes such as improved patient care, reduced adverse events, reduced turnover and lets get all bottom line here REDUCED COSTS!

So here are some ideas on where we can start:

Engage, Engage and Engage again: From Director level down it is imperative you engage with your staff. Listen to them, show empathy, control and change what you can control and change, explain to them with empathy things that are out of your control and help them understand why.

There are many things in health we cant control right now, ratios’, award pay rates and the pressure COVID has placed on the staff. But we can control how we as leaders engage with our staff and how we show empathy to the current situation.

Career Planning and Support Ongoing Development: If you asked your leaders what each and everyone of their direct staff wants out of their career. Do they know? If not, why not?

Not everyone wants to be a Chief Nurse, an NP or a CNC and that’s fine but I am sure even the nurse that is happy working at an RN8 level might want something more than just a pay packet. Maybe they have ideas around improving safety they want to share, an idea reduction of costs by better use of disposables or just feedback from a course you supported them to attend or a project they might want to support on. Engage and Support them as well.

It is imperative leader know, support and engage (there is that engage word again) each and every staff member in supporting their goals and aspirations and acknowledging (no matter how small) the value they can bring to the unit, the hospital and the health service. No matter how big or small it may seem.

Collect Data, Measure and Make it a KPI: Human Resources needs to collect data on wards and hospitals around staff net promoter scores or staff engagement scores. This could become a KPI if its not already for leaders. Leader then need to be supported in their education and development on how to improve staff engagement or performance managed if they are the problem and refuse to engage with changing their behaviours to improve this.

Support and Nurture New Graduates: Stop expecting new graduate nurses to be anything other than new graduate nurses. Now lets make this simple, If I complete a finance degree and I go an work for a company in their finance department. I am not hired as a Chief Financial Officer, I am hired in a very basic, very supported and structured finance role.

But if I complete Nursing degree I am thrown into situations that are often life and death, complex in nature and under pressure and under resourced. Its often not very structured, its challenging and its hard bloody work.

So when we (and I am speaking to all nurses here) when we are faced with a new graduate nurse, remember it takes years to become a CFO despite completing a finance degree and further study.

So support them, nurture them, have patience with them and one day in the future they will no longer be that green inexperienced nurse that frustrates you, ask what you think are stupid questions and make mistakes from time to time.

In the future they will be your experienced and extremely valuable team mate, standing beside you when things get tough, supporting you in times of crisis, covering for you when that post operative delirium patient is making it impossible for you to get to the patient in bed 15 that needs urgent care and if you do treat them well, they in turn can pay it forward to the next generation. Thus creating a culture from the ground up rather than purely from the top down.

The 3 Be’s: You are busy I know that, but your staff are busy and you are their leader. Be seen, be approachable and be nice.

Imagine an AIN (who maybe is a student nurse) working on a busy medical ward to have the Director of the LHD/HSS approach them in the corridor one day, introduce themselves to them and just quickly find out something about them (that they are a nursing student for example).

And let say in 6 months time, said Director is walking down the corridor and bumps into said AIN and asks how their study is going and if they have applied for the new grad program.

Do you think this AIN might apply for a new graduate position at this hospital?

Do you think this AIN might tell other students or colleagues about this interaction?

This isn’t by any means an exhaustive list and maybe I am unrealistic, but in my free time during conference sessions, networking events and lack of sleep I wanted to put down the opportunity I see for leaders and organisations/services right now and how getting it right can have significant impacts on your ability to deliver services, improve quality, reduce adverse events and reduce costs.

As always, I am open to feedback, both positive and constructive? What are you doing to be a better leader and improving culture in your health setting?

But right now, in the talent war we are facing. Those who lead in this space will win.