1. 10 Leadership Strategies for Creating Healthy Work Environments Carol Huston, MSN, MPA, DPA, FAAN Director, School of Nursing, California State University Chico

2. Thank you for inviting me to be here!

3. Happy Nurse’s Week!

4. Healthy Work Cultures Don’t Happen by Accident….

5. Changing unhealthy work cultures can be very difficult.

6. An organizational culture is a system of symbols and interactions unique to each organization. It is the ways of thinking, behaving, and believing that members of a unit have in common.

7. Subcultures are common in nursing.

9. Ten Strategies Nurse Leaders Can Use to Create Healthy Work Environments

10. #1.Create a Culture of Civility and Mutual Respect and Guard It Judiciously

11. A recent survey of 2,100 physicians and nurses by the American College of Physician Executives documented that unprofessional conduct in the workplace is increasing, with a shocking 98% of those surveyed reporting having witnessed behavior problems in the workplace in the past year. This is referred to in the report as “health care's dirty little secret.” Source: Johnson, C. (Nov. 2009). Bad blood: doctor-nurse behavior problems impact patient care. Physician Executive, 35 (6), 6-11.

12. Bullying in the Workplace Source: Roche, Diers, Duffield, and Catling-Pauli (2010)

13. Patients Also Inflict Violence On Nurses

14. Workplace Violence Statistics • In 2009, more than 50% of emergency center nurses experienced violence by patients on the job. • There were 2,050 assaults and violent acts reported by RNs requiring an average of four days away from work. • Of these acts, 1,830 were inflicted with injuries by patients or residents (Emergency Nurses Association). Source: American Nurses Association (2014). Bullying and workplace violence. Available at: http://www.nursingworld.org/Bullying-Workplace-Violence

15. In 2008, the Joint Commission identified workplace bullying in a sentinel event alert saying that it threatened patient safety.

16. Is incivility “just part of the job?”

17. Workplace Bullying is NEVER OK.

18. Courage to stand up for what is morally right. Obligation to adhere to the ANA Code of Ethics. Danger management by developing strategies to avoid risk aversion. Express your concerns effectively and take action. Source- Lachman, V. D. (Sept. 30, 2010). Strategies necessary for moral courage. OJIN, 15 (3), manuscript 3.

21. Pitbulls On the Attack

22. Bullying must always be confronted immediately.

23. Potshot Artists

24. Confronting the Potshot Artist….

25. The Clams

26. Getting the Clam to Talk….

27. #2. Find Someone Outside the Organization to Vent To and Maintain Appropriate Boundaries

29. Social media sites are not an appropriate place for venting.

32. #3. Stretch and Empower Workers within Their Limits

35. #4. Avoid Micro-Managing. (Get Out of the Way When You Can!

37. Encourage Innovation

38. Don’t be so quick to solve problems for others or they’ll never try to do it themselves.

39. Your way is not always the “best way” or the “only way.”

40. #5. Make Sure that Assigned Workload Is Reasonable So that Success is Even Possible

41. Sometimes, the problem is that work load expectations are simply too great.

42. New graduate nurses often need some time to learn the complexities of the nursing role. Our expectations of them need to match this reality.

43. The need for graduates to 'hit the ground running' has manifested into a phenomenon coined 'Transition Shock' where the fear of making a mistake and feeling unsafe can be crippling to a new graduate’s confidence and self-image. Source- Harwood, M. (2011). Transition shock -- hitting the ground running. Nuritinga, (10), 8-18.

44. That first step can be so hard….

45. Many staff nurses continue to report unreasonable workloads.

46. A study comparing nurse staffing standards and staffing levels in nursing home care in six counties (the United States, Canada, England, Germany, Norway, and Sweden) found that both the standards and levels in most countries (except Norway and Sweden) were lower than the recommended levels by experts. Source: Harrington, C., Choiniere, J., Goldmann, M., Jacobsen, F., Lloyd, L., McGregor, M., & ... Szebehely, M. (2012). Nursing Home Staffing Standards and Staffing Levels in Six Countries. Journal Of Nursing Scholarship, 44(1), 88-98.

47. Source: Gillen, S. (2012). Most nurses are struggling with inadequate staffing, survey shows. Nursing Standard, 26(34), 9. • Three in four respondents felt they did not have enough time to spend with patients to deliver dignified, safe and compassionate care. • Nurses on early and late shifts were the most likely to feel that the skill mix was inadequate. • Almost 2/3 were being forced to work overtime and only 1 in 13 were being paid for it.

48. #6. Keep Lines of Communication Open and Deal with Problems As Soon As They Occur!

49. Conflict in the organization is inevitable and must be dealt with before it becomes manifest.

50. Sources of Conflict