Healthcare remains in crisis. COVID-19 started the disruption to an already fragile workplace where nurses, physicians, and other healthcare professionals were on edge. Short staffing, turnover, and leadership issues affecting engagement and employee commitment were starting to unravel. According to Gallup, the key driver of engagement is the employee’s relationship with their manager as a primary factor in how an employee feels about their role, understands expectations from the job, receives regular and meaningful feedback, and feels like someone at work cares about them. Sadly, this was waning before the pandemic and has now escalated to a crisis point with hospitals not having enough staff, nurses walking off the job and not returning, and the inability of hospitals to hire replacement staff.
Minus the pandemic, professional registered nurses were already in short supply. Or rather, nurses were not choosing to work in the acute care setting. There are more than enough opportunities in healthcare to find positions and roles that are not hospital-based.
The question then is what can be the mediating factor that helps the current workforce of attending nurses in acute care hospitals? I always come back to leaders and their leadership. There was a gap between leaders and staff in organizations and the pandemic widened that gap when decisions were made without nurses and the expectation that nurses continue to take care of as many patients as they can in surge situations that we have never experienced in modern times.
Another factor that we have heard about in the last 20 months is resiliency. Resiliency is a necessary emotional competence gained by learning how to weather tough times, building coping skills, and having the ability to reflect and learn from what is experienced to generate wisdom. What is missing is how nurses learn and develop the emotional and intellectual competence of hardiness. How hardy do you think you are and how did you build the skill of hardiness before going into battle? Hardiness has been studied and researched, especially in critical care nurses, as behavior that mediates our stressors so that we develop coping skills that can be assimilated into our coping skills. If people have not developed hardiness before trying to be resilient, we end up in the spot we are in with nurses dispirited, emotionally and physically depleted, and turning away from the profession. And these same nurses have no interest in formal leadership positions because they have had no positive role models. If a new graduate nurse was hired in the last 20 months during the pandemic, their frame for their role and what to expect from leaders and organizations have been distorted.
This brings us to the topic of leaders, leadership, and engagement. There is a short supply of nursing leaders, as much as clinical nurses. The need and demand for experienced and competent nurse leaders are high and the supply is low. Leaders, like staff, are functioning in crisis mode we are getting through the current hour and day is the primary goal. Thinking of other projects, improvement ideas, working on staff relationships, or starting new, exciting programs has moved to the back burner. If leaders can only focus on the moment and staff are trying to get through the shift, there is little time left for leaders to lead and for nurses to connect and be engaged. This is the gap that exists. If you layer that gap with a workforce, including leaders, that may not have fully developed their hardiness and therefore have limited capacity for resilience, it makes complete sense that we are in crisis trying to develop engagement in a crisis.
Crisis leadership and crisis clinical care will help create the disruption in the employee and employer relationship, and as a result how we frame engagement. Employee engagement is a reciprocal relationship between leaders, individuals, teams, and the organization. With fewer people entering the workforce and the current workforce leaving the profession, it creates an odd opportunity. What is coming is a gig-based workforce so that workers can have greater control, pace their work, and remain stronger mentally and physically. The workforce will be engaged for the duration of their assignment. They will rely less on a relationship with a leader and will be there to do the job with self-confidence, self-esteem, and self-efficacy. This is not travel nursing. I predict that nursing will move to a model where they will work for themselves or a managing organization as contracted staff- the physician model.
Leaders, engagement, and creating change. The change is here in the nursing workforce. We must innovate and think of different models of care, diverse types of caregivers, and how the attending nurse can lead and feel good about what they do as a self-managing autonomous professional who collaborates with a team to care for patients and families. Gary Hamel’s prediction is that management will become obsolete, and this change might be a sign of that disruption and challenges our precepts of workforce engagement and the role of managers; leaders build relationships, innovate, and influence others.
Craig Laser is a clinical associate professor at Arizona State University within the Master of Global Management in Healthcare Services program.