good 1

Creating a Healthy

Workplace

59

The global pandemic has strained health care delivery systems and the work- force running them. Amid this landscape, nurse burnout has reached an

all-time high.1 Although the nursing shortage was already at crisis levels before the pandemic, COVID-19 exacerbated the emotional exhaustion nurses faced, contributing to what is now dubbed the “Great Resignation.”2 According to the 2022 NSI National Health Care Retention and RN Staffing Report, the regis- tered nurse (RN) turnover rate increased by 8.4%, to an average of 27.1% in 2021, outpacing hospital turnover at 25.9% for the first time since the survey was conducted.2 Moreover, a study of over 5000 nurses found that at least 11% of nurses intended to leave the profession at the height of the pandemic, and another 20% were undecided.2

With such a significant decline in nursing supply, it is clear the nursing short- age cannot be resolved overnight. However, nurse leaders can start addressing turnover by fostering healthy work environments and nurse well-being. Healthy work environments share several important characteristics, defined by the American Association of Critical-Care Nurses (AACN) as skilled communica- tion, true collaboration, effective decision-making, appropriate staffing, authentic leadership, and meaningful recognition.3 Organizations that demonstrate these

Danielle Gabele is Chief Nurse Executive, Ventura County Medical Center and Santa Paula Hospital,

300 Hillmont Ave, Ventura, CA 93003 ([email protected]).

Tina Cartwright is Senior Director–Nursing Excellence, Professional Development and Research, Stan-

ford Healthcare Tri-Valley, Pleasanton, California.

Faye Christen is Primary Nursing Care Director, LAC+USC Medical Center, Los Angeles, California.

Erica Martinez is Dean of Nursing, American Career College, Ontario, California.

Lindsay McKenzie is Nursing Director- Telemetry and Medical-Surgical Inpatient Units, Keck Hospital

of USC, Los Angeles, California.

Rachael Murray is Neonatal Nurse Practitioner, Rady Children’s Hospital, San Diego, California.

Staci Peavler is Director of Case Management, Stanford Health Care, Palo Alto, California.

Nancy Blake is Chief Nursing Officer, LAC+USC Medical Center, Los Angeles, California.

The authors declare no conflicts of interest.

DOI: https://doi.org/10.4037/aacnacc2023422

Nancy Blake, PhD, RN, CCRN-K,

NEA-BC, NHDP-BC, FACHE, FAONL,

FAAN

Department Editor

AACN Advanced Critical Care Volume 34, Number 1, pp. 59-62

© 2023 AACN

Authentic Leadership: Pearls of Wisdom

Danielle Gabele, DNP, RN, CENP, CCRN-K

Tina Cartwright, DNP, MBA, BSN, RN, NE-BC

Faye Christen, DNP, RN, NEA-BC, CCRN-K

Erica Martinez, DNP, MSN, BSN, CCRN, NEA-BC

Lindsay McKenzie, MSN, MBA, RN, CCRN

Rachael Murray, MSN, NP, RN

Staci Peavler, MSN, BS, RN, ACM, CMAC

Nancy Blake, PhD, RN, CCRN-K, NEA-BC, NHDP-BC, FACHE, FAONL, FAAN

CREATING A HEALTHY WORKPLACE WWW.AACNACCONLINE.ORG

60

attributes experience greater employee engage- ment and lower turnover.4

By implementing authentic leadership, nurse leaders have the greatest impact on healthy work environments. Authentic nurse leaders create supportive work environments that decrease staff turnover, promote emotional well-being, and have been associated with bet- ter nurse satisfaction and patient outcomes. But what is authentic leadership, and how can nurse leaders embed this style into their prac- tice? This column aims to define authentic nurse leadership and provide practical tips for implementing this leadership style.

Authentic Leadership The concept of authentic leadership arose

and evolved over the past 20 years in response to several business scandals that highlighted the poor outcomes of arrogant leaders.5 Today, authentic leadership encapsulates leaders who empower others and create a sense of purpose and optimism. It is a style in which the leader acts in a way that supports their personal val- ues.6 A nurse leadership model developed by Giordano-Mulligan and Eckardt7 conceptual- izes leader caring and other attributes, differ- entiating authentic leadership in the context of the nursing profession. Authentic nurse leadership comprises 5 key attributes: moral- ethical perspective, self-awareness, relational integrity, shared decision-making, and caring.6 The authentic nurse leader’s alignment of per- sonal and organizational values cultivates credi- bility, trust, and respect. Leaders who possess self-awareness have a greater understanding of their strengths and vulnerabilities. They have a strong moral foundation that allows them to act in ways that support their core values. Authentic nurse leaders build connections and communication styles that promote psycho- logical safety, facilitating a culture of open ideas. In health care systems, nurse leaders are often overwhelmed with responsibilities and tasks that take time away from developing authentic leadership styles. However, with some practice, nurse leaders can use the following skills to promote authentic leadership at work.

Tips on Providing Authentic Leadership To Thine Own Self Be True

Authentic nurse leaders know their values, beliefs, and morals. They know where they stand on critical issues and are true to themselves

with their actions and decisions. Take the time to perform a personal inventory. Act with cour- age and confidence when it is most needed. Articulate what is important to you and what is nonnegotiable in your work environment. These values should be transparent and com- municated to your team members.

Do As I Say and Do As I Do Authentic nurse leaders walk the walk and

talk the talk. They do not just tell staff what to do and why to do it. They model the behavior themselves and have a vision. Consider a leader who tells you how important it is to perform hourly rounds on patients. If that leader never leaves her office, her credibility in asking for this is diminished. Authentic leaders regularly highlight the importance of hourly rounding and model it.

Listen More Than You Speak One of the critical authentic leadership attri-

butes is openness. When talking to staff, nurse leaders should practice active-listening skills. Active listening means hearing verbal messages and being aware of nonverbal cues and sig- nals. For example, a new graduate nurse may tell the leader about her excitement about meeting her preceptor in the first week but 2 weeks later begins to avoid eye contact and give one-word answers when asked if the pre- ceptor has been a good teacher. Authentic lead- ers also listen without distraction, meaning they are present with staff in the moment and avoid interruptions. This means avoiding multitask- ing and putting away the cell phone when speaking to an employee.

Know Your Team Nurse leaders already understand the clini-

cal strengths and weaknesses of team members. However, this is not the only information valuable to the authentic leader. Authentic lead- ers take the time to get to know team members more personally. Whether that means knowing which team member plays flag football or aspires to be a nurse educator, get to know what motivates your team. Doing so helps to build trust.

Be Vulnerable Authentic leaders do not just expect their

team members to share personal information without sharing it themselves. Nurses want to see their leaders as real people too. Talk

CREATING A HEALTHY WORKPLACEVOLUME 34 • NUMBER 1 • SPRING 2023

61

about your family, where you like to travel, or your future career aspirations. Tell your team members honestly when you have made a mistake and express remorse if you uninten- tionally hurt someone. These practices help others see you as genuine.

Take Office Hours Out of the Office Gone are the days when nurse leaders sit

in offices and wait for staff to come to them. Authentic leaders create opportunities to meet staff where they are at the point of care. Con- sider setting aside time to shadow frontline nurses and observe their workflows. Round on your team members just as you would on patients. These encounters often lead organi- cally to conversations about workflows and engender trust between leader and employee. Often, employees take this time to share sug- gestions for improving the work environment with the leader or request additional resources.

Show You Care for Yourself as You Care for Others

The idea that nurse leaders must be avail- able 24/7 has, at best, created a culture that self-care in leadership should not exist. At worst, it may create a culture that self-care in nursing should not exist. Nurse leaders who take time to refuel through well-being activities are better positioned to support their teams, normalize self-care, and encour- age staff to prioritize their own well-being. Compassion, empathy, and awareness of your needs are foundational in caring for others. Plan for time off. Be open about when you are unavailable and who will be the point of contact so you can enjoy uninterrupted time to re-energize and be present.

Say Thank You Early and Often During the pandemic, nurses were thanked

profusely by their leaders and the general pub- lic, who had coined them health care heroes. As time passes, generic thank you messages become less impactful. Authentic leaders dole out personal, targeted messages of gratitude that address specific instances. For example, a nurse leader rounding on patients hears one nurse’s name repeatedly mentioned for his compassionate nature. The authentic nurse leader may then write a thank you note directly to this nurse giving thanks for great care and may also recognize the nurse in a monthly staff meeting.

Celebrate Even the Smallest Successes

In these challenging times, clinical outcomes may not mirror prepandemic levels. But some- times, even preventing a further decline in out- comes is worthy of celebration. Don’t wait until you achieve a national benchmark to cel- ebrate success. Let’s say your telemetry unit has been experiencing a high rate of falls, dou- ble the national average. In the past month, your rate has stayed higher than benchmarks, but you replaced 2 falls with injury with 2 witnessed falls. Congratulations! That is a success, and authentic leaders take the time to celebrate these small milestones with their teams.

Empower, Empower, Empower Authentic leaders share decision-making.

They look for opportunities to give staff a voice, whether that be in a robust shared- governance model or an employee open forum. Create chances for nurses to speak up and tell you what they need. When nurses come to you with problems, do not send them away until they have a solution. Work with them to brainstorm suggestions or connect them with resources who can help. Empowering your team members gives them the confidence to make their own decisions and makes them feel their suggestions are considered.

Know That the Journey Never Ends Authentic nurse leaders understand they are

not perfect. Authentic leadership is a journey of self-discovery and self-awareness. The journey of self-improvement should not end. Rather, authentic leaders seek out opportunities to improve themselves. Be transparent about your opportunities and tell your team how you plan to improve. The ability to learn and self-reflect is the hallmark of an authentic leader.

Conclusion Authentic nurse leadership is a distinct style

that focuses on openness, honesty, and trust. Although the suggestions here do not address all aspects of this type of leadership, they do provide a start on changes you can make to become a more authentic leader. Authentic nurse leaders lead from the heart and practice what they preach. They create healthier envi- ronments for their teams and themselves. Do not get caught up in the details of this leader- ship style. Just remember what Oscar Wilde

CREATING A HEALTHY WORKPLACE WWW.AACNACCONLINE.ORG

62

once said: “Be yourself. Everyone else is already taken.”8 If you can adapt your style to include some of these characteristics, you can expect improved morale, decreased turnover, and greater employee satisfaction.

REFERENCES 1. Blake, N. Caring for the caregivers during the Covid-19

pandemic. AACN Adv Crit Care. 2020; 31(4): 416-418. doi:10.4037/aacnacc2020612

2. NSI Nursing Solutions. 2022 NSI National health care retention and RN staffing report. Published March 2022. Accessed September 30, 2022. https://www.nsinursing- solutions.com/Documents/Library/NSI_National_Health_ Care_Retention_Report.pdf

3. American Association of Critical-Care Nurses. AACN Standards for Establishing and Sustaining Healthy Work

Environments: A Journey to Excellence. 2nd ed. AACN; 2016.

4. Raso R, Fitzpatrick JJ, Masick K. Nurses’ intent to leave their position and the profession during the COVID-19 pandemic. J Nurs Adm. 2021;51(10):488-494. doi:10.1097/ NNA.0000000000001052

5. Kester K, Pena H, Shuford C, et al. Implementing AACN’s Healthy Work Environment framework in an intensive care unit. Am J Crit Care. 2021;30(6):426-433. doi:10.4037/ ajcc2021108

6. Raso R. Be you! Authentic leadership. Nurs Manage. 2019;50(5):18-25. doi:10.1097/01. NUMA.0000557619.96942.50

7. Giordano-Mulligan M, Eckardt S. Authentic nurse lead- ership conceptual framework: nurses’ perception of authentic nurse leader attributes. Nurs Adm Q. 2019; 43(2):164-174. doi:10.1097/NAQ.0000000000000344

8. Wilde O. Thoughts on the business of life. ForbesQuotes. Accessed October 11, 2022. https://www.forbes.com/ quotes/11441

Copyright of AACN Advanced Critical Care is the property of American Association of Critical-Care Nurses and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.

Creating a Healthy

Workplace

59

The global pandemic has strained health care delivery systems and the work- force running them. Amid this landscape, nurse burnout has reached an

all-time high.1 Although the nursing shortage was already at crisis levels before the pandemic, COVID-19 exacerbated the emotional exhaustion nurses faced, contributing to what is now dubbed the “Great Resignation.”2 According to the 2022 NSI National Health Care Retention and RN Staffing Report, the regis- tered nurse (RN) turnover rate increased by 8.4%, to an average of 27.1% in 2021, outpacing hospital turnover at 25.9% for the first time since the survey was conducted.2 Moreover, a study of over 5000 nurses found that at least 11% of nurses intended to leave the profession at the height of the pandemic, and another 20% were undecided.2

With such a significant decline in nursing supply, it is clear the nursing short- age cannot be resolved overnight. However, nurse leaders can start addressing turnover by fostering healthy work environments and nurse well-being. Healthy work environments share several important characteristics, defined by the American Association of Critical-Care Nurses (AACN) as skilled communica- tion, true collaboration, effective decision-making, appropriate staffing, authentic leadership, and meaningful recognition.3 Organizations that demonstrate these

Danielle Gabele is Chief Nurse Executive, Ventura County Medical Center and Santa Paula Hospital,

300 Hillmont Ave, Ventura, CA 93003 ([email protected]).

Tina Cartwright is Senior Director–Nursing Excellence, Professional Development and Research, Stan-

ford Healthcare Tri-Valley, Pleasanton, California.

Faye Christen is Primary Nursing Care Director, LAC+USC Medical Center, Los Angeles, California.

Erica Martinez is Dean of Nursing, American Career College, Ontario, California.

Lindsay McKenzie is Nursing Director- Telemetry and Medical-Surgical Inpatient Units, Keck Hospital

of USC, Los Angeles, California.

Rachael Murray is Neonatal Nurse Practitioner, Rady Children’s Hospital, San Diego, California.

Staci Peavler is Director of Case Management, Stanford Health Care, Palo Alto, California.

Nancy Blake is Chief Nursing Officer, LAC+USC Medical Center, Los Angeles, California.

The authors declare no conflicts of interest.

DOI: https://doi.org/10.4037/aacnacc2023422

Nancy Blake, PhD, RN, CCRN-K,

NEA-BC, NHDP-BC, FACHE, FAONL,

FAAN

Department Editor

AACN Advanced Critical Care Volume 34, Number 1, pp. 59-62

© 2023 AACN

Authentic Leadership: Pearls of Wisdom

Danielle Gabele, DNP, RN, CENP, CCRN-K

Tina Cartwright, DNP, MBA, BSN, RN, NE-BC

Faye Christen, DNP, RN, NEA-BC, CCRN-K

Erica Martinez, DNP, MSN, BSN, CCRN, NEA-BC

Lindsay McKenzie, MSN, MBA, RN, CCRN

Rachael Murray, MSN, NP, RN

Staci Peavler, MSN, BS, RN, ACM, CMAC

Nancy Blake, PhD, RN, CCRN-K, NEA-BC, NHDP-BC, FACHE, FAONL, FAAN

CREATING A HEALTHY WORKPLACE WWW.AACNACCONLINE.ORG

60

attributes experience greater employee engage- ment and lower turnover.4

By implementing authentic leadership, nurse leaders have the greatest impact on healthy work environments. Authentic nurse leaders create supportive work environments that decrease staff turnover, promote emotional well-being, and have been associated with bet- ter nurse satisfaction and patient outcomes. But what is authentic leadership, and how can nurse leaders embed this style into their prac- tice? This column aims to define authentic nurse leadership and provide practical tips for implementing this leadership style.

Authentic Leadership The concept of authentic leadership arose

and evolved over the past 20 years in response to several business scandals that highlighted the poor outcomes of arrogant leaders.5 Today, authentic leadership encapsulates leaders who empower others and create a sense of purpose and optimism. It is a style in which the leader acts in a way that supports their personal val- ues.6 A nurse leadership model developed by Giordano-Mulligan and Eckardt7 conceptual- izes leader caring and other attributes, differ- entiating authentic leadership in the context of the nursing profession. Authentic nurse leadership comprises 5 key attributes: moral- ethical perspective, self-awareness, relational integrity, shared decision-making, and caring.6 The authentic nurse leader’s alignment of per- sonal and organizational values cultivates credi- bility, trust, and respect. Leaders who possess self-awareness have a greater understanding of their strengths and vulnerabilities. They have a strong moral foundation that allows them to act in ways that support their core values. Authentic nurse leaders build connections and communication styles that promote psycho- logical safety, facilitating a culture of open ideas. In health care systems, nurse leaders are often overwhelmed with responsibilities and tasks that take time away from developing authentic leadership styles. However, with some practice, nurse leaders can use the following skills to promote authentic leadership at work.

Tips on Providing Authentic Leadership To Thine Own Self Be True

Authentic nurse leaders know their values, beliefs, and morals. They know where they stand on critical issues and are true to themselves

with their actions and decisions. Take the time to perform a personal inventory. Act with cour- age and confidence when it is most needed. Articulate what is important to you and what is nonnegotiable in your work environment. These values should be transparent and com- municated to your team members.

Do As I Say and Do As I Do Authentic nurse leaders walk the walk and

talk the talk. They do not just tell staff what to do and why to do it. They model the behavior themselves and have a vision. Consider a leader who tells you how important it is to perform hourly rounds on patients. If that leader never leaves her office, her credibility in asking for this is diminished. Authentic leaders regularly highlight the importance of hourly rounding and model it.

Listen More Than You Speak One of the critical authentic leadership attri-

butes is openness. When talking to staff, nurse leaders should practice active-listening skills. Active listening means hearing verbal messages and being aware of nonverbal cues and sig- nals. For example, a new graduate nurse may tell the leader about her excitement about meeting her preceptor in the first week but 2 weeks later begins to avoid eye contact and give one-word answers when asked if the pre- ceptor has been a good teacher. Authentic lead- ers also listen without distraction, meaning they are present with staff in the moment and avoid interruptions. This means avoiding multitask- ing and putting away the cell phone when speaking to an employee.

Know Your Team Nurse leaders already understand the clini-

cal strengths and weaknesses of team members. However, this is not the only information valuable to the authentic leader. Authentic lead- ers take the time to get to know team members more personally. Whether that means knowing which team member plays flag football or aspires to be a nurse educator, get to know what motivates your team. Doing so helps to build trust.

Be Vulnerable Authentic leaders do not just expect their

team members to share personal information without sharing it themselves. Nurses want to see their leaders as real people too. Talk

CREATING A HEALTHY WORKPLACEVOLUME 34 • NUMBER 1 • SPRING 2023

61

about your family, where you like to travel, or your future career aspirations. Tell your team members honestly when you have made a mistake and express remorse if you uninten- tionally hurt someone. These practices help others see you as genuine.

Take Office Hours Out of the Office Gone are the days when nurse leaders sit

in offices and wait for staff to come to them. Authentic leaders create opportunities to meet staff where they are at the point of care. Con- sider setting aside time to shadow frontline nurses and observe their workflows. Round on your team members just as you would on patients. These encounters often lead organi- cally to conversations about workflows and engender trust between leader and employee. Often, employees take this time to share sug- gestions for improving the work environment with the leader or request additional resources.

Show You Care for Yourself as You Care for Others

The idea that nurse leaders must be avail- able 24/7 has, at best, created a culture that self-care in leadership should not exist. At worst, it may create a culture that self-care in nursing should not exist. Nurse leaders who take time to refuel through well-being activities are better positioned to support their teams, normalize self-care, and encour- age staff to prioritize their own well-being. Compassion, empathy, and awareness of your needs are foundational in caring for others. Plan for time off. Be open about when you are unavailable and who will be the point of contact so you can enjoy uninterrupted time to re-energize and be present.

Say Thank You Early and Often During the pandemic, nurses were thanked

profusely by their leaders and the general pub- lic, who had coined them health care heroes. As time passes, generic thank you messages become less impactful. Authentic leaders dole out personal, targeted messages of gratitude that address specific instances. For example, a nurse leader rounding on patients hears one nurse’s name repeatedly mentioned for his compassionate nature. The authentic nurse leader may then write a thank you note directly to this nurse giving thanks for great care and may also recognize the nurse in a monthly staff meeting.

Celebrate Even the Smallest Successes

In these challenging times, clinical outcomes may not mirror prepandemic levels. But some- times, even preventing a further decline in out- comes is worthy of celebration. Don’t wait until you achieve a national benchmark to cel- ebrate success. Let’s say your telemetry unit has been experiencing a high rate of falls, dou- ble the national average. In the past month, your rate has stayed higher than benchmarks, but you replaced 2 falls with injury with 2 witnessed falls. Congratulations! That is a success, and authentic leaders take the time to celebrate these small milestones with their teams.

Empower, Empower, Empower Authentic leaders share decision-making.

They look for opportunities to give staff a voice, whether that be in a robust shared- governance model or an employee open forum. Create chances for nurses to speak up and tell you what they need. When nurses come to you with problems, do not send them away until they have a solution. Work with them to brainstorm suggestions or connect them with resources who can help. Empowering your team members gives them the confidence to make their own decisions and makes them feel their suggestions are considered.

Know That the Journey Never Ends Authentic nurse leaders understand they are

not perfect. Authentic leadership is a journey of self-discovery and self-awareness. The journey of self-improvement should not end. Rather, authentic leaders seek out opportunities to improve themselves. Be transparent about your opportunities and tell your team how you plan to improve. The ability to learn and self-reflect is the hallmark of an authentic leader.

Conclusion Authentic nurse leadership is a distinct style

that focuses on openness, honesty, and trust. Although the suggestions here do not address all aspects of this type of leadership, they do provide a start on changes you can make to become a more authentic leader. Authentic nurse leaders lead from the heart and practice what they preach. They create healthier envi- ronments for their teams and themselves. Do not get caught up in the details of this leader- ship style. Just remember what Oscar Wilde

CREATING A HEALTHY WORKPLACE WWW.AACNACCONLINE.ORG

62

once said: “Be yourself. Everyone else is already taken.”8 If you can adapt your style to include some of these characteristics, you can expect improved morale, decreased turnover, and greater employee satisfaction.

REFERENCES 1. Blake, N. Caring for the caregivers during the Covid-19

pandemic. AACN Adv Crit Care. 2020; 31(4): 416-418. doi:10.4037/aacnacc2020612

2. NSI Nursing Solutions. 2022 NSI National health care retention and RN staffing report. Published March 2022. Accessed September 30, 2022. https://www.nsinursing- solutions.com/Documents/Library/NSI_National_Health_ Care_Retention_Report.pdf

3. American Association of Critical-Care Nurses. AACN Standards for Establishing and Sustaining Healthy Work

Environments: A Journey to Excellence. 2nd ed. AACN; 2016.

4. Raso R, Fitzpatrick JJ, Masick K. Nurses’ intent to leave their position and the profession during the COVID-19 pandemic. J Nurs Adm. 2021;51(10):488-494. doi:10.1097/ NNA.0000000000001052

5. Kester K, Pena H, Shuford C, et al. Implementing AACN’s Healthy Work Environment framework in an intensive care unit. Am J Crit Care. 2021;30(6):426-433. doi:10.4037/ ajcc2021108

6. Raso R. Be you! Authentic leadership. Nurs Manage. 2019;50(5):18-25. doi:10.1097/01. NUMA.0000557619.96942.50

7. Giordano-Mulligan M, Eckardt S. Authentic nurse lead- ership conceptual framework: nurses’ perception of authentic nurse leader attributes. Nurs Adm Q. 2019; 43(2):164-174. doi:10.1097/NAQ.0000000000000344

8. Wilde O. Thoughts on the business of life. ForbesQuotes. Accessed October 11, 2022. https://www.forbes.com/ quotes/11441

Copyright of AACN Advanced Critical Care is the property of American Association of Critical-Care Nurses and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.