Author: Darbyshire, Philip
Date published: August 1, 2010
Journal code: CONU
INTRODUCTION: IS YOUR WORKPLACE MAKING YOU SICK?
I love the old Tommy Cooper joke: 'I came home one night and my wife was crying. I said "what's wrong?" She said "I'm homesick." I said "This is your home." She said "Yes and I'm sick of it".' Most of us will also have heard every variant of the, 'This would be a great place to work if it weren't for the staff/patients/clients/students' gag. And then some.
For many staff however, the state of our health and higher education workplaces is no laughing matter. The research and professional literature is replete with reports of horizontal violence, vertical violence and various other forms of bullying, intimidation and harassment in every other imaginable direction. Blend that with a miasma of other workplace and interpersonal dissatisfactions and it makes for a less than pretty picture (Clarke, 2005; Furåker, 2009; Kristiina & Denise, 2009; Munch-Hansen et al., 2009; Spence Laschinger, Leiter, Day, & Gilin, 2009; Stanic, 2009).
Does it have to be this way? Must our health care organisations and universities be run as joyless, micromanaging, Stalinist fear factories? No, for there are demonstrably better ways. As Gavin and Mason's review showed, 'Organizations have the capacity to create healthy and happy as well productive lives for their members, if only their leaders commit themselves to it' (Gavin & Mason, 2004, p. 390).
In 2009, I heard the great proponent of evidence- based management, Jeffrey Pfeffer from Stanford, speaking about how visionary and determined leaders and managers could transform their workplaces and consequently the professional lives of their staff and ultimately the care of their patients/clients. How CEO Kent Thiry turned a moribund and near-bankrupt dialysis company called DaVita into one of the US's top healthcare companies by investing in education and staff development in support of a genuinely shared vision, as opposed to dumbing down and downsizing, is near-legendary (Pfeffer & Sutton, 2006). Pfeffer also told the story of a Kaiser Permanente hospital in the US where the CEO asked nurses why the staff turnover rates were so high and morale was so low. The nurses described a culture where verbal abuse and disrespect among colleagues were commonplace and said that nurses were voting with their feet. 'Is that it?', the CEO asked, almost incredulously, as if this was a mere trifl e. Leadership action was swift and from that point on, Kaiser adopted a zero tolerance policy towards verbal abuse of nurses. Result? Kaiser demonstrated better nurse retention and attraction following its implementation (Pfeffer, 2007). Now there's a surprise.
TWIST THE KALEIDOSCOPE - CHANGE THE PICTURE
If your workplace atmosphere is unduly pessimistic, negative and cynical, try twisting the kaleidoscope in these ways and start seeing a different picture.
Instead of meetings and discussions being held only when there is a problem (in Scotland we used to call these 'greetin meetings'), why not meet regularly to speak about and acknowledge your ward or unit's nursing successes? The Ritz- Carlton Hotel group is the acknowledged world leader in customer service, the yardstick against which all other hospitality and customer service industries are judged. Every morning in every Ritz-Carlton hotel, all staff1, from managers to housekeepers, gather for what they call a 'lineup' meeting. Here is where they spend 15 min sharing 'Wow Stories' with their colleagues (Gallo, 2008). These are the stories about something they did for a guest that helped make their stay truly special. The Ritz group understands the power of stories and tangible examples in making all of their company values and promises absolutely 'real' for guests.
Imagine if nurses were to do this at the start of every shift. In nursing, we know the power of narrative and story and have done for over 25 years now. This should not be 'new' to us. I remember in the early 1990s editing a series in Nursing Times in the UK where we encouraged nurses to share their stories of when and how their care and skill had made a real positive difference in the lives of patients, clients and families (Darbyshire, 1992). Is anyone going to claim that we are 'too busy' or 'don't have time' for such a 15 min? A Ritz Hotel would be a fairly busy place I imagine, but these regular narrative reminders of why they are there and what they do so well are hardwired into the organisation for good reason. They fi nd the 15 min because they know exactly how much they would lose if they didn't.
Make a personal policy decision to stop telling anyone who will listen that 'Nurses eat their young' (Bartholemew, 2006). It's a great soundbite but one that is surely coming back to bite us all. How much pride, enthusiasm and hope can nurses (and especially new nurses or students) have if the opinion leaders and role models of our profession genuinely believe that this is an accepted professional norm? Let's remind ourselves that nurses also nurture, support, encourage, teach and inspire other nurses to greater heights. Just think of the superb colleagues and mentors who helped you get to where you are today and of the nurses that you currently admire and respect. How much better to tell people about them rather than suggest, as Dilbert does, that 'If all else fails, your co-workers are edible' (Adams, 2009).
If we are unhappy about 'nursing's image', and how nurses are viewed or treated in the workplace, then we have an obligation to do something about it (Darbyshire, 2010). Recognise that as nurses we all have a responsibility for nursing's PR and our public image. If the only stories that you tell people about nursing and your work are horror or war stories, you are part of the problem. When was the last time that you contacted your media or PR department to tell them about a positive nursing intervention, a new care initiative, or skilled nursing response that helped transform a life, strengthen a family or enrich a community?
Practice unexpected acts of gratitude. This isn't some new-age twaddle from 'The Secret' but a practical approach to improving your workplace and its relationships. Most nurses appreciate that being courteous to colleagues, thanking them for their efforts and praising a job well done is fairly basic 'people management' that helps create a positive workplace. So why restrict this to local level? Do you ever send a quick note or email to your CEO or Director of Nursing to let them know that you appreciate what they are trying to do to help improve nursing or the organisation? Do you ever invite them down to the ward or unit for a coffee and a quick update on some of the great results that your team are achieving? Do you ever thank a relative for the valuable contribution that they made to making a patient's stay more tolerable? What did you do today to show the students or new graduates in your ward that that they have made the best career choice possible by becoming nurses?
'YES BUT, NO BUT': WHY THIS WILL 'NEVER WORK HERE'
I can already hear the 'yes but chorus'. Yes, but these CEOs have power. Yes, but we're 'only' nurses. Yes, but that's the business world. Yes but they don't work at MY place. Yes, but 'they' would never allow us to do that. Yes, but we tried that before. Yes but the media don't want good news. Yes, but it's a bad time just now. All partially true and all largely irrelevant. You may not be able to effect global change across your entire organisation but what you can assuredly infl uence and alter is your practice and your responses to people and situations. When you work in clinical practice or in a clinical leadership role; know this. You may never again be in such a powerful and infl uential position from where you can directly infl uence your particular workplace culture. From early studies of the 'Ward Sister' role (Cameron- Buccheri & Ogier, 1994; MacLeod, 1996; Pembrey, 1980) to the latest reports (Offi ce of the Chief Nursing Offi cer, 2008; RCN UK, 2009), the evidence is incontrovertible that the infl uence of this nursing leader (for better or for worse) on the working 'atmosphere' is critical.
CONCLUSION: FROM HOMESICK TO AT HOME
I don't propose that we become Pollyannas and imagine that everything in the workplace world in rosy when it is not. There is a price to pay however for an unfl inching preoccupation with everything that is negative, problematic and unpleasant about either our workplace or nursing as a whole. We unwittingly help perpetuate and sustain such a one-dimensional view if this is all that we ever talk about. Positive self-talk works and we know that words make worlds. Consider how much time we spend in our workplace and how important job satisfaction and what our work means to us are. The dualistic notion that we have a work life and a private or home life that are hermetically sealed off from each other is ludicrous. Heidegger wrote that 'Language is the house of Being. In its home man dwells. Those who think and those who create with words are the guardians of this home' (Heidegger, 1947/1977, p. 193). How much more productive, satisfying, meaningful, fulfi lling, creative and enjoyable all of our time would be if we felt 'at home' and 'houseproud' in our workplace instead of 'homesick'.
1 Ritz-Carlton of course do not have 'staff '. They have 'ladies and gentlemen serving ladies and gentlemen'. The difference is not just semantic but profound.
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Philip Darbyshire Consulting Pty Ltd, Adelaide, SA, Australia; University of Western Sydney, Sydney, NSW, Australia; Honorary Visiting Professor, Swansea University, Swansea, UK; Bournemouth University, Poole, England