Caring for Those Who Care: Creating a Loving Culture for Nurses

As an advocate for the nursing profession, I have been spending a lot of time looking more deeply into the current state of nursing today. The headlines and social media stories have been beyond sobering – escalating burnout, turnover, nurses leaving or considering leaving the profession in record numbers.?So why is this happening? I think this article from McKinsey Senior Partner and Nurse Gretchen Berlin and her associates at McKinsey does a great job raising why nurses are leaving the profession and potential approaches to solutions. And when I look at those solutions, the overall concept that comes immediately to mind is an urgent need to listen, retool and build a thriving workplace culture.?A place where people are excited to work, where everyone feels supported, visible, a part of the team, works with purpose, and has room to innovate.?Why? Check out this HBR article from 2015, connecting culture with employee motivation, ultimately tied to driving performance.?In this case, improved performance could mean improved patient care. I think what we urgently need right now are leaders who are committed to transforming the healthcare workplace, listening, and taking bold steps to make it happen. And that’s why I’m very honored to pass the “virtual pen” to Julie Kennedy Oehlert, DNP, RN, who is doing just that. As Chief Experience Officer at Vidant Health in Greenville, North Carolina, Julie is dedicated to “operationalizing a culture based in empathy and belonging.” You can hear her story on the SEE YOU NOW podcast, but today I’m thrilled to have her share more about her approach in her own words.

Our workforce at Vidant Health is unique. We are located in rural eastern North Carolina and many of our nurses grew up here, went to school here, and their families live here. Our nurses take care of each other and each other’s families. In short, our team members are our patients too.

We’re tied together by both our relationships with one another and our connection to the community, and we’re on a journey together to transform our culture to be based on love and belonging. This approach may seem daunting, but it is rooted in science and data and backed up by work I was exposed to as a doctoral candidate in the Health Innovations and Leadership program at University of Minnesota. Cultural transformation theory supposes that cultures based in love and belonging achieve improved health care outcomes! The root of the work is this: culture emerges through how interpersonal relationships are structured, be they power-over relationships, or power-with relationships. Power-with relationships tend to drive cultures that are collaborative, mentoring, innovative and empathetic. So we have to ask ourselves, how do you change the structure of the relationships people have with each other? How do we remove barriers so that a more loving culture can emerge? I became obsessed with figuring out how we could operationalize cultural transformation theory and enjoy the cultural environment we desire in healthcare.

For anyone seeking to remove barriers, change the structure of relationships, and make space for a healthy work culture, the keys to success lay in these areas: leadership development, policies and procedures, human resources, and internal and external communications. Each of these inform and drive the relationships we have with one another and may need to undergo radical change to support a loving culture for our teams. Leadership sets the tone for the culture of a workplace. If leaders (intentionally or just developmentally) use fear, shame, or retaliation to lead, change is needed! Leadership that is not relational and loving will not build a relational or loving culture. Often policies and procedures are like ghosts – they haunt us long after they should be dead and gone. Removing policies and procedures that are punitive, or those that do not allow nurses to practice with autonomy, will drive a culture of power-with. Human Resources is a powerful culture-maker or breaker; how HR deals with human errors, with coaching and with development is key. In addition, I firmly believe that all communication needs to be a representation of your future and desired culture. We bring emotion and empathy into our communication with our teams – we tell them we love them and we care about them, we want to be authentic and human, and this brings caring into the healthcare setting. How can nurses be caring to patients when they do not feel cared for? This is why in my role, I also function as the chief marketing and communications officer – how we communicate with the organization is simply that important to our organization’s culture.

Ultimately, I believe culture has everything to do with the ability to attract and hold tight to our nurses. I do not think of myself as working on ‘nurse retention’ - we really need to expand the definition and lexicon of what we are really trying to do. Our workplaces cannot just ‘retain’ our nursing workforce anymore; we have to attract – and keep attracting – nurses who are engaged, cared for spiritually, emotionally and physically so they are motivated to stay, grow, develop and thrive! We need to go beyond traditional recruitment techniques and focus on creating an environment in which they feel loved and heard.?Attracting and holding on to the nursing workforce is everyone’s job, not just the CNO’s. It is an organizational imperative for healthcare systems to create an environment where nurses (and all employees) can thrive, so patients get great care – that is, after all, the magic connection.

There has been a long-standing need to innovate and transform the healthcare workforce culture, and the COVID-19 pandemic brought this need sharply into focus. Nurses are leaving the profession and, while compensation is certainly important, it is not the sole reason nurses leave. I believe that paying nurses more to suffer is a horrible strategy. Compensation alone will not help an uncaring work environment! Nurses leave because of work schedules, lack of career development and work environment relationships as well. We need to think about what we are doing to bond them to us. What unique and desirable opportunities are we offering them?

During the past two years, this meant listening to our nurses and placing a focus on their well-being. We implemented tranquility rooms, well-being pop-ups on the units, and delivered food and fun to the units for both convenience and to lift their spirits. We know they need more support, but with the nursing shortage in full swing, how do we provide that support when we do not have adequate staffing? This for me is a key consideration. Nursing should not have to carry organizational results fully on their shoulders. Healthcare is a team delivery system so we created three new non-clinical support positions so that nurses did not have to carry the full burden of meeting all patients’ non-clinical needs on the floor anymore. We trialed these positions with nurses, who both helped design the job descriptions and hire candidates. The most impactful statement for me was from a young ED nurse who said that it made her less anxious knowing someone was there to bring her patients’ coffee when she could not find the time! Decreasing anxiety by supporting nurses with non-clinical support roles is an innovative model that both supports nurses and supports compassionate patient care.

This moment is the opportunity for us to be better employers and better leaders, and I want to challenge my colleagues across the nation to innovate and disrupt how we have thought about ‘recruitment’ and ‘retention’ in the past because it is not going to serve us going forward.

I do not hold a traditional nursing executive role but I am still a nurse at heart. I think like a nurse and that is the beauty of nurse executives in non-traditional roles! We can support caring from any place we sit in the organization.

People sometimes fear disruption, but I just tell them I will love them right through it, and we will get to the other side together.

Read more about Julie’s work and learn how you can apply her insights and approach to your healthcare system:

What’s Love Got To Do With It?

Vidant Health: Changing Healthcare From the Inside Out

Watch: How Design Thinking Revolutionized Nurse Retention at Vidant Health

Listen to Julie’s interview on our SEE YOU NOW Podcast for a deeper discussion on her work.

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