Nurse Leader - Nursing Staff Relationships in an Era of Health Reform

By Rose O. Sherman, EdD, RN, FAAN

When he was mayor of New York City, Ed Koch used to walk the streets and ask the question “how am I doing?”. This is a brave question and one that I would bet few of us ask our staff because we may not want to hear the answer. My nurse leader colleagues have been telling me for the past several years that they feel their relationships with their staff are not as strong as they once were. The unrelenting change in healthcare, focus on costs and increased span of control in many leadership roles have contributed to these perceptions. It now appears we have evidence-based research that their hunches are right – staff perceptions about the competence of their leaders has declined.

New Evidence

For a number of years now, the American Association of Critical Care Nurses has been a pioneer in supporting healthy work environments because of their impact on nurse satisfaction and patient outcomes. AACN identified 6 key factors for healthy work environments. These include skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition and authentic leadership. Over the past 7 years, AACN has funded research to study the work environments of critical care nurses as well as nurses in other high acuity areas such as the emergency department. A research team led by Dr. Beth Ulrich surveyed nurses nationally on each of the 6 key factors asking specifically about their perceptions of how well their frontline leaders and CNOs/CNEs were doing on each of these dimensions. Studies were conducted in 2006, 2008 and again in 2013. The 2013 study included a very robust sample of 8000 nurses nationwide. The findings indicate a deterioration of scores at a statistically significant level on every dimension for both frontline managers and CNEs. Ulrich, Lavandero & Early(2014) urge that their research should be a call to action for nurse leaders.

There is Something Happening Here

This research is the first firm evidence that we have that pressures in our healthcare environment are impacting leader-staff relationships. Anecdotally, staff nurses are complaining in any number of online forums about the growing emphasis on budget and patient satisfaction performance measures, and a lack of focus on staff satisfaction and engagement. What can get easily lost in high stress environments is attention to communication, collaboration and respect. The authors point out that leadership is a key factor in nurse outcomes, patient outcomes and ultimately the success of healthcare organizations. Hopefully, this important research can be a catalyst for nursing leadership teams nationwide to closely examine and improve their own relationships with staff.

Reference

Ulrich, B., Lavandero, R. & Early, S. (2014). Leadership competence: Perceptions of direction care nurses. Nurse Leader. 12(3), 47-49.