During times of turbulence in US health care, organizations do all they can to decrease costs. Turbulent times also bring feelings of uncertainty to nurses, potentially causing unhealthy work environments. Nurses must remain resilient and learn how to cope with changes so they can focus on patient safety. Dyer and McGuinness1 define resilience as the ability to “bounce back from adversity and go on with their lives.” They further describe the critical attributes for resilience to be rebounding and carrying on, a sense of self, determination, and a prosocial attitude.1
Workplace adversity in nursing is associated with issues such as excessive workloads, lack of autonomy, bullying, and violence. This adversity is caused by (and not limited to) organizational restructuring, low retention rates, and labor cost reductions.2 Researchers have found that adversity associated with low retention rates can contribute to work environments that are hostile, abusive, and unrewarding.3,4 Ultimately, nurses choose to stay at facilities that have turmoil or decide to move on to organizations that focus on patient and staff satisfaction and have a culture of safety. Many nurses leave organizations during times of adversity; however, some do stay. This column of Creating a Healthy Workplace focuses on how changes affect nurses’ work environments and offers some tips for nurses to remain resilient during turbulent times.
Support During Restructuring
Healthy work environments are important for patient safety and staff retention.4,5,6 Laschinger and Leiter5 found that patient safety outcomes relate to the quality of nurses’ work environments. In their 2011 book, The Future of Nursing, the Institute of Medicine raised concerns about hospital restructuring and the effect on nurses’ work environments.6 Hospital restructuring may lead to cost-saving measures such as laying off nurse managers and departmental staffing changes. These measures can lead to decrements in the work environment for nurses, especially when engaged and supportive nurse managers leave or are let go. Organizations can support nurses by keeping the lines of communication open and including nurses in staffing decisions regarding positions that may be essential. Skilled communication and effective decision-making are two of the American Association of Critical-Care Nurses’ standards for a healthy work environment.7
Changes may end up costing organizations more than what is saved monetarily, as staff leave and go to work for different organizations. Blake et al8 found that how nurses rank their leaders correlates strongly to the nurses’ intentions to leave (or stay at) an organization.8 Most nurses do not move on because of the organization; they leave because of an ineffective leader.
When nurses believe they have a strong, supportive manager, they are more likely to stay at an organization. Effective leaders understand how to support frontline staff. These leaders comprehend how keeping the lines of communication open and including staff in decision-making are important for staff satisfaction and, ultimately, staff retention.
A lot of changes occurring in a health care work setting may not be positive; however, nurses and nurse leaders must cultivate personal resilience. It is possible to go through change and maintain a culture of safety and a healthy work environment. Everyone should contribute to a healthy work environment. Even if an organization has had a history of a strong culture of support, new leadership can change this culture, causing staff to question whether it is still a good place to work.
To cope with changes in the health care industry, nurses need to be resilient and prac-tice self-care; by doing so, they can fully care for their patients. Nurses must understand the control they have of their surroundings. This control includes being able to make the decision to leave an organization whose culture is no longer a good fit.
Jackson and colleagues2 explored the concept of personal resilience as a response to adversity and identified strategies nurses can use to respond to adversity in the workplace. They identified 5 strategies to build personal resilience: (1) build positive nurturing professional relationships and networks, (2) maintain positivity, (3) develop emotional insight, (4) achieve life balance and spirituality, and (5) become more reflective.
Build Relationships and Networks
Nurse leaders can support a sense of community in which the staff does things as a team, in the department and outside the organization. Encouraging unit committees that work together on departmental goals encourages a professional network.
Nurse leaders can be a role model in positivity and encourage staff to mirror this behavior and discourage negativity. Setting up recognition systems, such as the DAISY award in which staff nominate their peers for profession recognition,9 is another way to encourage staff. Further, leaders can communicate the positive aspects that may come from changes. This type of communication may include sharing the reasons behind the changes (eg, financial viability of the organization).
Develop Emotional Insight
Leaders may share information about the concept of emotional intelligence to enable staff to understand their own emotions and responses to changes. The nursing staff must be aware of how members present themselves and how others view them.
Achieve Life Balance and Spirituality
To achieve life balance and spirituality, staff need time away from the department; these breaks are essential for staff to refresh during a shift. Thus, nurse leaders should encourage staff to take personal time off; this personal time can ensure a work-life balance is achieved. Staff should understand the importance of time away for vacations or days off work.
Become More Reflective
Nurse leaders should help staff become more reflective. Ways to facilitate reflection include encouraging staff to write in a journal; doing so may help staff understand their responses to events. The unit can have debriefing sessions to allow staff to discuss and share responses to further understand how events have affected them.2
Controlling the Situation
Tugade and Fredrickson10 found that when individuals find positive meaning and can control negative emotions, even in adverse situations, they build personal resilience. Nurses who are affected by organizational changes can be resilient when they have control over their own situation. Thus, during turbulent times, nurses should focus on the things they can control—and their place of work is one of the things they can control. A nurse who works in a unit that has an unhealthy work environment can choose to work in a unit elsewhere that has a better work environment.
At times, organizational changes are out of the control of nursing staff. Sometimes these changes can seem detrimental. If organizational changes result in a seemingly dysfunctional culture that does not improve, a nurse may need to decide whether the organization is still the right fit or whether the best option is to leave.
Jackson et al3 found that nurses can control their personal response to adversity in the workplace through professional education on the strategies described in this article. Reorganization may affect nurses personally, and how nurses respond to these changes may affect their personal outcome. Good leaders usually can be supportive and may be able to stop or mitigate changes that are detrimental to the nursing staff. As nurses, we must stay positive and promote healthy work environments. Everyone can make a difference.
The author declares no conflicts of interest.