Motivational tips work, but require commitment
Supervisor’s style determines results
Volumes of research have been published in recent years offering motivational tips that promise they can boost quality of care and bedside productivity. But can these ideas work for nurses in critical care?
Yes, says Maureen Harvey, RN, MPH, CCRN, a consultant in Lake Tahoe, NV, who advises ICU managers on nursing effectiveness.
They may seem like useless homilies, but concepts such as nurse empowerment, accountability, encouragement, and management support can work, but often don’t due to problems with individual management styles. In critical care, administrators and senior managers often don’t spend sufficient time with nurses at the bedside, Harvey says.
Although managers are quite capable and experienced as leaders and clinicians, they often get out of touch with what is affecting rank-and-file nurses on the job, Harvey says. "The best-run hospitals actually put into action what they say about nurse empowerment," adds Harvey, a 33-year ICU veteran.
Best nursing may be invisible
Managers can easily motivate their nurses but often don’t. They focus instead on mistakes and shortcomings, she adds. This is a natural tendency, but one that hurts employee morale and erodes productivity. It arises from what Harvey calls the "invisible nursing effect."
Once they advance beyond the bedside, many managers forget that the best nursing isn’t always visible. "The better a nurse is, the less we tend to see things go wrong. Everything is as it should be," Harvey notes. For this reason, department heads should take note and give praise when things are running correctly as often as commenting when they are going badly.
"Managers need to put their ears to the ground. That’s how you motivate," Harvey says.
Autocratic management style passé
Research increasingly supports this view. "A [distant] autocratic management style propels action primarily through fear," says researcher Linda Rennick Breisch, RN, MPA, a manager at Penn State Geisinger Health System in Hershey, PA. "The my way or the highway’ approach, while effective in the short-run, isn’t a long-term solution."
For managers, motivating nurses rather than ordering them to perform effectively involves meeting a higher need that employees have for fulfillment and satisfaction. "Staff members want to feel a commitment to their jobs," Breisch says. Managers must find ways to make that happen. Head nurses can begin doing this by:
• creating a trusting work environment where ideas flow freely between staff and managers;
• encouraging nurses to ask questions and share experiences;
• giving timely, honest feedback about job performance;
• enabling self-teaching through posters, lectures, and self-learning packets;
• expressing clear expectations of staff members;
• letting staff know you appreciate their good work;
• helping individuals with problems;
• practicing effective, confident decision making;
• illustrating to staff how their efforts fit in with the organization’s goals.1
"Nurses have been in a bad mood for a long time," says Harvey. "Hospitals have to recognize that the better we treat our RNs, the better they will be with patients, and the better will be our outcomes, which in the long-run saves money."
Reference
1. Breisch LR. Motivate! Nurs Manage 1999; 30:27-30.
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