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What’s on Your Mind? The Power of a Question

By Linda Shell, DNP

I recently had the opportunity to be with a group of acute care nurses who had started their nursing careers in long-term care. During our time together, I asked them, “Why did you leave long-term care?” I fully expected them to say it was for more money. To my surprise, they never mentioned money. What they did offer was a reflection on leadership: “Our leaders never listened to us.” When I further explored this statement, I heard stories about changes in staffing that were “announced” and about “sudden changes” in policies and procedures. One nurse described how the electronic medical record seemed different every time she went to work, without any warning or additional education. “They never asked for our input.” Clearly, not being heard is a problem among nurses in long-term care and is one of the factors contributing to turnover. A 2017 Gallup study identified a positive working environment, where people feel energized around the work, as  contributing to increased levels of employee satisfaction and reduced turnover.

Why is it that staff don’t feel heard? Most directors of nursing services (DNSs) are caring and compassionate toward their staff. So what is the root cause of the problem? Much of it relates to the changing environment of long-term care. It seems as if every week there are new policies or regulations to be implemented. Many of these are out of our control. DNSs are busy, busy people. Did I say busy? Most come to work each day just hoping there will be enough staff to cover shifts, no employee issues, and no changes. But that is not the real world. So how does a DNS respond?

First, schedule 10 minutes per day to make rounds and ask staff, “What’s on your mind?” As DNSs, we tend to believe we know what staff are thinking, but unless we ask, how can we truly know? Research suggests this one action can result in building trust and gaining insight into specific stressors of staff.

Second, when conducting meetings, open with the question, “What’s on your mind?” Then listen. Silence can be uncomfortable, but if you wait long enough someone will respond. Staff comments may generate an important discussion that you were unaware needed to be held. Resist the advice monster when someone shares something; just let people talk. Nurse leaders tend to feel they need to have all the answers—that is a myth! The role of the nurse leader is not to answer the questions, but rather to help staff find the answers by asking additional questions.

Third, take care of YOU! In challenging, busy work environments, nurse leaders tend to become task oriented and focus on getting stuff done. DNSs are good at getting stuff done and making things happen. This can result in a move from human being to “human doing.” Human doings are at risk for emotional outbursts, burnout, health problems, and other unpleasant afflictions. Take time for yourself. Spend time doing something you love to do. Research suggests that setting aside time for yourself during the work day can increase productivity. Even as little as 10 minutes focusing on YOU can be a big help.

“What’s on your mind” can be a powerful tool for engaging with staff. It can help you gain insight into their work satisfaction as well as learn what stressors they have that can be reduced or even eliminated. Try it for one week and see what valuable insights you gain from your staff.

Linda Shell, DNP, MA, RN, DNS-CT is a nurse leader and consultant/educator with a passion for developing strong, resilient leaders, effective teams, clinical quality, and healthy work cultures in the field of aging services. She has inspired thousands of leaders to discover their Leadership DNA through her SurTHRIVELeadership platform. For more information on nurse leadership and other topics, visit lindashell.com.

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