May Issue 2018


Bangalore Columbia Asia Msk Imaging Course

7 Ps of Nurse Engagement

The evolving role of genetic counseling in personalised medicine

By: Dr. AK Khandelwal

Nurses are critical to the delivery of efficient & effective healthcare in hospitals. Major studies have demonstrated the association of nurse staffing and patient outcomes, including lengths-of-stay, mortality, and hospital acquired infections. Literature mentions that engagement of nurses significantly improves a healthcare organisation's bottom line by improving its prevention of hospital acquired adverse events and reduced length of stay.
Private healthcare is passing through a very difficult time with increasing competition and decreasing payments by both private & government insurance entities. Thus, a strategy like engagement of nurses can help healthcare organisations to survive in the present environment.

What is engagement?

It is defined as the level of commitment nursing employees have toward their organisation and its goals.

Levels of engagement

Cognitive engagement: If a nurse considers her work as meaningful or not and whether the appropriate tools are available to complete the work.
Emotional engagement: When a nurse develops a connection that results in a commitment from her/him by providing a personal sense of beliefs, pride, and knowledge to the organisation.
Behavioral engagement: When a nurses' performance increases as a result of her or his emotional and cognitive engagement.

Advantage of nurse engagement

Nurse engagement is critical to any healthcare organisation that aims to provide affordable & quality healthcare. Studies say that engagement of employees is very important for effective utilisation of human resources and smooth running of the organisation. Some of the advantages of nurse engagement on the hospital industry are mentioned in the figure.

Signs of disengaged nurses

Researchers mention that disengagement is the withdrawal of physical, cognitive, and emotional absence from work roles to protect oneself from threat. Disengaged nurses do the least amount of work, resist change, are negative, and see the work as tedious.

Complaining: Disengaged nurses always complain; nothing is good for them in the organisation.

Making excuses: Disengaged nurses never take responsibilities for their actions and always find an excuse.

Lack of enthusiasm: Disengaged nurses will not take any initiative on their own.

Gossip: Disengaged nurses destroy morale and team culture and creates cliques within healthcare organisation.

Irresponsible: Disengaged nurses do not come in time, break their promises and always miss their deadlines.

Distracted: Disengaged nurses always distracted and they do not focus on their job.

No Growth: Disengaged nurses have no motivation and never invest in their growth by acquiring new knowledge and skill.

Non-co-operative: Disengaged nurses will rarely co-operate with other nurses, paramedics and doctors.

Lying: Disengaged nurses often lie about their assignments done and their observation.

Know-it-all attitude: Disengaged nurses often consider themselves above all and demonstrate that they know everything and do not consult others even when it is very critical.

Mood swings: Nurses who are disengaged tend to have more mood swings than others. They prefer to just go with their feelings, rather than have a rationale and work ethic behind their actions.

Strategies for engagement

Leaders in healthcare organisations should maximise employee engagement by implementing strategies to increase and maintain engagement. Strategies to implement engagement in the workplace require long-term leadership commitment.

Provide supportive leadership: Top management of a healthcare organisation should provide a positive environment and supporting leadership by valuing their contribution to the organisation. Appropriate staffing must be ensured based on acuity, complexity and skill mix and not solely on volume. Healthcare organisation leaders should take a proactive approach to manpower management for a better return on investment than the lost productivity and potential turnover costs associated with the frustration and lack of engagement.

Provide effective communication channel: One of the important drivers for engagement of nurses is clear, direct and timely communication. Needless to mention that communication is the fundamental for the demonstration of empathy and trust. Active listening is the key component of communication and often is not practiced by all stakeholders in a healthcare organisation resulting in mistakes, misunderstanding and mistrust. Communication at all levels may ensure that the organisation is working collaboratively on the common goals and mission of the organisation to implement engagement.

Provide need-based training: Literature mentions that training and development in organisations can motivate and increase performance. Researchers opine that training is vital to close the gaps and to promote the strength of the organisations' employees to achieve high performance. A need-based training of nursing staff makes them more confident, competent, contended and this results in reduced hospital-acquired conditions like fall from bed, pressure ulcer, hospital acquired infections, adverse drug reactions, equipment failure, etc.

Provide adequate compensation: Good wage is an important intervention that improves staff engagement and their outcome. Healthcare organisations that offer a total compensation package to nurses and offer performance-based bonuses may attract nurses who desire to meet the organisation's goals. Nurses should be compensated as per competitive market.

Prevent burnout: Burnout of nursing staffs resulting from stressful environment & poor job satisfaction adversely affect their engagement to the healthcare organisation. Leaders should implement strategies like stress management and positive feedback and training in communication to reduce burnout.

Provide proper environment: Literature mentions that provision of proper working environment with appropriate methods, machines, and materials enhances outcome of nursing professional with timely, effective and efficient delivery of care.

Provide appreciation: The nursing leaders and other colleagues must seek opportunities to appreciate & compliment when a job is well done. We must appreciate that jobs performed by nurses are very complex and challenging both physically and emotionally. Several studies emphasize that creating a culture of reward, appreciation and recognition increases productivity of nursing staffs.

In summary

Nursing is a fundamental driver of both outcomes and costs in most healthcare organisations. Nurse engagement is critical to the patient experience, clinical quality, and patient outcomes. Leader of a healthcare organisation should ensure engagement of nurses to survive in current competitive market.

About the author

Dr. Ashok Kumar Khandelwal is the VP & Medical Director, Anandaloke Hospital & Neurosciences Centre, West Bengal. He is a trained Assessor from the National Accreditation Board for Hospital and Health Care Provider (NABH). He carries around two decades of experience in the hospital industry and 20 years of experience as a hospital administrator.