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How to Transform Your Nursing Culture so Nurses Never Want to Leave

How to Transform Your Nursing Culture so Nurses Never Want to Leave

Shane Parker, RN
Co-Founder and Chief Nursing Officer

You may think your nurse turnover rate is entirely due to the nursing shortage, but in truth your nurses may be leaving due to poor nursing culture.

Let that sink in for a moment.

It can be hard to recognize – and acknowledge – toxic culture in a workplace you strive so hard to make excellent. CNOs, nurse managers and other leaders make huge emotional investments in their hospitals and health systems to drive excellence, and taking a hard look at the picture only to find out the environment actually drives nurses away can be tough to swallow.

The good news is once you acknowledge and accept the idea your company culture needs improvement, you can start immediately to change things. And when you do that, then you might watch your nurse turnover rate dive dramatically.

What is Poor Company Culture in Healthcare?

“Company culture” describes the overall personality of your organization. A few characteristics that contribute to company culture in a healthcare organization include:

  • Shared values
  • Clinical and administrative practices
  • Attitudes of employees from top to bottom

When the majority of people within an organization actively live the company’s values, work with a positive attitude to achieve exceptional patient outcomes and satisfaction, feel valued by their employer and take joy in their work, then you’ve got a great company culture.

Of course, no organization – healthcare or otherwise – can achieve a sort of workplace nirvana. But you can evaluate your company’s culture to identify weaknesses that might lead to higher-than-average nurse turnover rates and then begin to change them for the positive.

Characteristics of Poor Nursing Culture

A brief checklist of behaviors and practices that can contribute to a toxic nursing culture might include:

  • Punitive environment toward nursing errors
  • Nurse bullying
  • Unsafe or unsustainable workloads
  • Few or no opportunities for nurse engagement
  • Hostility or tension between nurses and other groups
  • Lack of standardized procedures for hiring, discipline, scheduling or termination
  • Poor nurse onboarding process that leaves nurses unprepared to perform their best work
  • Absent or invisible top leadership
  • Managers playing “favorites” when it comes to scheduling, discipline, etc.

No nurse wants to work in an environment where they may be subjected to routine bullying or disrespect. Nurses want to succeed and provide the best possible care to their patients, and they look to the organization to support them. In a toxic nursing culture, that support is absent…and so, nurses leave.

How to Transform Your Nursing Culture in Four Steps

Transforming the nursing culture of your facility or organization takes time, so the sooner you start, the sooner you can see results in terms of reduced turnover. Use this step-by-step process to make your organization the one nurses join and never want to leave.

Step One: Review the Organization’s Core Values

If your healthcare organization doesn’t have a core values statement, you should start by spearheading an initiative to create it. Your company values should drive every decision your organization makes – which obviously can’t happen if you have no values statement.

As you review the core values, ask yourself if they still apply. When were they created? Are they still relevant?

Then go one step further and create a statement of core nursing values for your organization, if you don’t have one already. Provide an opportunity for nurses to participate in this process to feel engaged and to ensure the nursing values hew to the over-arching organizational values statement.

For ideas about what your organization’s core nursing values might include, look to these examples from Duke Nursing and MedStar Good Samaritan Hospital.

Step Two: Assess the Current Nursing Culture

Create a standing culture committee tasked with continuously improving your organization’s nursing culture on an ongoing basis. Be sure to include key stakeholders from the C-suite on down, such as yourself (the CNO) and a human resources representative. Aim for a broad representation of nurses but keep your committee lean and tight, too, so its members can work efficiently.

Start by performing a deep dive into the culture to find out where things stand. Which elements of the existing nursing culture speak clearly to the nursing values you’ve established? Which elements make a negative contribution to the culture?

You can assess several broad and specific elements of nursing culture. Try:

  • Asking prospective nurses about their perception of your organizational culture when they apply for a job
  • Surveying local nursing students about your organization’s reputation
  • Surveying your nurses about their opinions on the nursing culture
  • Evaluating nurse engagement and communication levels
  • Reviewing the onboarding process and getting feedback from nurses about how adequately it prepared them to provide exceptional patient care
  • Reviewing your scheduling policies and procedures for fairness and empowerment (such as through self-scheduling)

Step Three: Create an Improvement Plan

The cultural improvement plan should not focus exclusively on fixing individual elements (such as scheduling unfairness) but should incorporate goals that address key questions, such as:

  • How can we better model our values?
  • What initiatives can we create to reward positive behaviors?
  • How can we change (and ultimately eliminate) negative behaviors?
  • What steps can we take to ensure prospective nurses are a good fit with our nursing values before we hire them?
  • How can we foster continuous culture improvement?
  • In what ways can we increase nurse engagement?

Answering these questions will lead to probing many procedures and workflows to ensure they contribute to a positive nursing culture. These assessments, plans and changes can take a long time to develop, so make sure everyone involved knows that culture improvement is not a quick fix but an ongoing process.

Step Four: Evaluate

The nursing culture improvement plan should begin by answering the broad questions and then flow into details regarding specific initiatives to undertake for culture improvement. For example:

  1. How can we better model our values? Task: Create a procedure for addressing nursing errors in a non-punitive way.
  2. What steps can we take to ensure prospective nurses are a good fit with our nursing values before we hire them? Task: Add questions to the hiring forms to assess a nurse’s attitudes toward specific values, such as “Agree or disagree: We take care of each other as well as we care for patients”?
  3. In what ways can we increase nurse engagement? Task: Implement self-scheduling for improved empowerment and productivity.

Your culture committee should convene regularly to stay abreast of progress and to continually reassess how well the plan is working.

The Rewards of Creating a Positive Nursing Culture

Nursing culture improvement should continually be nurtured in order to see rewards. When your organization develops a reputation as a place that truly values nurses, hears them, engages with them and cares for them, not only will your nurse turnover slow to a trickle, but nurses will be beating a path to your facility doors.

Although the entire culture change process takes time (and never really ends), you can see quick benefits by making one simple change: empowering your nurses with self-scheduling.

ShiftWizard delivers proven nurse retention benefits. In fact, our case study showed self-scheduling with ShiftWizard improved nurse retention an average of 7% across three healthcare systems. Based on average nurse replacement costs, retaining just 14 nurses per year by offering self-scheduling could save your hospital a whopping $850,000.

Contact us today for your complimentary demonstration of this revolutionary scheduling software designed by nurses, for nurses, and discover how it can make a very positive contribution to your nursing culture (and your bottom line).

Healthcare Staff Scheduling. Developed by Nurses for Nurses.

ShiftWizard makes nurse scheduling and communication easy, so you can focus on what really matters---improving patient outcomes.

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