By Rose O. Sherman, EdD, RN, NEA-BC, FAAN
Building environments that feel psychologically safe for staff in what can seem like a turbulent world is at the top of many nurse leaders’ minds. Leaders will admit that it is more challenging today. Patients and families have high expectations about the care they will receive. Young nurses are often given assignments beyond what they feel comfortable managing. There are fewer expert nurses to ask for support.
Dr. Amy Edmondson is an expert on psychological safety in the workplace. She states, “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 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.”
Assessing Psychological Safety
Psychological safety can be hard to gauge. You won’t know unless you ask. The following statements are considered important indicators of the level of psychological safety (Ask on a scale of 1 to 10, with one feeling very psychologically unsafe and ten feeling very psychologically safe – how safe do you feel on this team) :
- On this team, speaking up about what is on your mind is easy.
- 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 works and does not.
- Keeping your cards close to your vest is the best way to get ahead on this team.
On a team where staff feel psychologically safe, staff have confidence that they will receive respect and consideration from others. A group with a culture of psychological safety encourages open discussion of thorny issues. Nurse leaders set the tone. You play a crucial role in fostering psychological safety by modeling desired behaviors, including acknowledging their own mistakes and demonstrating vulnerability. I often ask nurse leaders during workshops how they build psychological safety for staff. The following are ten suggestions from leaders about things that work:
- I normalize making mistakes by pointing out mine when I make them. “No one is perfect” is my mantra, and we may each have our unique way of doing things.
- I often ask my nurses in huddles, “What do you think about this before I voice my opinion?”
- I make it clear to staff that it is okay to disagree with me – it may not change what I am asking them to do, but I respect that they see things differently.
- I leave my office door open (most of the time) and invite staff in when sometimes they look hesitant – I tell them it’s okay not to be okay.
- I use humor to help cool my unit’s temperature. Leaders sometimes take themselves way too seriously. Showing grace is so essential.
- Whenever one of my experienced staff members says that “the critical thinking skills of these new graduates are terrible,” I stop them and ask, “So, what are you doing to help them think more effectively?”
- I talk with my new staff about bullying and am very explicit about our cultural norms and that I have no tolerance for disrespect.
- I maintain a very stoic face even when someone tells me something that sounds unbelievable, and then I say, “Tell me more,” while I think of a good response.
- I always tell my new nurses that there are no dumb questions. You are probably just asking a question that someone is thinking but is afraid to ask.
- When I present a new idea, I urge my staff to oppose it. If they don’t, I say, “Well, if you didn’t think this was a great idea, what are some objections you might have to it?”
Feeling safe at work can increase a person’s energy, enthusiasm, and zest for life. Nurse leaders who hold themselves and the team accountable to behavioral standards that improve psychological safety can create a more positive and safe work environment.
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