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14 Steps to Improve Nursing Work Environments

There is a critical need for skilled leaders within the field of nursing. Nurses who assume leadership positions are responsible for managing health care settings such as hospitals, doctors’ offices, rehabilitation centers and hospices. These nurse leaders are tasked with the responsibility of impacting systems and processes within their organizations to improve overall patient outcomes.

If you want a happy, motivated and productive workforce you need to create a work environment that allows this to happen. One way to achieve this is by putting into place effective nursing leadership and management practices. As a nurse manager, you need to take the right steps to ensure you adopt positive workplace management initiatives and have the right leadership and management skills. Here are 14 of the key factors that will contribute to a happy workplace1.

  1. Quality of Leadership
    It is perfectly acceptable for nurse leaders to be risk takers in the pursuit of a healthy work environment. Positive workplace management initiatives such as shared goals, opportunities to learn, career development, reward schemes, job satisfaction and open management styles all play a part in creating a healthy staff-focused workplace.
  2. Organizational Structure
    The most effective organizational structures in healthcare are flat with decentralized departments and strong nursing representation across the organization as a whole. Some care delivery models create nurse managed, patient directed care, elevating the registered nurse to primary care manager2. However, in an ever-changing healthcare system, no single model can be deemed superior.
  3. Management Style
    The best management styles are those that are participative and encourage feedback from staff at all levels in the organization. Nursing leaders need to be visible, accessible and committed to effective communication3.
  4. Personnel Policies and Programs
    The most effective personnel policies and programs are created with staff involvement and provide opportunities for promotion4. In fact, with the right level of support from managers and a focus on evidence-based practice, employees can be involved with the development of policies in general.
  5. Professional Models of Care
    Nursing practice models have evolved greatly over the years. From case management models in the 1920s and functional and team nursing used in the 1950s to the arrival of the primary care model in the 1980s. By 2000, professional nurses were leading interdisciplinary teams5.
  6. Quality of Care
    It is the responsibility of nurse leaders to develop an environment of quality of care delivery in which staff nurses feel they are providing a quality service6. To ensure quality of care, nurse leaders need to make sure their staff have the right balance between providing patient care and support and teaching patients, as well as fulfilling their non-value support duties. The better the care environment, the lower the risk of death and failure to rescue.
  7. Quality Improvement
    This is the process of working together to improve outcomes and increase the quality of care locally7. If it is to work, quality improvement needs to be educational and focused on the quality of care delivered8. It also needs to be supported by both leaders and clinicians9.
  8. Consultation and Resources
    The key consultants and resources identified as essential support for hospital nurse include: nurse leaders, supervisors, clinical nursing specialists, psychiatric liaison nurses, ethicists, philosophers, nursing professors and researchers1011.
  9. Autonomy
    Autonomy is related to power and empowerment. A nurse's power can come from a workplace that promotes empowerment; a psychological belief that they can become empowered; or the understanding that there is power in the relationships and care they provide12. The workplace should allow nurses to be autonomously creative and innovative.
  10. Community and the Hospital
    Hospitals that maintain a community presence are better able to recruit and retain nurses. By developing a democratic and empowering partnership with the community it allows the community to identify and address priority health concerns13.
  11. Nurse as Teacher
    Nurses who incorporate teaching into all aspects of their practice will get considerable professional satisfaction14. Not only does teaching make a large contribution to the lives of patients and helps train student nurses, it also advances the nurse's own learning15.
  12. Image of Nursing
    The image of nurses in general is good. They are seen as being an integral part of the patient care service16 and are considered competent, credible, valued, respected and necessary for the survival of the hospital.
  13. Interdisciplinary Relationships
    Nurses need to interact with a number of disciplines ranging from pharmacists and physicians to social workers and chaplains. Leaders need to lead by example using techniques such as open communication, conflict resolution and reward schemes to create a good working environment.
  14. Professional Development
    Most successful hospitals place an emphasis on career development. When personal and professional development is valued, it allows for competency-based progression and ongoing development in the workplace17.

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Adapted from: Tomey A.M. (2009) Nursing leadership and management effects work environments. Journal of Nursing Management 17, 15-25. [WWW document]. URL [accessed on 24 June 2014].

1 Urden L.D. & Monarch K. (2002) The ANCC Magnet Recognition Program: Converting Research Findings Into Action. Magnet Hospitals Revisited: Attraction and Retention of Professional Nurses (M. L. McClure & A. S. Hinshaw eds), 106–107.
2 Kimball B., Joynt J., Cherner D. & O’Neil E. (2007) The quest for new innovative care delivery models. The Journal of Nursing Administration 37 (9), 392–398.
3 Urden & Monarch (2002)
4 Urden & Monarch (2002)
5 Marriner Tomey A. (2009) Guide to Nursing Management and Leadership. Mosby/ Elsevier, St Louis, MO.
6 Urden & Monarch (2002)
7 Newhouse R.P. (2007) Diffusing confusion among evidence-based practice, quality improvement, and research. Journal of Nursing Administration 37 (10), 432–435.
8 Urden & Monarch (2002)
9 McNicholl M.P., Coates V. & Dunne K. (2008) Driving towards an improved research and development culture. Journal of Nursing Management 16 (3), 344–351.
10 American Academy of Nursing (1983) Magnet Hospitals: Attraction and Retention of Professional Nurses.
11 Rundall T.G. (2007) Evidence-based management. Hospitals & Health Networks 81 (11), 72.
12 Manojlovich M. & Antonakos C. (2008) Satisfaction of intensive care nurses with nurse-physician communication. Journal of Nursing Administration 38 (5), 237–243.
13 American Academy of Nursing (1983)
14 Urden & Monarch (2002)
15 American Academy of Nursing (1983)
16 Urden & Monarch (2002)
17 Urden & Monarch (2002)

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