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Managing any nursing team carries its challenges, and the pandemic has added even more complexity to that formidable task. With such a daunting landscape, how do nurse leaders enable a nursing organization to perform at a high level, and what steps are needed to get there?

In developing a high-performing nursing culture, nurse leaders need to focus on two things, notes Courtney Vose, DNP, MBA, RN, APRN, NEA-BC, FAAN, senior vice president and chief nursing officer at Robert Wood Johnson University Hospital. The first is “truly driving employee engagement.” The second is to “really drive for RN satisfaction.”

Vose started her role in late January. Previously, Vose served as vice president and chief nursing officer in the New York-Presbyterian Hospital system.

Courtney Vose, DNP, MBA, RN, APRN, NEA-BC, FAAN.

Courtney Vose, senior VP and chief nursing officer.

“From a nursing leadership perspective,” says Vose, “I feel that if we take better care of our staff, they can take better care of patients and their families. The benefit of creating an engaged culture is that outcomes should improve in every domain, from quality to satisfaction to flow to affordability. When you have a high-performing team, they want to perform well in all domains.”

When it comes to employee engagement, “it’s really helping to create a shared vision and developing the strategy with the voice of the team from all levels and disciplines so that there’s a shared sense of purpose and direction on where we want to go,” says Vose

At New York-Presbyterian/Columbia University Irving Medical Center, employee engagement scores rose so quickly that Gallup, who measured these scores, wanted to know what they were doing. “At the end of the day, it was really very simple,” Vose says. “We listened to the collective voice of all team members. We created a shared vision that everyone got aligned to, and then we developed our strategy and then tactics on how we were going to get there.”

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“If I were to boil it down, I would say create a shared vision that gives people a sense of purpose. And then really dig into that to figure out how you’re going to get there and then take action to make it happen.”

RN satisfaction, notes Vose, is tied to employee engagement since it is a key component of engagement. Satisfaction measures how much employees enjoy their work. Components of this for nurses include autonomy in their practice and access to professional development opportunities.

Vose notes that the American Nurses Credentialing Center (ANCC) Magnet Recognition Program is related to high-performing nursing organizations. “Magnet organizations invest more in nursing. The evidence strongly suggests Magnet organizations have higher engagement and RN satisfaction, which leads to better results for patients and families.”

Learning from the pandemic

The pandemic holds lessons for creating a high-performing nursing organization, notes Vose. One involves resilience. “How we provide respite and keep a workforce resilient is an incredibly important learning,” she notes.

A second lesson involves creating new models of care that allow nursing to become more “elastic,” says Vose. “That’s my word for how can we expand our workforce quickly when we have an event that requires more resources.”

At Robert Wood Johnson University Hospital, nursing students from Rutgers University School of Nursing assisted staff nurses during the Omicron wave. This allowed RNs to delegate to the nursing students and take better care of patients and families.

“So how could we utilize students all the time?” asks Vose. “Why do we have to wait for a pandemic to do that? How could we utilize licensed practical nurses who could be delegated to and allow us to take care of more patients, especially when the time comes when we really need additional resources? Those are the things that the nursing community at large is really engaged in trying to figure out.”

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No need to “complexify”

In developing a high-performing nursing organization, nurse leaders should avoid the tendency to “complexify” leadership, says Vose. “I think leadership is actually fairly easy, but the work is hard with long hours,” she says.

Many nurse leaders, says Vose, make the mistake of wanting to jump into higher-functioning activities before they’ve established trust with their team. “Establishing trust with your workforce is probably the most important thing that you can do as a leadership team,” says Vose. “Until you have that, it’s hard to get to the next levels where you would engage and empower them to really take ownership of their practice and make decisions about their practice environment.” If it takes a year to develop that trust “then take the year to do that because it will be a year well spent.”

Leadership, Vose notes, will set standards. “But for me, it’s always trust and respect first, however long that takes to establish, moving quickly into engaging and empowering leaders and staff. Once you have those two solid foundations in place, you can achieve anything that you want to.”

Louis Pilla
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