Creating Psychological Safety for New Graduates

By Rose O. Sherman, Ed.D, RN, NEA-BC, FAAN

Step back a minute and think about your first year in nursing practicing. What if the following was your experience:

• The country was in the middle of a pandemic.
• You did most of your nursing program remotely.
• You watched the team members change frequently.
• 50% of nurses who staffed your unit were travelers.
• Your preceptor had six months more experience than you did.
• Your unit was short-staffed almost every shift.
• Everyone wore masks, and there was little small talk.
• Nurses did not eat together or socialize with each other after work.
• You were assigned patients that were too complex for your skill level.
• You felt very unprepared to be a nurse and unable to discuss these feelings.

According to the recent ANA pulse survey, only 19% of nurses under 35 believe their organization cares about their well-being. It is not surprising that intent to leave is highest among this age group. Many young nurses just don’t feel psychologically safe in their work setting. They have naturally high stress and anxiety levels even without COVID. Last week, the RaDonda Vaught criminal conviction in Tennessee for a medication error added another layer to the anxiety young nurses already feel.

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.” There are four stages to psychological safety:

1. Inclusion safety – I am part of a team.
2. Learner safety – I can ask questions on this team.
3. Contributor safety – I am asked to contribute according to my skills, competency, and strengths.
4. Challenge safety – I can challenge the status quo without retribution.

All four of these stages were compromised during COVID. It is not surprising to see an interview such as the one recently published in Becker’s Hospital Review on March 11th.

 “We are in the unique position of graduating in a global pandemic where we might not have gotten well-rounded experiences, hands-on learning, or in-depth training because of alternate or virtual learning,” said Gabrielle Angeline, 25, BSN, RN, former cardiac nurse. “Hospitals are not prepared to train new grads on every aspect of nursing and make up for the deficits from nursing school. It is all unprecedented, but Gen Z nurses are the ones suffering in the workplace. We do not have the years of clinical judgment and experience that other nurses do, and healthcare organizations need to do more to prepare us to fill those roles and support us as we attempt to fill them.”

Steps to increase Psychological Safety

Nurse leaders play an important role in creating psychologically safe cultures for staff to question practices, report problems, or propose new ideas.  Here are three ways you can do this:

1. Promote critical thinking by asking good questions such as:

• Walk me through how you made that patient care decision?
• What safety or quality issues could have happened here?
• What is the real challenge here with this patient’s care?
• What will you do next in this situation?
• Is there another way that you could have managed this?
• Who could you seek out for help if you need it?
• How will you do the next time differently?
• What would great look like right now?

    2. Foster a speak up and speak out culture by doing the following:

• See out negative feedback about the unit culture – what do we need to start, stop or continue doing here.
• Debrief and do after-action reviews about medical errors that happen in the unit.
• Coach new nurses to say something when they see something that is not safe.
• Talk about stopping if you have not done something before and immediately seeking help.
• Urge them to speak out if they see bullying.
• Give examples of when nurses did not speak out, and patient care suffered.
• Be okay with conflict and work toward resolution.

Do STAY Interviews with new graduates in the first 30-60 days and seek feedback with these questions.

Question 1: What do you look forward to each day when you commute to work?

Question 2: What are you learning here, and what do you want to know?

Question 3: Why do you stay here?

Question 4: When was the last time you thought about leaving us, and what prompted it?

Question 5: What can I do to make your job better for you?

Young nurses are very unlikely to come to their managers to talk about their feelings. You need to be the one to reach out to them. Feeling safe at work is critical to developing professional efficacy. We need to get much better at figuring out how to help our young nurses in their transition. It cannot be left to nurse residency program coordinators alone. Nurse managers also need to get involved.

References

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