Striving For Nurses’ Greater Good

As nurse stress goes up, patient satisfaction and quality outcomes go down.

Factors reported to generate nurse stress are workload, shift work, interpersonal conflicts, inadequate preparation, death and dying and uncertainty regarding treatments. (Tucker et al)

The work environment and individual response lend to the stress levels.

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Daniel Pink has another angle. He claims in his book, Drive, that there is …

a vast mismatch between what science knows and what businesses do.

Business has yet to realize that 21st century people are motivated by intrinsic drivers:

  1. Autonomy – Urge to direct own lives
  2. Mastery – Desire to get better and better
  3. Purpose – Yearning to do that which is larger than ourselves

If this is true for the workforce at large, we know that this especially applies to nurses.

Programs focusing on contextual approaches exist that facilitate quality, leadership, engagement, autonomy and education   Shared Governance, Relationship-Based Care, Transforming Care at the Bedside, The Center for Nursing Excellence, Magnet Recognition.



But how about that greater good …. that which motivates us to be involved with something larger than ourselves?  What efforts exist to create and preserve this motivating factor?

Work place interventions have shown to improve health-promoting behaviors of nurses in numerous studies (Tucker et al), but this approach has limitations. No doubt, wellness programs are challenging for organizations and for individual nurses. They require time, space, money and commitment by the organization and the nurse.

Health-promoting behaviors and practices, among 2247 nurses, were studied by the University of Iowa Hospitals and Clinics and Mayo Clinics. These were defined as multidimensional, “self-initiating behaviors motivated by the desire to improve well-being and actualize human health potential.” (Tucker et al, p 283). The health-promoting behaviors were associated with spiritual growth (inner resources), interpersonal relationships, nutrition, physical activity, health responsibilities, and stress management. The significant finding in this study was the high correlation of the development of inner resources (spiritual growth) with decreases in stress. Neville found same high correlation between health-promoting behavior scale in spiritual growth & burnout & compassion fatigue (2013).


Amendolair found a strong correlation between nurses’ ability to express their caring behaviors (those that brought meaning in their work) and job satisfaction. And Dotson et al found a surprisingly high importance of altruism in attrition prevention; concluding that a sense of altruism can have a buffering effect on the negative aspects in the work environment.

A compassion resiliency program was developed for Barnes-Jewish Hospital to address compassion fatigue, which specifically focused on development of inner resources skills. The education program elements included self-regulation (ability to relax while caring), intentionality (following one’s inner mission), self-validation (perceptual maturation), connection and self-care.  Potter et al studied the impact of this program on nurse burnout and job satisfaction. Their main accomplishment was to increase awareness, acceptance and conversations system-wide about compassion fatigue and resiliency practices. University of Penn established a Center for Nursing Renewal (a space, education, lots of services, etc). [n=500, pre & post satisfaction survey]. They acknowledged the probable need for outside renewal programs.



Acknowledgment of our need for and preservation of the higher good

is always heartwarming.


Amendolair D. Caring Behaviors and Job Satisfaction. JONA, 42(1), January 2012.
Heard PL, Hartman S, Beal BD, Bushardt SC. Nurse Comfort … More That Helpful Hands. Nursing Management, April 2014.
Dotson MJ, Dave DS, Cazier JA, Spaulding TJ. An Empirical Analysis of Nurse Retention. JONA, 44(2), February 2014.
Potter P, Deshields T, Rodriguez S. Developing a Systemic Program for Compassion Fatigue. Nursing Administration Quarterly, 37(4), 326-332; 2013.
Tucker SJ, Weymiller AJ, Cutshall SM, Rhudy LM, Lohse CM. Stress Ratings and Health Promotion Practices Among RNs. JONA, 42(5), May 2012.
Neville K, Cole DA. The Relationships Among Health Promotion Behaviors, Compassion Fatigue, Burnout, and Compassion Satisfaction in Nurses Practicing in a Community Medical Center. JONA, 43(6), June 2013.
Romano J, Trotta R, Rich V. Combating Compassion Fatigue- An Exemplar of an Approach to Nursing Renewal. Nursing Administration Quarterly, 37(4), 333-336; 2013.

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