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Nursing is challenging work. Burnout, dissatisfaction, disengagement, as well as exodus from the profession are rampant, and COVID-19 has amplified these issues. Although nurse leaders cannot change the work, they can create work environments that support nurse satisfaction, enjoyment, and meaning at work. A literature review on work environment and job satisfaction conducted pre-COVID for a dissertation project revealed several factors that support healthy work environments. This article defines and describes the qualities of both unhealthy and healthy work environments, discusses the impact they have on employees, and offers suggestions for nurse leaders to improve the work environment in their organization.
The psychosocial work environment is created by the interactions of staff and leadership and impacts how people behave and how they feel about their work.
Work environment and the experience one has at work impact employee health, well-being, and satisfaction.
Managers play a key role in creating and supporting the psychosocial work environment.Health care is challenging work; it is emotionally and physically demanding. The environment within which work is performed can either support or hinder productivity and worker health. Toxic and unhealthy work environments create negative outcomes for staff, management, and the organization, as well as the community at large because the individual returns to the community following interactions in the work environment. Facing escalating suicide rates, burnout, turnover, and exodus from health care professions, leaders seek new ways of managing staff to support personal and professional well-being.
COVID-19 has amplified and intensified these issues, especially within the nursing profession. The pandemic has shined a spotlight on the problems faced by nursing professionals and the damage the problems cause physically, mentally, emotionally, and spiritually. Strategies for improving the nursing work environment are more important than ever before.
Although nurse leaders cannot necessarily change the work, they can behave in ways that support the workforce by creating safe, healthy work environments where all staff can be their best, be productive, and thrive. Managers play a key role in shaping the work environment through the procedures they implement and how they behave as a leader. A literature review conducted pre-COVID on work environment and job satisfaction revealed several factors that support a healthy work environment. Nurse leaders can use this information to inform decisions that will shape the future of health care today by creating work environments that support staff well-being and increase employee engagement and organizational commitment.
Health care workers must create a safe space for patients to heal and improve. Because the nature of nursing service work is about caring for people, there is great personal responsibility for providing good, high quality service; connecting with patients; and caring for patient well-being. 1 High workloads, increased acuity, and emotional demands for caring for other’s well-being places physical and emotional demands on staff. Because nursing professionals typically assume great responsibility in providing quality care, they often put the needs of others first and do whatever is necessary to help the patient. This often means working long hours with little opportunity to rest and recover.
The nature of health care places staff at risk due to the stressful situations faced daily. Combine the normal demands of health care service with a lack of teamwork, poor communication, bullying, lateral violence, lack of support from leadership, equipment issues, a blaming and fearful culture, an inability to share one’s expertise or make decisions, and a work environment that discourages free expression of ideas and concerns, and this becomes a recipe for disaster.
The work environment is the space that we create within which people come together to perform their work and achieve outcomes. It’s how we experience our work together. Also known as psychological climate, the work environment causes a psychological impact on the individual’s well-being. 2 The person–environment interaction determines the psychological and social dimensions of that environment, which then influences how one behaves in that environment. 3 This is an important definition because how the individual behaves in the environment and the reactions to that behavior then determines how the environment supports continued actions within that environment.
Feelings of satisfaction or dissatisfaction occur in response to the individuals’ experience within the environment. In other words, satisfaction is an emotional response to the job and results from mentally challenging and interesting work, positive recognition for performance, feelings of personal accomplishment, and the support received from others. 4 This corresponds with the research on burnout, which is contrary and includes cynicism, exhaustion, and inefficacy. 5 Researchers found burnout to be a function of factors within the organizational context including work environment and leader effectiveness. 6 Whether positive or negative, research concludes that leader effectiveness and work environment affect employee outcomes.
As social beings, the environment created by the interactions of staff and leadership impacts how people behave and how they feel about their work. The experience people have at work impacts their personal well-being as well as job satisfaction. The occupational health movement of the 1960s grew from a need to explore the environmental hazards that created dangerous conditions for workers and to provide adequate safety interventions for protecting employees. 7 Over the past few decades, much research has focused on the psychosocial impact of the work environment on individual health and well-being.
The psychosocial work environment encompasses those factors that impact individuals and contribute to worker health, including both individual factors and the social work environment. Psychosocial factors include work demands; work organization including influence, freedom, meaning of work, and possibilities for development; interpersonal relations such as leadership and coworkers, a sense of community, role clarity, feedback, and support; and individual health and personal factors, including one’s ability to cope and family supports. 8 All these factors come together to create a space within which people interact and perform. Depending on how these elements support or hurt the individual determines the outcomes to that individual and how effectively they perform.
The pandemic has forced people to explore their personal resources for well-being and resilience and implement self-care strategies. People are taking more of an interest in health affirming activities. Family time has a different meaning today and people are re-exploring their priorities. Restorative practices have been found to lessen the sufferings, anxieties, and concerns generated in the workplace and provide inner peace and spiritual support. 9 Assuming responsibility for one’s health and well-being is important to being a contributing member of the workforce and to society at large. Managers must find ways to support these efforts as part of life at work.
Several factors contribute to a negative work environment. Traditionally, poor salaries and working conditions, and a lack of respect for nurses have led to high turnover and an increase in nurses leaving the profession. 10 Other factors include the lack of support, being short staffed, and an increased workload. 11 Lateral violence, bullying, and abuse by coworkers and physicians, as well as ineffective responses to such incidents by leadership, cause job strain, turnover, and exodus from the profession. 12
Much research has been done on bullying and its impact on the individuals involved, the organization, as well as the quality of patient care. Researchers found these negative behaviors led to increased errors, decreased quality, absenteeism, lost productivity, and turnover. 12 As the profession of nursing is already struggling to retain the nursing workforce and attract needed newcomers, creating a work environment that is supportive, satisfying, and one where people feel a sense of belonging is essential.
The stress and strain of work has been linked to physical and mental health issues. Unhealthy work environments lead to increased use of sick time, lost productivity, turnover, increased cost to care provision, and strain felt in personal relationships. 13 The costs in terms of absenteeism, turnover, and lost productivity are estimated in the billions of dollars annually. 14
Nurse leaders play a key role in creating work environments where people feel safe by implementing procedures for minimizing bullying and lateral violence and facilitating harmonious relationships by supporting respectful interactions. 12 , 13 , 15 Left unattended, the cycle of bullying and bad behavior is perpetuated as nurses move into academia from the bedside and continue the behaviors. 15 Although one of the toughest things to do as a leader, and the most time-consuming, upholding expectations and following through on such procedures is critical for creating a supportive and safe work environment.
A healthy work environment is described as one where people are valued, treated respectfully and fairly, where personal and professional growth is supported, communication and collaboration are championed, and there is a sense of community and trust at all levels, which enables effective decision-making. A healthy work environment comprises competent employees, appropriate workloads, effective communication, collaboration, and empowerment, which leads to positive outcomes for patients, employees, and the organization. 14 The American Association of Critical-Care Nurses identified 6 areas for establishing and sustaining a healthy work environment including skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership. 16 These align with the practices identified in psychologically healthy workplaces which emphasize employee involvement, work-life balance, employee growth and development, employee recognition, and health and safety. 17
A healthy and safe work environment correlates significantly with job satisfaction as well as other positive employee outcomes including engagement, productivity, and organizational commitment. Additionally, when people feel good and experience satisfaction at work, they report increased self-efficacy, autonomy, higher levels of personal accomplishment, and organizational commitment.
Significant qualities identified in the literature on healthy work environments are presented in Table 1 . Those include areas of collaboration and teamwork, growth and development, recognition, employee involvement, accessible and fair leaders, autonomy and empowerment, appropriate staffing, skilled communication, and a safe physical workplace. 18 Other factors contributing to satisfaction and retention include positive orientation experiences, good teamwork, clear procedures and instructions, appropriate workloads, managerial support, and autonomy. 11 Additionally, leader support and leader effectiveness protect against negative consequences from a stressful environment, 19 contribute to the provision of high quality and timely care, 20 decrease burnout, 6 and reduce turnover. 21
Key Qualities Found in Healthy Work Environments
Acknowledgement, appreciation, and support 20 Autonomy, involvement in decision-making 11 Clear communication 4 , 11 , 16 , 20 Leader authenticity and effectiveness 16 , 18 , 20 Respectful interactions 14 , 18 Opportunities for personal and professional growth 14 , 17 , 18 Teamwork and collaboration 11 , 16 , 18 , 20 , 21 Trust and safety 5 , 14 , 17 , 20Nurse leaders can take a proactive role to shift the work environment and create the space for health and well-being, and for nurses to thrive at work. There are 2 aspects to changing the work environment. The first is creating and communicating a new vision, setting the tone, being clear about expectations, and ensuring staff understand that what was tolerated previously may no longer be acceptable. Nurse leaders must ensure staff know what is being asked of everyone and paint a picture for how it will feel in the new environment. And second, nurse leaders must uphold the new standards by teaching staff new ways of interacting and correcting behaviors when they do not align with the new vision.
A collaborative approach with positive interactions and active participation requires nurse leaders to encourage and facilitate teamwork. Staff rely heavily on interpersonal relationships and teamwork for cooperation, collaboration, and safety. 20 Interpersonal relationships are a key element of satisfaction at work. Collaboration, professional cohesion, and positive interactions with colleagues help create a sense of value and become a buffer for the demands of managing complex and challenging patients. 21 Nurse leaders need to champion teamwork and collaboration to ensure that staff work together to accomplish required work demands. Respectful interactions must be encouraged, and disrespectful ones addressed promptly and eliminated.
Nurse managers, through their behaviors and attitudes, create an environment which induces motivation, they demonstrate belief in their ability, listen thoughtfully, and bring out the best in the team. Nurse leader behavior directly impacts job satisfaction, morale, and employee performance which are critical factors to organizational success. Effective communication by leaders includes honesty, respect, good listening, and empathy, which impacts team effectiveness and outcomes and can create an environment of inclusiveness that supports team members to aid in their retention. 22 The leaders’ failure to address employee feelings and not win their respect leads to the failure of the manager, increases the stress of the team, and decreases organizational effectiveness. 15
Other themes in the literature include the use of acknowledgement and appreciation to help employees feel valued. Nurse leaders can find ways to coach, encourage, recognize, and support their staff and create an environment that reinforces the positive feelings that come from celebrating one another. It requires attention and consistent effort, but the effects are very impactful. Formal and informal acknowledgement serves to garner positive feelings within the work environment and can spread throughout the team.
Another important factor for job satisfaction is autonomy or job control, the ability of the individual to make decisions impacting their work. Staff who are permitted a sense of autonomy, and the perceived capacity to influence decisions at work, reported higher levels of personal accomplishment and lower rates of burnout. 11 Nurses need a work environment that offers respect and supports their scope of practice. Nurse managers can assist individuals to gain job control by ensuring adequate onboarding and orientation, ongoing training, and promoting an environment where questions and asking for help are encouraged and supported.
Organizations that offer opportunities for personal growth and professional development have a competitive advantage. Some individuals enjoy the bedside and want to remain there for their careers, yet they still want to learn, grow, and develop within that scope of practice and they want to be recognized and appreciated for their years of service. Other persons may want to advance in their roles and responsibilities. Nurse managers must take an interest in the individuals on their team, discover their desires for learning and growth, and identify their strengths so they can find ways to maximize them.
Although the pandemic has shifted people’s attention to the self-care strategies implemented by individual employees, caring for employee well-being must include management strategies that support a healthy, safe work environment. The problems facing the health care workforce—burnout, stress, disengagement, and dissatisfaction—existed well before the pandemic and will continue to exist after it unless leaders change their approach to the work environment and how people behave within the workspace. Now is the time to envision a new work environment and to do things differently so that nurses, health care leaders, and workers at all levels can be productive, engaged, and thrive at work. By attending to the psychosocial work environment, health care can course correct for the factors troubling the health care workforce today and produce different outcomes—satisfaction, enjoyment, growth, joy, and meaning.
Julie Donley, EdD, MBA, BSN, RN, PCC, is an ICF professional certified coach, certified team coach, author, speaker, award-winning thought leader, adjunct professor, and prior executive nurse in behavioral health. She partners with established and aspiring leaders so they lead with confidence, communicate effectively, and create work environments that support the wellbeing and productivity of employees and create a fulfilling work experience. Visit her online at www.DrJulieDonley.com.
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