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Low Staff Morale

Low Staff Morale. Jessica Swanson RN. Scope of Low Morale. Low nurse morale has a direct adverse effect on patient outcomes (1) The difficulty and complexities of the nursing field prevent people from entering nursing, exacerbating the shortage (2)

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Low Staff Morale

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  1. Low Staff Morale Jessica Swanson RN

  2. Scope of Low Morale • Low nurse morale has a direct adverse effect on patient outcomes (1) • The difficulty and complexities of the nursing field prevent people from entering nursing, exacerbating the shortage (2) • Low engagement of nurses is directly linked to higher mortality and morbidity (2) • Low morale is strongly linked to nurse turnover, at a cost of $22,000 to $64,000 per nurse (3)

  3. Identification of the Problem • A study by Hegney et al. showed that 40% of nurses believed that morale was “extremely or quite” poor (4). • Nurses believed that morale was deteriorating instead of improving (4). • Ways to identify problems in specific practice areas include staff surveys, gallup polls, HCHAPS scores on patient satisfaction, patient complaints, turnover rates, and the milieu on the floor.

  4. Role of the Nurse Leader • Research indicates that effective management has a direct impact on staff morale and satisfaction (5).

  5. Role of the Nurse Leader • All nurses have the potential to impact morale, but the most effective change begins at the top (5).

  6. Motivation: Internal and External • Some people have a high level of internal motivation, rewarded by satisfaction from doing a good job (5).

  7. Motivation: Internal and External • Other people require external motivation, such as bonuses, recognitions, or awards. These factors will never keep people performing at their best, however (5).

  8. Solutions to Improve Low Morale • Improved nurse-physician collaboration is strongly linked to improved morale (6). • Strategies like education and opportunities to shadow the other role may help collaboration.

  9. Solutions to Improve Low Morale • Coaching nurse managers can help with role preparation (5). • Coaching helps with personal development and with long term goal achievement (5). • Nurse leaders and managers can be coached to show more warmth and appreciation towards staff, which improves morale (5).

  10. Solutions to Improve Low Morale • When work is perceived as meaningful, self-motivation improves (5). • During shift handoff, nurses can encourage each other to reflect on their work that day. This allows nurses to find meaning in their work and fosters positive relationships amongst staff (5).

  11. Solutions to Improving Low Morale • Many nurses are motivated by patient gratitude (5). • Patients should be given ample opportunities to compliment nurses. • Nurses should receive recognition for these compliments (5).

  12. Identify the direction a nurse wants to take her practice, and provide opportunities to pursue that direction (5). A nurse with management aspirations could receive relief charge nurse training A nurse with teaching goals should work with clinical students. Solutions to Improve Low Morale

  13. Solutions to Improve Low Morale • The highest performing managers show more warmth and appreciation towards staff than the lowest 25% (7). • Nurse leaders and managers can be taught to positively impact the mood of individual and group interactions (5). • Qualities such as empathy, rapport building, genuineness, and respect are vital for supervising nurses (5).

  14. Many Factors Affect Morale • A survey by Hegney et al. (4) found that staff morale is associated with: AutonomyPhysical Demands Equipment Availability Safety Rewards Teamwork Perceived Value of Work Work StressWorkload

  15. Solution: Active Reflection Encourage nurses to find deeper meaning in their daily routines.

  16. Rationale for Active Reflection • Schon developed the process of reflective practice, which involves reflection while doing something and reflection after doing something (9). • Reflective practice needs another person who can serve as a mentor to ask appropriate questions and ensure quality reflection (9).

  17. Rationale for Active Reflection • Studies show that reflection can increase job satisfaction and feelings of competence (8). • Reflection on practice contributes to internal motivation and an engaged life-long learning process (5). • This strategy is easy to implement and requires little to no cost.

  18. Implementing Active Reflection • At the next unit meeting, nurses would be introduced to the concept of active reflection through a handout and brief presentation. • Each nurse would be given a piece of paper and will be asked to write down why he or she became a nurse • These papers will be displayed on the unit to inspire nurses and visitors.

  19. Implementing Active Reflection • Hopefully this brief exercise will remind staff why they wanted to join the profession in the first place. Most people become nurses for altruistic reasons (5).

  20. Implementing Active Reflection • Then all nurses will receive a note card with Stephenson’s framework for Reflective Practice on it. • Nurses will be encouraged to ask each other some of these questions during hand-off • This can promote active reflection and team-building (5). • Alternatively, nurses can perform active reflection on their own or by journaling (10)

  21. Implementing Active Reflection Stephenson's Framework • Choose a situation and ask yourself: • What was my role in this situation? Did I feel comfortable or uncomfortable? Why? • What actions did I take? How did I, and other act? Was it appropriate? • How could I have improved the situation for myself, the patient, others involved? • What can I change in future? • Do I feel as if I have learnt anything new about myself? • Did I expect anything different to happen? What and why? • Has it changed my way of thinking in any way? • What knowledge from my theory and research can I apply in this situation? • What broader issues, for example ethical, political or social, arise from this situation? • What do I think about these broader issues? Excerpt from: (Stephenson, 1993, p. 56-57). (11)

  22. Implementing active reflection • Nurse leaders and managers can assist with implementation by rounding at shift change and asking reflective questions • Signs can be posted with reflective questions in staff bathrooms and nurses’ stations

  23. Plan for Evaluation • Evaluating the effectiveness of active reflection on morale can be accomplished by: • Staff surveys • Milieu of floor (observed by managers) • Gallup polls • HCHAPS scores of patients (high morale equates to higher patient satisfaction)

  24. Plan for Evaluation • Nurses will be asked how they feel about reflective practice during the next staff meeting. • Changes to improve the process will be discussed during the meeting. • Hopefully, active reflection will become a part of nurses’ daily routines.

  25. References • Low morale hits patient outcomes. (2006). Nursing Standard, 21(5), 5. • Paller, D. (2004). Rx for the nursing shortage. GMJ. Retrieved from: http://gmj.gallup.com/content/13603/nursing-shortage.aspx#2 • Jones, C., Gates, M. (2007) The costs and benefits of nurse turnover: a business case for nurse retention. OJIN: The Online Journal of Issues in Nursing. 12(3), 4. • Hegney D., Eley, R., Plank, A., Buikstra, E., & Parker, V. (2006). Workforce issues in nursing in Queensland: 2001 and 2004. Journal Of Clinical Nursing, 15(12), 1521-1530. doi:10.1111/j.1365-2702.2006.01558.x

  26. References (continued) 5. Stapleton, P., Henderson, A., Creedy, D., Cooke, M., Patterson, E., Alexander, H., & ... Dalton, M. (2007). Boosting morale and improving performance in the nursing setting. Journal Of Nursing Management, 15(8), 811-816. doi:10.1111/j.1365-2934.2007.00745.x 6. Larrabee, J., Janney, M., Ostrow, C., Withrow, M., Hobbs, G., & Burant, C. (2003). Predicting registered nurse satisfaction and intent to leave. Journal of Nursing Administration, 33(5), 271-283. 7. Kouzes, L., & Posner, B. (1999). Encouraging the heart: a leader’s guide to rewarding and recognizing others. Jossey-Bass, San Fransisco, CA. 8. Lindberg, E. (2007). Increased job satisfaction after small group reflection on an intensive care unit. Dimensions Of Critical Care Nursing, 26(4), 163-167.

  27. References (continued) 9. Schon, D. (1983). The reflective practitioner: how professionals think in action. Temple Smith, London. 10. Richardson, G., & Maltby, H. (1995). Reflection-on-practice: enhancing student learning. Journal Of Advanced Nursing, 22(2), 235-242. doi:10.1046/j.1365-2648.1995.22020235.x 11. Stephenson. (1993). In Reflective practice in nursing: the growth of the professional practitioner, Blackwell Scientific Publications, Oxford, UK and Boston, USA.

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