Declining Nurse Engagement? Here’s What to Do About It.

A disengaged workforce can put patients in danger. Low engagement can yield poor performance in nurse sensitive outcomes, such as falls with injury, CAUTIs, CLABSIs, and pressure injuries, Doucette explained.

“When nurses are disengaged or have lower engagement at work, we see higher rates of adverse events, decreases in patient satisfactions, and then we see degradation in teamwork, which is really important from a safety perspective,” Doucette said.

“The top performing organizations in our database right now all have very high levels of employee engagement in common and have taken an employee first approach,” Doucette said.

Reengaging through resilience

According to Doucette, one way to reengage the workforce is through using the resilience model that breaks down the actionable parts of what drives resilience in organizations, specifically among nurses. Those two components are activation and decompression.

“We think about activation as our ‘why,'” Doucette said. “There’s both an intrinsic component of activation, which is why I became a nurse, why I work in healthcare, [and] then the extrinsic component of activation is the connection to the mission, vision, and values of the organization.”

The decompression part of the equation is how nurses are able to get away from their work and recharge. Doucette emphasized that a key driver of burnout among nurses and nurse leaders is the inability to disconnect from work and recuperate.

“Those two things together are really what drive higher levels of engagement,” Doucette said, “and it all begins with that building block of resilience.”

Reestablishing trust

Rebuilding the relationship between nurses and nurse leadership is critical to raising engagement as well. According to Doucette, it begins with a strong, continuous listening strategy where CNOs are hearing the nurses’ voices and acting upon their feedback.

CNOs must make sure that nurse leaders are rounding on a regular basis, and that staff know who their leaders are and how to access them. They should also ensure that leaders at the frontline and at middle levels are acting as ambassadors for the CNO, that they’re representing the voice of the CNO, and making sure that people understand that their voice is heard.

“Sadly though, in our data set now, only 55% of clinical nurses tell us that they feel like they have a voice in decision making,” Doucette said. “When staff understand that the senior-most leaders have their back and are responding to their needs and concerns, that’s where we see high levels of trust.”

Additionally, CNOs must help reestablish trust between nurses and clinical teams to boost communication and engagement. To Doucette, the key is practicing teamwork, communication, and healthy conflict.

“In healthcare, we don’t ever have time to practice,” Doucette said. “We may have an hour or two of simulation practice a year, or mandatory competencies, but we’re not practicing the skills that we need from a teamwork perspective.”

CNOs need to set clear expectations for professional behavior and hold people accountable to them, while creating opportunities for peer mentorship and shared governance.

“It’s the everyday teamwork and communication where the magic happens in terms of delivering on expectations around engagement for patients, for employees, and quality and safety,” Doucette said.