Creating Psychological Safety - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

I was recently asked by a new manager how to begin rebuilding psychological safety on a unit where staff deeply distrusted their previous leader. Mending a broken trust can be challenging. Blame and incivility were characteristics of the culture that had evolved over many years. New graduate turnover was very high because of the lack of support from experienced staff leaving new nurses with feelings of failure during their professional transition.

Dr. Amy Edmondson is an expert on psychological safety in the workplace. She provides the following description: “psychological safety describes the individuals’ perceptions about the consequences of interpersonal risk in their work environment.” It consists of taken-for-granted beliefs about how others will respond when you put yourself on the line, such as by asking a question, seeking feedback, reporting a mistake, or proposing a new idea. We weigh each potential action against a particular interpersonal climate, as in, “If I do this here, will I be hurt, embarrassed or criticized?” An action that might be unthinkable in one workgroup can be readily taken in another, due to different beliefs about probable interpersonal consequences.”

Steps to increase Psychological Safety

Nurse leaders play an important role in creating cultures that are psychologically safe for staff to question practices, report problems or propose new ideas. The following statements which you can ask your team are considered important indicators about the level of psychological safety:

On this team, it is easy to speak up about what is on your mind.
If you make a mistake on this team, it is often held against you.
People on your work team are usually comfortable talking about problems and disagreements.
People on this team are eager to share information about what does and does not work.
Keeping your cards close to your vest is the best way to get ahead on this team.

On a team where staff feel psychological safety, staff have confidence that they will receive respect and consideration from others. A group with a culture of psychological safety encourages open discussion of tough issues. It not only tolerates disagreement, it nurtures contrasting points of view. Leaders can help create these environments by developing and reinforcing the following team behaviors:

Civility – Showing civility is the most available contribution people can make to creating and sustaining psychological safety. Attending to what others contribute and responding with consideration not only reduces anxiety but encourages creative thinking.
Argue with Respect – Contrasting ideas are the greatest source of creativity. It is important for team members to learn to be tolerant of other viewpoints. Agreement should not be a mandatory value but agreeing to respectfully disagree should be.
Be supportive – Using supportive language towards others should be an expectation. Humor does not excuse a put-down nor does it make one palatable. People really don’t like it.

Feeling safe at work can increase the person’s energy, enthusiasm and zest for life. Nurse leaders who hold both themselves and the team clearly accountable to behavioral standards that improve psychological safety can a significant impact on the creation of a more positive and safe work environment.

Read to Lead

Edmondson A. Building a Psychologically Safe Workplace; 2014. Available at https://www.youtube.com/watch?v=LhoLuui9gX8

Sinek, S. (March 2014) Why Good Leaders Make You Feel Safe – A Leadership TED TAlK