Nursing: The Rules of Engagement, Part II

by Rick Blizzard, D.B.A.
Healthcare Editor

Gallup research has indicated that nurses score differently from other healthcare workers and the U.S. working population overall on several key employee engagement items. (See graphic below.) Last week's Tuesday Briefing examined how scores on two items on Gallup's Q12 employee engagement instrument (sense of mission and access to necessary materials and equipment) differ among nurses, other healthcare workers, and the U.S. working population in general. This week's column addresses two more Q12 items Gallup has found to be key differentiators between nurses and the general population, and addresses underlying causes of those differences.

"My associates are committed to doing quality work."

Of all of the Gallup Q12 questions, staff commitment to quality is one of the most important indicators for an engaged healthcare workplace. Healthcare workers score above the general Gallup workplace database on this item, but one specific group scores below even the overall Gallup database: nurses. Because nurses typically have more patient contact than any other healthcare worker does, this is an especially disturbing trend.

Nurses often carry the general feeling that their associates are becoming less driven by commitment to patient-care quality and more driven by business outcomes. However, a low nursing staff engagement level could also lead to an erosion of the quality of care commitment and delivery over time.

"I have a best friend at work."

The "best friend" question generates more discussion among professionals in all industries than does any other Q12 item, because its connection to productivity isn't intuitive. But Gallup research shows that it is an extremely powerful indicator of workplace engagement. Unfortunately, it is also the item on which nurses tend to register the lowest scores.

Providing high-quality healthcare is a team effort. Gallup's data analysis has established that patient perceptions of staff teamwork are strongly linked to patient satisfaction, and that the "best friend" question is a major predictor of successful teamwork and the level of trust employees have in one another.

Nursing managers sometimes offer the explanation that the need to work long shifts in a demanding hospital environment is not conducive to developing close friendships, but Gallup research has found that this is not necessarily true of comparable conditions in other professions. High turnover rates and staffing shortages are more likely to be causes of low scores on this item. Nurses often float from shift to shift and unit to unit, and large numbers of temporary staff members are employed to compensate for nurse shortages, so nurses may find themselves working with a different group every day. All of these factors can contribute to low scores on the "best friend" question.

Key Points

A strong sense of mission, insufficient access to materials and equipment, commitment to quality, and the lack a best friend at work are issues that, for better or worse, tend to differentiate nurses from other healthcare workers and the rest of the U.S. workforce. The "commitment to quality" and "best friend" items are two of the lowest-scoring Q12 items among nurses in Gallup's database. Hospitals may be able vastly improve the engagement levels of their nursing units by emphasizing the facility's commitment to quality patient care and creating a sense of teamwork at the unit level.

Ben Klima contributed to this article.


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