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Are Nurses Happy? How Nursing Leadership Fosters Organizational Culture.

A nurse in full scrubs and a face mask looks directly at the camera, giving a positive thumbs up.

Nurses spend significantly more time with patients than other providers, which may be why their feelings about work correlate so strongly with patient satisfaction and outcomes. Many studies examining the impact of health care professionals’ attitudes on quality of care look at metrics such as career satisfaction and engagement, but neglect to look at another crucial component. Career happiness is harder to measure because it encompasses job satisfaction, engagement, organizational commitment, interest in work, and whether work is meaningful. It’s a complex metric but evidence suggests workplace happiness has major consequences for both individuals and organizations.

Studies show, for example, that happy employees across industries are more likely to actively set and work toward new professional goals. They’re more productive, and they stay in their jobs longer. Happiness is especially important in nursing, where there’s a strong association between job attitudes and patient health and safety. Happy nurses can also positively affect the bottom line. Practices and health care networks with the happiest nurses tend to have lower turnover and lower costs.

That’s important, given that the United States Registered Nurse Workforce Report Card and Shortage Forecast predicts that the shortage of registered nurses will spread across the U.S. between now and 2030. Promoting nurse happiness proactively, via significant changes to organizational culture across health care systems, is a vital part of ensuring that there are sufficient nurses to care for Americans in the future. Skilled nurse leaders, with their on-the-ground view of provider and patient needs, have a key role to play in developing workplace cultures that promote happiness.

Advanced education programs such as the University of Michigan School of Nursing’s Online MSN in Leadership, Analytics, and Innovation teach the principles of nursing leadership RNs need to understand to enact positive changes in their organizations and boost nurse happiness at all levels.

Are Nurses Happy (and Why It Matters)?

Ask RNs, nurse practitioners, and other clinical nurse specialists whether they love their jobs and they’ll say yes. They may add that they are proud of what they do and that they can see the impact of their work. Ask whether they’re happy, and the answer is more complicated. Nursing careers are challenging, and provider happiness levels may fluctuate from day to day because demand is hard to predict in health care environments and the stakes are so high. Stress and burnout are common — particularly in settings like ERs, ICUs, and other critical care settings — and can have significant consequences, but leaders can mitigate both by making changes to organizational culture that promote happiness.

One survey of more than 200 nurses found that happy nurses “become immersed in their professional nursing practice, perform their work creatively and have a positive effect on organizational performance.” This is true even in challenging or unpredictable environments because happiness is an intrinsic motivator that inspires nurses to be their best. Consequently, leaders in clinical settings have an obligation to take nurse happiness into consideration when making administrative decisions and developing workplace policies.

What Is Nurse Leadership?

Nurses have traditionally been underrepresented in leadership roles, but that’s changing as health systems embrace collaborative care, patient-centered care, and value-based care (VBC) models designed to deliver more value for less money. Stakeholders in health care organizations are increasingly recognizing nurses as leaders capable of making smart, strategic decisions about not only patient care but also department administration. There are now more formal leadership positions for nurses than ever before, including nurse manager, executive director, patient care coordinator, nurse educator, health care team leader, clinical leader, service leader, Chief Nursing Officer (CNO), and Chief Nursing Executive (CNE).

In these and other more senior nursing jobs, nurse leaders take on departmental administration, people management, policy development, and quality improvement. They represent the voice of nurses on shared governance boards, task forces, and other committees, as well as in the c-suite. They educate and mentor the next generation of nurses and head up cross-functional health care teams, coordinating patient treatment plans. And crucially, they play an instrumental role in shaping the culture of their organizations.

What are the Benefits of Strong Nurse Leadership in Health Care?

Studies show that nursing leaders have a substantial effect on the quality of their work environments as well as on patient safety, staff engagement, and consumer satisfaction. Effective leadership in nursing has been linked to improved patient outcomes, reduced medical errors, and improved staff retention. The considerable impact nurse leaders have on their organizations may come down to the fact that their patient care experience gives them a unique insight into what providers need to care for patients effectively without burning out or becoming jaded or overwhelmed.

Nurse leaders tend to lead by example and create and implement the kinds of policies and procedures designed to ensure employees can do meaningful work and grow in their roles. They advocate for appropriate staffing ratios. And they plant the seeds of positive organizational culture when educating nurses so those new to the profession don’t feel undervalued and overworked.

Why Positive Organizational Culture Is Vital in Health Care

Dr. Elliott Jaques introduced the concept of organizational culture in 1951 in his book The Changing Culture of a Factory, defining it as organizational values shaped and reinforced by leadership. Numerous studies have found that positive organizational culture as fostered by leaders has a profoundly positive effect on job satisfaction and job commitment. In health care settings, the defining features of positive organizational cultures are collaborative, communicative, compassionate, respectful, supportive, and transparent. They’re also mission- and value-driven. Patient welfare is a top priority, but leaders in these organizations also recognize the importance of provider welfare.

The benefits of positive organizational culture in clinical settings cannot be overstated. Positive organizational culture correlates with “reduced mortality rates, falls, length of stay, and hospital-acquired infections.” Providers who work in facilities where leaders foster positive culture have lower rates of burnout and are more likely to act ethically. Studies of facilities with high culture ratings find better adherence to infection-control practices, increased success in EHR implementation, and higher patient-perceived levels of integrated care in these settings. There’s even evidence suggesting that patients cared for by hospitals and health care networks with positive cultures are more likely to receive uninterrupted treatments and report that they are satisfied with the care they receive.

How Nurse Leaders Create Positive Organizational Culture

Nurse leaders can do a lot to foster the five elements of positive organizational culture — collaboration, trust, innovation, fairness, and recognition — by developing competencies and qualities that allow them to:

Communicate Effectively

The most effective nurse leaders have excellent communication skills and can engage comfortably with support staff; doctors and specialists; RNs and LPNS; patients and their families; and senior administrators and executives. They solicit feedback from above and below regularly, fostering an atmosphere of psychological safety, trust, and continuous improvement. Their clinical, administrative, and leadership experience provides them with the context necessary to help people and departments with conflicting needs avoid the kinds of misunderstandings that can lead to clashes. Good nurse leaders also use communication to bridge gaps between policy and practice so administrators address understaffing and unreasonable provider expectations before they erode employee satisfaction and engagement.

Cultivate a Culture of Respect

According to the American Hospital Association (AHA), disrespect in health care settings negatively affects everything from staff performance and engagement to patient safety and patient outcomes. Disrespect can also lead to waste, driving health care costs up, and make it more difficult to train and retain new nurses. It should come as no surprise that nurses are less happy in settings with cultures that tolerate disrespect.

Nurse leaders foster positive organizational culture by recognizing that everyone has a meaningful role to play in patient care, including non-clinical support staff, and developing official codes of conduct that promote respectful interactions. They give everyone respect, regardless of where they fall on the org chart — and they expect others to do the same. That respect extends to clinical practice. They trust their part-time and full-time staff and respect their clinical decisions, allowing them to work autonomously whenever possible.

Most importantly, they don’t tolerate bullying of any kind. They watch for signs of conflict and help employees communicate through their differences, guiding conflict in a positive direction that can lead to increased team cohesiveness, employee satisfaction, and happiness.

Ensure Appropriate Staffing Ratios and Shift Lengths

Hundreds of looking at the effects of short staffing and extra-long shifts in health care have confirmed what empathetic leaders already know: overwhelmed and overworked providers simply can’t perform at peak levels. Nurses are 23% more likely to experience emotional exhaustion for each additional patient they cover after exceeding a 4:1 patient-to-nurse ratio. Longer shifts also correlate with patient dissatisfaction and higher rates of nurse burnout.

Studies also show that appropriate staffing affects nurses’ happiness positively and that keeping nurse shift lengths reasonable reduces workplace dissatisfaction and makes nurses less likely to quit. Some nurse leaders — particularly nurse executives — have the power to reduce shift length and nurse-patient ratios by hiring more nurses. Those who don’t can still communicate staffing issues with executives in a data-driven way, making a compelling argument for increased hiring to ensure there is an adequate nursing workforce at all times.

Make Work Meaningful

A study by Globoforce’s WorkHuman Research Institute and IBM’s Smarter Workforce Institute found that meaningful work plays a big role in employee happiness. This may be especially true in nursing, which involves physically and emotionally demanding work that can quickly become overwhelming. Meaning is a powerful motivator among nurses, who tend to do better work when they believe the work they do has a purpose.

Nurse leaders make work meaningful by giving staff members opportunities to challenge themselves and grow in clinical nursing roles or other roles like nurse educator and through mentorship. They also help other nurses see their work as worthwhile and important by communicating organization and department goals clearly and articulating how everyone from shift nurses to support staff does their part to realize those goals.

Promote Teamwork

A study of over 10,000 nurses in England found that those who worked for facilities that prioritized teamwork were more likely to be satisfied with their jobs and felt more confident working autonomously. Nursing leaders who support functional teamwork create cultures in which good working relationships are common, people resolve conflicts quickly, and everyone is motivated by a shared purpose. This, in turn, boosts clinician well-being and resilience. Studies also show thoughtful coordination of care and collaborative value-based care can reduce clinician burnout, and that teamwork promotes nurse happiness and mental health.

Support Staff Development

The nursing profession is fulfilling, but it can also be stressful. The best nurse leaders recognize that cultivating and celebrating staff success is one way to mitigate the demoralizing impact of stress. Leaders in nursing who are confident decision-makers align the decision-making process across an organization to empower other nurses to act with autonomy and confidence. They also support their staff members’ continuing education goals by encouraging them to develop their unique strengths.

Gallup surveys show that managers “get the best performance from their team members when they identify what their people do best, praise them for it, and guide them into tasks and partnerships that maximize their natural talents.” This may be one of the most important principles of nurse leadership because employees who have the opportunity to do what they do best and grow in their roles are 57% less likely to experience burnout and are happier, too.

How to Learn the Principles of Nurse Leadership that Contribute to Workplace Happiness

Levels of happiness at work are, of course, affected by various factors. In medical practices, home health agencies, and hospital settings, these include teamwork support, the accessibility of management, recognition and respect, staffing levels, status equality, and supervisor behavior — all of which affect nurse happiness levels in varied and sometimes complicated ways. What is certain, however, is that when great nurse leaders foster positive culture, nurses are happier.

The challenge is that the leadership skills nurse leaders need to promote employee happiness in their organizations aren’t innate. Nor are they part of typical nursing education or continuing ed nursing programs. That’s why the University of Michigan School of Nursing developed the 33-credit Online MSN in Leadership, Analytics, and Innovation program. Coursework in the program teaches the principles of nursing leadership and gives RNs who have already earned bachelor’s degrees the tools to create a long-term, sustainable change in health care.

MSN candidates hone their problem-solving, critical thinking, and decision-making abilities, as well as soft nursing skills related to people management that make fostering positive organizational culture possible. They graduate with the ability to answer the question “Are nurses happy?” and develop strategies for boosting workplace satisfaction, engagement, commitment, and interest. They’re also prepared to support professional development in their organizations. Most importantly, nurses with U-M’s MSN in Leadership, Analytics, and Innovation have what it takes to enact the kinds of organization-wide transformations that lead to both increased happiness and better quality of care delivery so providers and patients can thrive together.