By Don Sadler
Employee engagement has been a hot topic recently, driven at least in part by the emergence last summer of the term “quiet quitting.” As described by the twentysomething TikToker who is credited with coining the term, quiet quitting is not outright quitting your job, but quitting the idea of going above and beyond in your duties.
Engagement is just as important in the perioperative field as it is in any other industry. Many health care organizations today are making nurse engagement a priority to combat nurse fatigue and burnout, increase retention rates, boost patient satisfaction scores and improve patient outcomes and safety.
Defining Nurse Engagement
What exactly is nurse engagement? Or a better way of asking the question: What does an engaged nurse look like?
“An engaged nurse is a nurse who is willing to tackle change, is a good team member, enjoys work satisfaction and looks for ways to improve his or her job performance,” says Beverly Kirchner, MSN, RN, CNOR, CNAMB, compliance officer with SurgeryDirect. “Engaged nurses feel empowered to speak up and speak out without fear of being shamed.”
Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN, CEO and executive director of the Association of periOperative Registered Nurses (AORN)
“To assess nurse engagement, I view how committed nurses are to their job and how satisfied they are with their job and the profession of perioperative nursing in general,” says Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN, CEO and executive director of the Association of periOperative Registered Nurses (AORN).
“Engaged nurses are involved in unit activities, participate in task forces, volunteer to pilot projects and communicate at staff meetings,” adds Groah. “And, they’re involved professionally by joining a nursing organization and being aware of changes in nursing practice.”
David Taylor, MSN, RN, CNOR, president of Resolute Advisory Group LLC, believes that nurse engagement describes a nurse’s commitment to and satisfaction with his or her job. “These are two different things,” says Taylor. “Perioperative leaders today should be able to navigate both of them if they want to fully engage their nursing staff.”
Taylor points out that much has been written and discussed about nurse engagement over the past two decades. “You’d think we’d have it figured out by now, but health care organizations are still struggling with nurse engagement,” he says. “There is no quick fix for improving nurse engagement; instead, it’s a process that evolves over time and needs to be continuous.”
“Nurse engagement is the result of perioperative leaders being able to connect with nurses and have meaningful ongoing communication,” says Leslie Petruzzelli, DNP, MBA, RN, CNOR, NE-BC, director nurse consultant with Surgical Directions. “The tone and engagement of nursing leaders can drive the culture of the department, either positively or negatively.”
Units with strong leaders who are able to promote nurse engagement will enjoy greater staff stability.
“Word will travel fast that it’s a great environment to work in,” says Petruzzelli. “High levels of nurse satisfaction will attract more nurses who want to work on a unit with a great culture.”
Groah believes that the lack of nurse engagement is contributing to the nationwide nursing shortage.
“The increase in the number of travelling nurses can be attributed to the lack of engagement,” she says. “Many nurses want to have more control over the hours they work, their salary and where they work.”
Passionate About Nurse Engagement
Farrah Marsh, BSN, RN, CNOR, director of surgical services at Sanford Health Fargo in Fargo, N.D., is passionate about creating and maintaining an environment that promotes nurse engagement.
“As an OR nurse for more than 20 years, I have seen many nurses underestimate the demands of this career,” says Marsh. “They may find themselves in a role that is a poor fit, which puts stress on the unit, staff, surgeons and preceptors and depletes the energy required for successful onboarding.”
Nurse engagement begins during onboarding and orientation.
“Creating a partnership between unit educators/preceptors and the orientee is essential because this allows trust and connectedness to develop,” says Marsh. “Successful completion of orientation is the building block for nurse engagement.”
Leslie Petruzzelli, DNP, MBA, RN, CNOR, NE-BC, director nurse consultant with Surgical Directions
Petruzzelli stresses the importance of clear, concise and ongoing communication between perioperative leadership and OR nurses.
“Leaders should be visible and available to nurses as they’re making their rounds,” she says.
“Great leaders create great working environments and nurses gravitate to those environments,” says Taylor. “When the word gets out that there’s a great leader in a particular unit, nurses seek roles in that area because they want to work with a leader who is responsive to their needs, both personally and professionally.”
Groah believes that so-called “soft” leadership skills – things like emotional intelligence, effective communication, conflict resolution and coaching – are just as important for perioperative leaders as any other skills. “OR leaders need to follow through on issues presented to them, provide positive feedback and be visible to the staff, and keep the focus on the patient in order to promote nurse engagement.”
Meanwhile, the days of new nurses “paying their dues” or “putting in their time” are long gone.
“This is folklore and was a big part of creating an unengaging, uncivil work environment,” says Petruzzelli. “We need an OR team that builds each other up if we want to promote nurse engagement, and this starts with OR leaders building up the team.”
High-Accountable vs. Low-Accountable Nurses
Kirchner believes that a high percentage of perioperative nurses are engaged at work.
“But that still leaves some nurses who aren’t engaged and just consider their jobs a paycheck, not a career or profession,” she says.
In her efforts to learn more about engaging with her team members, Kirchner recently came across a video from leadership guru Cy Wakeman about leading high-accountable and low-accountable employees. The message was that the same leadership behavior can’t please high-accountable employees who are willing to be engaged and low-accountable employees who aren’t at the same time.
One of these groups will always be uncomfortable, says Wakeman. It’s the leader’s job to make the right group uncomfortable.
“After watching this I realized that my approach was wrong,” says Kirchner. “Cy asked, who do you want to please as a leader? The answer is easy: I want to support the high-accountable and high-performing employees. If a low-accountable, low-performing nurse leaves, I can replace him or her with a high-performer who wants to be engaged.”
The next generation of OR nurses places a higher priority on work-life balance than the baby boomer generation, which has discouraged some from striving for leadership.
“I’ve heard some next-gen nurses say they don’t want to put in the hours required for leadership,” says Kirchner. “As seasoned nurse leaders, we need to encourage young nurses by showing them the rewards of being engaged and taking on leadership roles.”
At the same time, nurses entering the perioperative field today are more informed than ever. “They know they are in demand and understand their value to the organization,” says Marsh. “Many want to receive feedback and mentoring and find meaning in their work.”
Rewards of Promoting Nurse Engagement
Hospitals and ASCs can reap many rewards by promoting engagement among perioperative nurses. For starters, patients receive more personalized care. And boosting nurse retention rates allows leadership to focus on improving the work culture instead of the constant cycle of hiring and onboarding new nurses.
“Institutions reap the value of having engaged nurses through retention of the workforce, which impacts the recruitment of new nurses to the facility,” says Groah. “Use of sick leave is reduced, patient satisfaction scores are higher, and there are fewer patient injuries and improved patient outcomes.”
“Developing well-rounded and engaged nurses with advanced skill sets deepens our bench as we look to future succession planning,” says Marsh. “On the other hand, nurses who aren’t engaged and don’t feel connected to their work will find another job or career. Nurses today aren’t afraid to look around and relocate for better opportunities.”
“Nurse engagement drives patient safety, quality and job satisfaction,” says Kirchner. “Patients recognize an engaged nurse and rate their care as excellent.”
Taylor believes that nurse engagement is integral to the profession’s sustainability. “Nursing pressures are many and being felt across the industry,” he says. “Therefore, engagement is fundamental to improve health care delivery outcomes across the continuum of care.”
Unfortunately, some health care organizations assess nurse engagement but do little about it after they receive the results.
“It’s not that they don’t care about the nursing staff,” says Taylor. “It’s just that there are so many competing priorities. Failure to address nurse engagement is having dire consequences as more nurses than ever are combating fatigue and burnout. This is resulting in high turnover and contributing to the nursing shortage.”
Ways to Promote Nurse Engagement
Given all the potential rewards of increasing nurse engagement for health care organizations, patients and nurses themselves, it would be wise to consider some of the ways to promote engagement of OR nurses within an organization.
Petruzzelli suggests implementing formal recognition and rewards programs for nurses.
“Everybody loves being honored in front of their peers,” she says. “You can also set aside times when there are no meetings to make it easier for leaders to make the rounds and engage with nurses.”
Marsh says that work-life balance is more of a factor for many nurses now than it has been in the past, so focusing on this can promote nurse engagement. “Instead of overtime, nurses may choose ‘time back,’ ” she says. “This is a cultural shift from previous generations. Newer nurses are teaching us a different way to view our workload.”
Offering opportunities for promotion and advancement is another way to promote nurse engagement.
“Many ORs are utilizing a career lane/ladder approach to reward nurses with advanced skill sets and flexibility,” says Marsh. “This provides a pathway for career advancement and potentially a financial reward as well.”
Taylor lists a number of ideas for promoting nurse engagement:
- Give nurses control of their own schedule, such as modified shifts and even work from home opportunities.
- Have interdepartmental social events like happy hours and birthday and anniversary celebrations.
- Promote nurse health and wellness with schedule breaks and on-site mental health counseling.
- Help nurses find the right “fit” within your organization.
- Create a mission, vision and values that are specific to your department but align with the organization.
- Expand continuing education programs, including in-services and CEU offerings both on- and off-site, conferences and higher education.
- Sponsor family activities for nurses like picnics, cook outs and sporting events.
- Acknowledge and reward nurses’ achievements with gift cards and movie passes and celebrate publicly with them.
“Nothing speaks louder to nurses than the way you lead,” says Kirchner. “Create a positive work environment through a culture of respect and always lead by example.”
Make Education Engaging
Education is another key factor in promoting nurse engagement.
“Most education provided in our hospitals and ASCs is not engaging. In fact, it is just plain boring,” says Kirchner. “Who wants to read a PowerPoint presentation and take a test for hours on end?”
Kirchner cites research indicating that if education is provided in nurses’ learning styles, they will engage better.
“Research also shows that gamification, with its competition, engages nurses in learning while testing their skills,” she says. “Everybody loves to win the game.”
Some researchers believe that using breakout rooms with scenarios is a great way for nurses to learn and be more engaged. “One research article I read said if a team works in a breakout room to solve a problem, the team members retain 80% of what they learned 30 days after the experience,” says Kirchner.
For Groah, a big part of promoting nurse engagement goes back to what Aretha Franklin sang about: R-E-S-P-E-C-T.
“Foster a culture of mutual respect within the perioperative department,” says Groah. “Leaders who inspire the ‘why’ behind the work will provide meaning in the work. This helps develop a sense of shared values among everyone.”
