Creating A Culture That Retains

Creating a Culture that Retains

By Kirsten Ferren, MSN, RN

Leaders have numerous, diverse topics of concern to address daily, weekly, and yearly.  We worry about retention and turnover.  We think about budgets and productivity.  We communicate robustly around patient satisfaction and error reporting.  We educate consistently around best practices and new initiatives.  There is no doubt that the complexity of healthcare leadership today, perhaps more than ever before, is especially challenging. 

One area that may not get enough of leadership’s attention is addressing the culture of the unit, department, or the entire organization. ³ Many leaders are unaware of the culture they are cultivating or that the team embodies. Yet creating a culture that empowers and retain staff is now an essential component of nursing leadership. ⁴

Addressing department culture can feel difficult, overwhelming, and sometimes futile.  Many times, dysfunction in the workplace culture is so embedded it can be difficult to make key changes to improve the environment for staff.  As we address the ongoing issues with burnout, stress, and staff turnover, one leadership tool we can utilize to improve retention is to create a department culture that is welcoming, accountable, and psychologically safe. 

A positive culture within a healthcare setting can significantly impact staff morale, patient outcomes, and overall organizational success. When leaders prioritize culture, they foster an environment where employees feel valued, supported, and motivated to perform at their best. This, in turn, leads to higher retention rates and a more cohesive team. ¹

Assessing five key components of culture that include team dynamics, leadership engagement, communication, psychological safety and the system support structure can help you assess and create a culture that is welcoming, accountable and sustainable.

Utilize the following questions to perform a culture assessment on you team or organization.  The answers can be used to design an action plan to create a culture that retains your best staff.

• Start with an assessment.
  • If you do not know the answers to these questions you have a culture problem.
  • Answering these questions is the beginning of creating a roadmap to a better work culture.
    • The team
      • How is the team getting along?
      • Are there reports or evidence that staff are fighting with each other?
      • Is bullying and bad behavior tolerated by other members of the team? By the leadership?
      • Are there silos within the team?
      • Is there inequity in the workload?
      • Do poor performers take all the attention?
      • Does the culture include staff supporting each other or working against each other? ²
    • The leader
      • How do people get along with the leadership?
      • Do staff view leadership as an unapproachable hierarchy or as part of the team?
      • As the leader do you know what is going on? Will staff tell the leader about issues and concerns?
      • Do leaders listen and seek input, or do they make unilateral decisions?
      • How present are the leaders to the front-line team? ²

• Communication
  • Does the team know what is going on?
  • Are staff kept up to date on changes in the workplace?
  • Do staff voice that there is frequent miscommunication or rollouts that have not been communicated?

• Psychological Safety
  • Do staff feel like they can speak up without fear of retaliation from peers, leaders, others?
  • Are people able to make mistakes with learn from them without fear, punishment, or embarrassment? ²
  • Will someone on the team show them the right way?
• System
  • Does the system have processes, policies, and initiatives in place that support employees mentally, physically, emotionally? ³
  • How many of those are mandatory?
  • What opportunities are there for creativity, growth, and ongoing development?
  • What/who supports the leaders so that they can do the vital work of improving and creating a culture that retains?

As you document the answers to these questions you will start to create a roadmap of how to address and improve the culture in your department or organization.  Next steps include creating an action plan for the answers you do not feel live up to the example and standards of your organization or your leadership.  Start with one or two questions and begin to develop a plan to address those concerns. 

It is rare to find a workplace culture that gets all these components correct 100% of the time.  Knowing where your team stands and keeping an eye on areas that can impact workplace culture negatively is essential to improving retention of our staff.

We discuss many issues today that would have never been discussed years ago.  We must dialog around culture at the center of our leadership discussions to continue to create a sustainable healthcare culture.

1. Majeed N, Jamshed S. Nursing turnover intentions: The role of leader emotional intelligence and team culture. J Nurs Manag. 2021; 29: 229–239. https://doi.org/10.1111/jonm.13144
2. Róisín O’donovan, Eilish Mcauliffe, A systematic review of factors that enable psychological safety in healthcare teams, International Journal for Quality in Health Care, Volume 32, Issue 4, May 2020, Pages 240–250, https://doi.org/10.1093/intqhc/mzaa025
3. Wu, Ashley MHS; Roemer, Enid Chung PhD; Kent, Karen B. MPH; Ballard, David W. PsyD, MBA; Goetzel, Ron Z. PhD. Organizational best practices supporting mental health in the workplace. Journal of Occupational and Environmental Medicine. December 2021. 63(12):p e925-e931, DOI: 10.1097/JOM.0000000000002407
4. Bally, Jill MG. The role of nursing leadership in creating a mentoring culture in acute care environments. Nursing Economic$.2007; 25.3.