What Do Nurses Need … In Our High Risk Work Environments?

The AMN 2019 Nurse Survey Results are out and highlight Opportunities for Progress.

This AMN study shrinks our challenges down to a bird’s-eye view.

The Top 2 Positive Influences on RN Quality Care:

  1. Improve safety practices
  2. Improve engagement of nurses

There you have it … Safety and Engagement

How are Engagement, Safety and HWEs Connected ?

Engagement science is the foundation of the AACN Healthy Work Environment (HWE) Standards.  Nurse engagement is framed like this:

Nursing is Stressful,
And stress undermines nurse engagement and authenticity.

 Nurse engagement requires 2 things:

  1. organizational resources to mitigate job and environmental stressors
  2. nurses’ inner resources to navigate personal stressors

We see organizational resources at work supporting nurse empowerment structures:

  • Shared governance, Magnet recognition, Pathways to excellence, professional practice models
  • These programs have reduced job stressors and have improved nursing professional development and practice
  • Their research has demonstrated triple wins in nurse turnover, patient outcomes and costs

Regarding Safety? – We know that these empowerment structures and organizational resources are required to fuel the engine for Safe Work Environments and Safety Practices. And one could say, “now more than ever”.

In regard to organizational resources required to support cultivation of nurses’ inner resources to navigate their personal stressors?  Not so many resources are dedicated to this …

Which leaves us with caring fatigue, burnout, moral distress and depression.  

Authentic Caring Connections – What role do these play in our high risk healthcare jobs?

While …

  • Role of organizations as the engines of healthcare:  to keep nurses safe & mitigate job stressors
  • Safety practices & Nurse engagement are the critical ingredients for quality of care (AMN)

At the same time …

  • Authentic caring connections create meaning and purpose in nurses’ work and require the support of organizational resources and cultivation of nurses’ inner resources (Galuska, Mason, Halldorsdottir/Watson)
  • Meaning and purpose in nurses’ work keeps nurses in nursing (same as above)

Note – Authentic caring connections have a reciprocal nature.  They are both life-giving and life-receiving for both patient and nurses.  Not only does this deep level of caring help patients feel safe and heard in the moment; they also activate a sense of purpose and meaning and can re-commit nurses to nursing.

The Canaries in the Mines-  The Path From Here is Nurse-Centric

Authentic caring connections are nurse-centric.

Nurses’ desire to authentically care can be greater than their inner resources. Nurses can feel alone and disconnected from their original sense of purpose and from others.

“These authentic connections originate within the nurse, spark from a connection between the nurse and patient, are nurtured by the nurse’s internal resources, and can only be sustained by the nurse” (NM, 2017).

How nurses balance stress, stress relief and cultivation of their inner resources is a sticky mess.

It starts with self-care and is personal, individual and voluntary. It cannot be mandated or managed by nurse leaders or organizations.   This makes it complicated for nurse leaders and organizations to take on.

We as organizational leaders not only have to mitigate the job stressors that drive nurses out of nursing, we as nurse leaders must help nurses cultivate their caring consciousness that keeps them in nursing (Getting Real .. 2019).

Authentic caring is like the antidote to healthcare’s global warming,
and nurses are the canaries in the mines struggling to breathe, struggling to survive.

How to Start?  I needed a solution and it had to be practical

How we mainstream caring consciousness cultivation in today’s healthcare environments and cultures is part of the bigger picture, …. that I could no longer wait for.

I had been one of 100s … or 1000s … of nurse leaders who had not had a meaningful impact on nurses and their passion for nursing.

I was at a turning point in my career, and I needed a solution then and it had to be practical.

I do believe that the Wellness Renaissance happening in our daily culture will eventually shift healthcare organizations away from the hard science- body- centric care … over to a more holistic nurse-centric caring.  But not anytime soon.

When I realized that I was on my own, I knew that I would have to shift my mindset – how I viewed my work.  At that point, I shifted what I  talked about … everyday.  I started talking about  authentic caring with nurses.

I knew that this deep level of caring – however momentary and episodic – has a positive impact on nurses, and I wanted to acknowledge their conscious caring and explore it with them to reinforce it.

That Bigger Bird’s-Eye View from the AMN RN Survey 

Yes, there’s more to my story.

But for right now,  from the bird’s-eye view, the story I’m speaking of is the role nurse leaders can have in giving voice to nurses’ authentic connections with their patients to reinforce and honor nurses healing skills, in-spite of the daily challenges you and nurses live daily in our healthcare organizations.

The dual demands of simultaneously slaying the safety dragons And engaging nurses in their sense of purpose and meaning by talking about their authentic caring experiences everyday.. here and there … is doable and it makes a difference to nurses… even when you both are busy.

Here are the Big Picture Benefits:

  1.    For nurses –   Your nurses are longing for those breaths of fresh air in their task-compressed shifts where they are prompted to think and talk about their deep connections with patients.  And when it comes from YOU, even in brief exchanges, has  a double benefit for them;  it makes them feel heard!
  2.  For you, nurse leader – These momentary, meaningful exchanges with nurses about authenticity and connection …  will fill your lungs and brain with fresh air in that moment.  You will get out of your office more, round more, deep breathe more …. and feel better about yourself, and about your nurses … and maybe your work … in different moments throughout each day.

These brief exchanges between you and nurses may not sound like much …  but they are.  The energy  they carry elevates all.

This is how safety, nurse engagement, authentic caring connections, nurses caring consciousness and YOU all  fit together in the course of the day.

“Consciousness sounds radical to the sleepwalker”  (DanielleLaPorte.com)  Your nurses are not sleepwalking.  And neither are you… show them.

  1. Galuska L, Hahn J, Polifroni EC, Crow G. A narrative analysis of nurses’ experiences with meaning and joy in nursing practice. Nurs Admin Q. 2018;2:154–63.
  2. Mason VJ, Leslie G, Clark K, Lyons P, Walke E, Butler C, and Griffin M. Compassion Fatigue, Moral Distress, and Work Engagement in Surgical Intensive Care Unit Trauma Nurses. Crit Care Nurs. 2014;33(4):215–25.
  3. Watson J. Human Caring Science. 2nd Sudbury, MA: Jones & Bartlett Learning; 2012.
  4. McClendon P. Authentic caring: Rediscover the essence of nursing. Nurs Manage. 2017;48:

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