CNUR225 WK 2 Leadership in Nursing PDF

Week 2: The Nature of Nurses’ Work and Work Environments HHR Introduction The concept of workplace psychological safety was first defined in 1965 as an “atmosphere where one can take chances without fear and with sufficient protection.” In the psychologically safe environment, n...

Week 2: The Nature of Nurses’ Work and Work Environments HHR Introduction The concept of workplace psychological safety was first defined in 1965 as an “atmosphere where one can take chances without fear and with sufficient protection.” In the psychologically safe environment, nurses and other staff members develop positive interpersonal relationships that are perceived as supportive and trusting. When nurses feel psychologically safe, they view the healthcare team as a place where it's okay to share ideas, recognizing that any criticism received will be constructive and supportive rather than destructive and belittling. They also feel comfortable and encouraged to ask questions, voice potential concerns, and brainstorm new ideas. In a psychologically safe environment, nurses believe that the benefits of speaking up about a concern will outweigh the costs (such as potential embarrassment). When individuals have high levels of psychological safety, their concerns regarding potential repercussions for speaking up are assuaged. Moreover, when a positive environment is created, nurses' self-esteem is enhanced, enabling them to feel more connected to the healthcare team and the patient care they provide. High levels of psychological safety have been associated with more effective team learning and improved performance (Pfeifer & Vessey, 2019). This module will include: Examining the concept of psychological safety Exploring strategies to promote psychological safety Looking at the current landscape of nursing in Canada and challenges to the profession Learning Objectives 1. Describe the importance of psychological safety and why it is important 2. Examine the challenges facing the nursing profession 3. Identify implementing strategies to foster psychological safety 4. Discuss priority actions to sustaining nursing in Canada 5. Explore changes needed to retain nurses Required Readings Ahmed, H. & Bourgeault, I. (2022). Sustaining nursing in Canada: A set of coordinated evidence-based solutions targeted to support the nursing workforce now and into the future(Opens PDF document). Canadian Federation of Nurses Unions. (Read pages 11–24) Barrowclough, M., Morel, T., Chua, S., & Wu, S. (2023). Where are they going, and what can we do to keep them? Intent to leave among nurses in British Columbia, Canada. Witness: The Canadian Journal of Critical Nursing Discourse, 5(2), 5–17. Pfeifer, L. & Vessey, J. H. (2019). Psychological safety on the healthcare team. Nursing Management, 50(8), 32–38. Villeneuve, M. & Silas, L. (2023). Nursing in Canada: Broken, but not beyond repair. Witness: The Canadian Journal of Critical Nursing Discourse, 5(2), 1–4. Watch 3 videos 3 ways to create psychological safety: 1. Framing the work: Add meaning to the work (why is the work we do so profoundly important – people's lives depend on it); remind people of the nature of the work (remind people that the work we do is uncertain and interdependent and a lot of potential for error. By reminding you the riskiness of the work we do, it brings an invitation for you to take it seriously) 2. Modeling Fallibility: “I may miss something; I need your help” I'm letting you know that I know that I am a human being. Asking for input (what did you see last night?) 3. Embrace messengers: thank people when they’re willing to share their ideas and make it a positive experience or that behavior will die out in time. 4 Critical Outcomes of Psychological Safety  1. Learning: personal learning (if I’m in a psychologically safe environment, you’re able to ask for help and gain better info on what’s happening around you. 2. Risk Management 3. Innovation (better brainstorming, more possibilities, better assessment and testing of ideas and see what works and engage in rapid cycle learning processes) 4. Job Satisfaction/Meaning (feel more valued and respected, more committed to the job, better for everyone) Psychological Safety Current research shows that many nurses are afraid to ask questions or seek clarification for clinical issues due to past experiences of intimidation. In addition, many healthcare professionals work in environments where they don't feel psychologically safe or empowered to pose new ideas, ask for help, or voice concerns. Consequently, these nurses are likely to become disengaged, have lower job satisfaction, increased absenteeism, and poorer retention rates—all of which are known to endanger patient care. In the absence of psychological safety, the open exchange of information among professionals is particularly jeopardized Research shows that approximately 33% of all nurses have experienced bullying in the past 6 mths & 50% witnessed it in the past yr Workplaces that condone these behaviors inhibit the cultivation of psychological safety. When bullying remains unchecked, nurses feel psychologically unsafe and are less inclined to share their ideas and engage with team members. Positive correlations have been found between workplace bullying and medication errors, patient falls, and delayed medication administration. Pause and Reflect Based on your own experience, have you ever been afraid of being perceived as incompetent while asking a question or voicing an opinion in the workplace? Why is this? What happened? Where do you think workplace bullying/violence stems from? Have you done anything to address these concerns? What was effective? What wasn’t? Table 2.1. Strategies to promote psychological safety (Pfeifer & Vessey, 2019, p. 35). Objectives Organizational strategies Nurse manager strategies Develop agency-specific videos and/or Be visible on the unit Create electronic newsletters to communicate Establish daily unit rounds and/or opportunities for updates and make outreach to frontline staff huddles with interdisciplinary team dialogue and Schedule open meetings for staff across all members reduce perceived shifts with upper-level administrators Implement an open-door policy barriers Round on units regularly to promote during certain hours and cross all engagement between organizational leaders shifts and frontline staff Utilize an electronic suggestion box for both anonymous and signed comments and feedback Consider creating an ombudsman position Annually disseminate relevant human Role model positive and supportive Foster a resources policies and discuss updates during language professional staff meetings and with new orientees Learn staff members’ names practice Develop organizational policies (such as zero Role play difficult situations in environment that tolerance) that address disruptive behaviors leadership meetings to prepare for emphasizes Create an interdisciplinary task force that unit issues collegiality, includes frontline staff to develop policies civility, and and strategies for handling unprofessional Celebrate staff achievements at staff accountability conduct meetings and through electronic Use the internal website’s home page to post messaging relevant social media messages, reminders, or Provide opportunities for informal quotes activities Nominate staff members for a DAISY Award or similar awards Create a nursing organizational structure that Educate staff about shared Promote shared supports shared governance governance during staff meetings and governance and Review upcoming interdisciplinary team through electronic messaging encourage staff projects and events at leadership meetings Pay staff members for their feedback participation in shared governance meetings and projects Work with staff members’ schedules to improve attendance at shared governance meetings Provide opportunities for shared governance representatives to report information back to unit staff Promote transparency by providing the Review eros at staff meetings to Model openness frequency and trending data of safety events reinforce the principles of a just and fallibility and near-misses on the internal website culture Establish formal morbidity and mortality Acknowledge your own mistakes, rounds questions, and concerns during team meetings Practice self-reflection techniques (such as journaling) to consider leadership skills that need improvement Post information about key nursing quality indicators on unit bulletin boards Develop unit initiatives that support transparency Closely monitor retention, absenteeism, and Include discussions about workplace Collect and turnover rates across units because poor culture during annual reviews with review data on results may indicate a negative working staff members employee environment Develop “good catch” programs to performance Communicate findings from collected give positive recognition to staff metrics organizational data and ensure managers members who report errors and near know how to interpret it misses Conduct exit interviews with staff members to learn more about the unit culture and contributing factors that led to their resignation Establish nurse residency programs Meet with novice nurses at Develop Include communication skills building predetermined/scheduled times to transition support sessions during orientation discuss their transition experience programs for Schedule both joint and individual meetings with the preceptor and  novice nurses Provide avenues for new hires to discuss their novice nurse to discuss progress, orientation process with human resources and questions, and concerns support personnel Ensure that preceptors are Offer longer unit orientation programs with appropriately prepared and interested an assigned preceptor in the role and align patient assignments appropriately Support/require educational offerings on Post recent position statements that Provide enhancing interprofessional communication discuss the importance of a just opportunities to and offer continuing-education credits for culture on the unit board enhance participation After attending professional education Develop annual training modules for workshops and conferences, present employees to review updated policies, what you learned at staff meetings protocols, and strategies to improve the Encourage frontline staff to attend professional practice environment professional conferences and report Provide resources for nurse managers to back to coworkers on content specific attend professional conferences focusing on to psychological safety leadership development and psychological Create in-person or online journal safety clubs to share articles and position statements It's critical to recognize that organizational standards are only likely to be effective if nurses are aware of them, contribute to their development, and feel psychologically empowered to use them. One of the most important elements of a professional practice environment is the incorporation of a shared governance model. As leaders, we should acknowledge our own mistakes, questions, and concerns to reiterate that when issues do occur, they're nothing to be ashamed of and should be perceived as learning opportunities. On the unit level, share professional goals with staff members to reinforce their ongoing commitment to personal growth, learning, and improvement. When it becomes evident that a workplace has low levels of psychological safety, nurse leaders need to join forces with staff to appropriately reconstruct the unit's culture. Once a unit requires such an extensive overhaul, the existing issues are typically widespread and require multifarious interventions focused on both the promotion of psychological safety among team members and frequent evaluation of the unit culture. (Pfeifer & Vessey, 2019, p. 32-38) Current Landscape of Nursing in Canada In Canada, nurses are currently facing the following challenges (Ahmed & Bourgeault, 2022, pp. 11–24): Nursing retention Nursing shortages Excessive workloads/patient-to-nurse ratios Return of nurses to healthcare system – post-COVID Integration of internationally educated nurses (IENs) According to its 2022 national survey that was conducted with 4,467 practicing nurses (Ahmed & Bourgeault, 2022, pp. 11–24): 94% of nurses are suffering from symptoms of burnout 45% of nurses are experiencing severe burnout, up from 29% pre-pandemic Nurses in BC indicated that 82% of nurses experienced a decline in their mental health through the pandemic. (Barrowclough, Morel, Chua, & Wu, 2023) How Did We Get Here?  Figure 2.1. Nursing issues. Source: Ahmed & Bourgeault, 2022, p. 18 Leadership and Psychological Safety: A First-hand View Now that you are familiar with the concept of workplace psychological safety, you can watch an interview with Sue Bookey-Bassett, RN, PhD. Sue is an Assistant Professor in the Daphne Cockwell School of Nursing and President-Elect for the Nursing Leadership Network of Ontario. She currently teaches professional practice, interprofessional education, and leadership in the undergraduate and graduate programs. In previous roles, she developed professional development programs for nurses and other health professionals. Her research program centers on two key areas: 1) creating positive healthcare work environments with projects focused on nurse workload, patient and nurse safety; 2) health workforce development including leadership, interprofessional education, integrated care, and team-based models of care. Sue's methodological interests include qualitative, and mixed methods approaches. Video Sue Bookey-Bassett, RN, PhD interview: Strategies for Recruitment & Retention and Leadership Development [03:18] Resources for Leadership and Psychological Safety [04:52] Psychological Safety [02:46] Leader and Staff Strategies to Create Psychological Safety [03:35] Implications for Creating Healthy and Psychologically Safe Work Environments [02:57] Current Healthcare Environment [2:32] The Work Environment According to Barrowclough et al. (2023), what are the top-two changes nurses need to see to keep them in nursing? a. Compensation and work/life balance b. Workplace culture and opportunity c. Work/life balance and opportunity d. Safe staffing and compensation e. Safe staffing and workplace culture According to Ahmed and Bourgeault (2022), which of the following is NOT a main root cause of the perpetuation of nursing issues in Canada? a. Inadequate forecasting methods b. Workloads and unhealthy workplaces c. Lack of IEN integration into workforce d. Poor data for planning e. Insufficient funds for the health sector f. Poor nursing planning and short term