Nurses feel their opinions don't count
First in a three-part series
During a review of employee engagement results at a hospital I recently visited, the CEO told his management team that he believes nurses have the most difficult job in the hospital. He challenged his managers to improve engagement among all hospital employees -- because, he said, nurses will not be able to stay engaged in their jobs, and hence provide the best quality care to their patients, without the full support of the rest of the staff.
Employee engagement, as measured by Gallup's Q12 survey, is the level at which employees are psychologically committed to their jobs and workplaces. In addition to physicians, there are three main categories of healthcare employees that make up the core patient care team: registered nurses, licensed technical staff (including licensed professional nurses, radiology technologists, and respiratory therapists), and professional staff (including pharmacists, physical therapists, and medical technicians). Each of these three groups also suffers from high vacancy rates in hospitals nationwide.
This article is the first of three examining how hospitals should approach improving engagement in each category. Let's begin with registered nurses (RNs).
Improving Nurse Engagement
According to Gallup's 2004 hospital employee engagement database, RNs score .12 points below hospital employees overall in employee engagement. (Scores are based on a scale of 1 to 5.) This puts nurses' engagement slightly higher than licensed technical staff, but significantly below professional staff. Nurses are the core of the patient care team, so hospitals are eager to figure out how to raise the relatively low engagement scores among this group.
Looking at scores on each of the items in Gallup's Q12 survey, RNs score above the overall hospital database on four of the 12 items. The highest-scoring item for RNs in comparison to the rest of the database is, "My supervisor, or someone at work, seems to care about me as person." At the other end of the spectrum, there are three items on which nurses score .20 or more below the hospitals' database average:
- I have the materials and equipment to do my work right.
- In the last seven days, I have received recognition or praise for doing good work.
- At work, my opinions seem to count.
What do these results tell us?
First, many nurses don't feel they have the resources they need to do their jobs. As discussed in previous articles, low scores on the "materials and equipment" item often relate to staffing shortages and a lack of necessary supplies. But there is more to this problem than staffing and supplies. Broken processes also prevent nurses from doing their best work, and these broken processes may be reflected in low "materials and equipment" scores. For example, let's say a patient reports to a nurse that his toilet is leaking. How many people will the nurse have to contact, and how many forms will she need to fill out, in order to get the toilet fixed? Will the toilet ever get fixed at all? Such process issues make nurses feel they don't have what they need to get their jobs done.
Second, nurses have poor scores on the "recognition" item, meaning they feel as if no one cares whether they do a good job. Basic psychological theory suggests that positive reinforcement will lead to positive behavior. Nurses must be recognized for their good work, or they will get frustrated and quality of care will suffer.
Third, nurses don't feel that their opinions count at work. Nurses are team leaders in the delivery of care, and their input is important to achieving quality improvement and reducing medical errors. If hospital managers aren't asking nurses for their opinions, they are not only contributing to nurse disengagement -- they are also hindering their efforts to improve hospital performance.
Nurses are caring people committed to quality. They have one of the most difficult jobs (if not the most difficult job) in the hospital, but they don't perceive they are getting the support they need to do that job well. Next week, we will examine another important group of employees vital to supporting RNs -- licensed technical staff.
The Q12 items are protected by copyright of The Gallup Organization, Princeton, NJ, 1992-1999. All rights reserved.