Retaining New Nurses: The Six Keys to Nursing Success

The good news is that the nursing profession is attracting younger nurses. The bad news is that many of these younger nurses change jobs within the first year.

Each nurse hire costs the organization about $65,000 according to HR professionals. Many hospitals have initiated programs to increase retention of nurses; however, most of the programs only address the extrinsic issues – not the intrinsic issurs.

Other retention program work from the “outside in” – the Shift Change Coaching Program works from the “inside out”. When nurses, both young and seasoned, learn the Six Keys to Nursing Success they will stay in the profession longer and provide higher quality patient care.

The Six Keys to Nursing

Success are:
1. Shift from the one up role to equal partnership. Be intentional when you leave work to shift out of work mode.

2. Shift from selflessness (being last on the list) to self care. Practice self care before nursing care.

3. Shift into balance in your work and professional life.

4. Shift from no boundaries to healthy boundaries. Learn how to say no.

5. Identify your passion so that you find the “best fit” in your nursing profession.

6. Clarify your values and make sure your values align with those of your employer.

By integrating the Six Keys to Nursing Success into orientation programs and into school nursing curriculum, organizations will retain nurses and discover higher patient care and satisfaction.

Contact Betsy Smith or Merrily Sable for more information at Shift Change Coaching Group.

Welcome to a new decade and 2010!

We are excited about shifting from the challenging economy and “on hold” mentality of 2009 to the freedom of moving to opportunities and possibilities in 2010.   By the time you read this newsletter, about 94% of you will have made and already broken your New Year’s resolutions.  It is time to regroup, take action and move forward! We will help to jumpstart your year by introducing Shift Change Coaching’s Six Keys to Leadership series.  Just like our foundational Six Keys to Nursing Success, these Leadership Keys are valuable assets for your personal and professional life.

In the December 2009 newsletter, we invited you to begin identifying your personal and professional leadership roles. We posed the question, “Should you lead, follow or get out of the way?”  There is accidental leadership and then there is purposeful effective leadership.  The Peter Principle is the theory that employees within an organization will advance to their highest level of competence and then be promoted to and remain at a level at which they are incompetent.  In nursing that is demonstrated when the best staff nurses are the ones promoted to management positions with little or no training.  Many of these nurses don’t have a desire to lead but are following the next step offered to achieve an increased salary or improved working hours.

One of our nurse coaching clients shared that she was “promoted” to a management position with no salary increase and actual increased hours to accommodate the staff and management nursing roles.  This is not an unusual occurrence in the current nursing climate.  Is this the solution to effective nursing leadership and fulfilled nurses who desire to stay in the profession long term?

The Six Keys to Nursing Leadership guide nurse leaders/managers to shift from a hierarchical model to functioning more in professional collaboration practicing the coach approach to leadership.

1. Respect/honor – how do leaders show respect, and how do they earn it?  Honor self – honor each other – honor others
2. Communication – how to shift to clear and valuable communication using powerful language, critical conversation for conflict resolution, and creating purposeful and respectful interactions
3. Courage –how to make the shift to leader, develop confidence in yourself and others and inspire those you lead
4. Recognition – celebration and acknowledgment, intrinsic versus extrinsic rewards, giving yourself credit
5. Trust – integrity, honesty and accountability for yourself and others; confidentiality
6. Passion – find the best fit, empower others to succeed, be the cheerleader, discover the passions of those you lead and utilize them

Respect/honor, the 1^st key, is the foundation of effective leadership.  Utilizing the Shift Change Coaching logo above, the 3 pillars on the left side of the bridge represent the leaders and the 3 pillars on the right represent the followers or the team.  The bridge represents a two-way street where the leaders respect and honor the followers and the followers respect and honor the leaders.  The arch over the bridge represents the organization embracing this culture of honor and respect.  This type of mutual relationship results in a win-win situation often reflected in the quality of patient care, happy satisfied workers, greater productivity, increased cost effectiveness and decreased staff turnover.

How do you as a leader in your personal and professional roles show and earn respect and honor from those you serve?  Here are 3 suggestions; (1) Know your team members – ask how they are, what they need and what they are happy about  (2) Give frequent feedback, both positive and “needs improvement” (3) Set clear expectations and hold yourself and your team accountable.

Self-respect is essential.  A true leader is someone who is a role model and walks their talk as well as being able to admit their mistakes and shortcomings.  A leader remembers they are but one member of the team.

How does your leadership measure up to the six keys?  Are you seeing low morale, staff confusion, errors in patient care, high number of incident reports and call outs, frequent staff turnover or other crisis issues?  Work with Shift Change Coaching to implement the Six keys to Nursing Leadership.  Build the foundation to promote excellence in leadership.  Convenient teleclass or in-person workshop formats are available.  Schedule now as our 2010 is filling up fast!

In the February issue we will discuss the 2^nd Key to Nursing Leadership, communication. In the meantime, please visit our Shift Change Blog and let us know your ideas and challenges around nursing leadership.

Warm regards,

Merrily Sable, RN, BSN and Betsy Smith, PhD

Six Keys to Nursing Success Review

Thank you for your continued interest in The Shift Change Coaching Group’s Monthly Newsletter! We have enjoyed communicating the Six Keys to Nursing Success over the past 6 months and are excited to bring you the Six Keys to Nursing Leadership in the New Year.

To review, the Six Keys to Nursing Success are as follows:

1. Shifting from the “one- up” position (as the expert, mentor, caretaker) to equal partnership
2. Shifting from selflessness (being last on the list) to self-care
3. Creating work/life balance
4. Establishing boundaries
5. Identifying and learning to live their passion
6. Discovering and integrating personal values into their life

We encourage you to continue to practice these as foundational elements for your personal and professional life as we introduce the Six Keys to Nursing Leadership.

This begins as an introduction to our series of articles on our Six Keys to Nursing Leadership.  Should you lead, follow or get out of the way?  We invite you to take the first step by becoming aware of you leadership roles in your personal and professional life.  Please note the exercise in this issue’s “Personal Practice Tip (PPT)” section to help you identify your leadership roles.

Leadership is near and dear to our hearts. We have both served in many leadership roles in nursing or academia as well as in our present field of professional life and business coaching.  You may have heard that leaders are “born not made”.  We beg to differ.  You may have the tendency, the personality and even the desire to be a leader but that doesn’t necessarily prepare you to be an effective leader.

How many nurse leaders do you know that have been promoted to “leader/manager” because they were exemplary nurses, yet were never given any leadership development training? This can be a very uncomfortable place for the new nurse leader, the staff and the patients. A common business quote is “people go to work for an organization and they leave because of the boss”. Leadership is not for the faint at heart.

Effective leadership requires passion and skill building.   Nurse leaders/managers are often caught in the middle – between administration, staff, patients and families. Too often, a promotion to leader/manager means more responsibility and often added work hours without a growing paycheck.  Leadership training is important so the new leader does not become frustrated and leave rather than lead.  Repercussions of inadequate leadership skills are high turn over, absenteeism, a toxic organizational climate, and poor quality patient care to name a few.

The Six Keys to Nursing Leadership guide nurse leaders/managers to shift from a hierarchical model to functioning more in professional collaboration practicing the coach approach to leadership.

Here are the Six Keys to Nursing Leadership:

1. Respect/honor – how does the leader show respect, and how do they earn it?  Honor self – honor each other – honor others
2. Communication – how to shift to clear and valuable communication using powerful language, critical conversation for conflict resolution, and creating purposeful and respectful interactions
3. Courage –how to make the shift to leader, develop confidence in yourself and others and inspire those you lead
4. Recognition – celebration and acknowledgment, intrinsic versus extrinsic rewards, giving yourself credit
5. Trust – integrity, honesty and accountability for yourself and others; confidentiality
6. Passion – find the best fit, empower others to succeed, be the cheerleader, discover the passions of those you lead and utilize them

Watch for the January 2010 newsletter where you will find out more about Shift Change Coaching’s 1^st Key to Nursing Leadership!

In the meantime, we want to thank all the clients of Shift Change Coaching this year, both organizations and individual nurses alike.  You have inspired us with your tenacity, wisdom and willingness to shift to new heights personally and professionally.  You have rewarded us with excellent positive feedback regarding the value of our work and offered much encouragement for us to continue bringing coaching into the nursing profession.  We wish you and your loved ones many blessings and joy this holiday season and look forward to serving many more of you in the New Year!  .

Warm regards,

Merrily Sable, RN, BSN and Betsy Smith, PhD

The Six Keys to Nursing Success Series 5th Key- Identify and Live Your Passion

When you operate from your passion you find your “best fit”. Why is “best fit” important? Life purpose itself is at the root of our being, the essence of who we are. It is fundamental, foundational. And it is as much about being as it is about doing. This makes it difficult to comprehend and describe, because our egos perceive our life and the world through doing. Many modern languages describe doing with far greater precision than they describe being, who you are.
 
Knowing your Life Purpose makes life more meaningful, significant and fulfilling. It is a rudder for decision-making in your life. Our Life Purpose is our path of maximum potential. Why am I here? What path gives the most benefit to me and to others? The world?
 
For you new nurses, knowing your purpose and passion before you take that first job, will give you new and valuable criteria to make that choice and greatly increase the odds you will stay in the position longer, be happier and more fulfilled. It has been reported that one out of five new nurses leaves their position in the first nine months. They may go to another nursing position; however, it costs the institution at least $60,000 to fill that position and the nurse leaving has to adapt to a new environment and new colleagues. Change can be challenging, even when you choose the change, but basing these choices on what is purposeful for you and what you are passionate about, makes your new path much easier, more fun and more exciting!
 
The path of experienced nurses is much smoother when you are also in tune with your purpose and passion. What criteria did you utilize in making you current job decision? Are you in the best fit for you in your profession? Are you passionate about your work or do you dread the sound of your alarm? Rethinking your choices aligned with your purpose and passion will give you new insight to either validate your current choice or get you thinking of new possibilities.
 
When you are working “on purpose” or in an area you are passionate about, how does that feel? You may still get tired but you are energized about the activity and, guess what, it may actually get done faster!
 
When you are working in an area you are not passionate about, how do you feel? (Exhausted, time stands still, nothing goes right…)
 
When you are living on purpose you are living life at a whole new level. What shifts can you make to be living more on purpose? Please think about this more and take this thought with you. For those of you who choose to work with us further in longer workshops, teleclasses or individual or group coaching, we go into this in more detail.
 
Your choices aligned with your purpose and passion are also influenced by your values and the vision you create for your life which will be discussed in Shift Change Coaching’s 6th Key to Nursing Success in the November Newsletter. Until then, practice the 1st five keys and report your ideas and successes on the Shift Change Blog @ www.shiftchangecoaching.com.

Six Keys to Nursing Success Series – 4th Key – Establishing Boundaries

There are 6 essential keys for nurses to embrace to move from surviving to thriving in nursing: Shifting from the “one- up” position (as the expert, mentor, caretaker) to equal partnership Shifting from selflessness (being last on the list) to self-care Creating work/life balance Establishing boundaries Identifying and learning to live their passion Discovering and integrating personal values into your life This is the 4th in our nursing success article series with the overview of each of these essential keys. The 4th key is establishing boundaries. The key is to shift from having no boundaries or weak boundaries to setting healthy boundaries in your personal and professional life. When you learn to set and maintain healthy boundaries for yourself and with others, you will discover your time becomes filled with activities of your choice instead of everything you “ought to”, “have to”, “should do”. Get clear on what you will, or will not allow into your life. The basis of boundary setting is the ability to say “no” and not feel guilty. Saying no seems to have become an art form, something people think they can’t do.  We are caught up in our busyness with the favorite line being, “Oh, I just don’t have time”.  Yet, we say yes anyway.   Schedules are frantic.  Exhaustion, frustration and the never-ending impatience are common.  Words like guilt abound.  Do you feel like a hamster on a wheel with no idea how to get off? One-way is to set personal and professional boundaries.   Just say no – Yes you can! Build a foundation for establishing boundaries by clarifying your values, passions and purpose in life.  These are longer coaching conversations than this article can address, but getting clear about your satisfaction versus your busyness in all areas of your life is a great first step.  Where are you in your life right now and where do you want to be?   Where is it meaningful for you to say yes and how often? Start where you are.  Are you one of those “too nice” people who always say yes?  Start by practicing your “no”.  Practice with a friend.  Practice in front of a mirror.  Practice your no without justifying your answer.  Adding a complimentary phrase such as, “Thank you for thinking of me, but I am unable to attend.”  is appropriate. Other responses are “I appreciate your kind invitation but I must say no.”    “I hear your situation but I am unable to help in that way.” You may want to offer an alternative resource.  “I can’t take you to work but I believe our friend Sue goes that way each morning so you may want to try her as a resource.” Decide your criteria for saying no ahead of time. Put a positive spin on it. Decide your 3-4 yes criteria.  For example, you may decide you only say yes if something is financially wise, aligns with your values and fun.  If a situation does not pass your 3 or 4 yes criteria, then the answer is no.  Sometimes the best yes in your life is actually a no.  Make sure the “no” handles the situation now.  No does not mean maybe, next time, etc… What yes creates fulfillment, meaning and fun in your life? You will be giving more of your authentic self to those in your life and those you want to make a difference with by setting your boundaries firmly.  You cannot give what you don’t have.  Giving of yourself in ways that are detrimental to you, your health, well being, your family, colleagues and friends results in an unfulfilling life. Say yes to your purpose and passion and no to busyness, stress and heartache.  It’s all about making the best, most purposeful choice for you. Exercise good choices so that you and those around you will reap the benefits over and over again.  What will you say no to today to create room for your best fit of yeses? Just say no -  Yes you can! Do you see yourself being very busy in very unsatisfying areas of your life?  Or, expending lots of energy tolerating an area of your life where you just can’t say no?  Is your time and effort filling up your calendar in areas that you are far from passionate about?  Use a strategy designed by Marcia Wieder, CEO of Dream University in San Francisco, California and “turn your calendar right side up”.  Marcia advises to “say no where you have a choice” to things about which you are not passionate, things that don’t bring you joy and fulfillment.   Going to work or picking up your children are responsible choices.   However, volunteering in an area where you are miserable and resentful only because volunteering is a “good thing to do” and you feel obligated to do so is not a positive choice in your life. Enjoy your newfound freedom by spending time in activities you have consciously said yes to.  Getting rid of many “shoulds”, “ought tos” and “have tos” will energize you and create greater meaning in your life. The most valuable boundaries you choose are also influenced by your purpose and passion which will be discussed in Shift Change Coaching’s 5th Key to Nursing Success in the October Newsletter.  Until then, practice the 1st four keys and report your ideas and successes on the Shift Change Blog @ www.shiftchangecoaching.com.

The Six Keys to Nursing Success Series 3rd Key- Creating Work/life Balance

There are 6 essential keys for nurses to embrace to move from surviving to thriving in nursing:

1. Shifting from the “one- up” position (as the expert, mentor, caretaker) to equal partnership
2. Shifting from selflessness (being last on the list) to self-care
3. Creating work/life balance
4. Establishing boundaries
5. Identifying and learning to live their passion
6. Discovering and integrating personal values into your life

This is the 3rd in our nursing success article series with the overview of each of these essential keys. The 3rd key is Creating work/life balance (inside and outside the organization).

Creating work/life balance is a process and one that is ever changing from day to day.  Reevaluating where you are as an individual and your part in fulfilling the vision of your organization on a regular basis is essential.

For organizations, the “new” healthy workplace is at least a combination of a hierarchy and collaborative model and ideally, all collaborative.  Creating balance and meaning within the workplace and life keeps us at our happiest and most productive. Employees skilled at life balance show up, give quality care and stay in the profession longer.

Strive for a balanced life now. Get clear on your definition of life balance. All work and no play makes Jack a dull boy! Is your life all about responsibilities and little enjoyment?  When was the last time you did something just for you?  Are you taking time to be still and reflect on your present life and what you wish for your future?

For organizations, is it all about what’s not working or also emphasis on a job well done?

What systems and resources are working well that can provide a foundation for excellence? The healthy balance lies in considering all these things to support continuous quality improvement and recognition of existing successes.

For the individual, living a balanced life doesn’t necessarily mean spending equal time in each area of your life. It does mean finding balance in your roles as giver and receiver. Take care of others and give to others a portion of your time versus 100% of the time.  Dedicate time for self-care, learning and replenishing yourself on a regular basis.  Who are you passionate about being and what are you passionate about doing?

What is your detailed picture of a typical day in your dream week?  Dream life?  If you see a gap between where you are and where you want to be, what action step are you willing to take this week towards the future you desire?  If you are not sure, go back and set aside time to create the specific details so you can clearly see the life you want.

Where do you see yourself in your dream nursing career?  Are you there yet?  If not, get clear and then create stepping-stones to reach those goals.  Any obstacles in your way are simply challenges to be overcome.  Elicit help from others to support you on this journey.  Create a Dream Team.  A Dream Team is everyone you know and everyone you don’t know that can help you achieve your dreams. Make specific requests for ideas and assistance and make it easy for others to say yes!  (Example;  “Can you give me some advance practice scholarship information resources?”  Vs. “Can you help me become a Nurse Practitioner?”)

Internalizing and practicing the Six Keys to Nursing Success is critical in moving nurses from surviving to thriving!  The September issue of the Shift Change newsletter will explore the 4th key to nursing success.  Until then, practice the 1^st through 3^rd keys and report your ideas and successes on the Shift Change Blog.

*For those of you who want more of this work for yourself or your organization, we offer life balance teleclasses or on site workshops and individual and group coaching.

The Six Keys to Nursing Success Series: 2nd Key – Shifting From Selflessness (being last on the list) to Self-care

The Six Keys to Nursing Success Series

2nd Key- Shifting From Selflessness (being last on the list) to Self-care

There are 6 essential keys for nurses to embrace to move from surviving to thriving in nursing:

1. Shifting from the “one- up” position (as the expert, mentor, caretaker) to equal partnership
2. Shifting from selflessness (being last on the list) to self-care
3. Creating work/life balance
4. Establishing boundaries
5. Identifying and learning to live their passion
6. Discovering and integrating personal values into your life

This is the 2^nd in our nursing success article series with the overview of each of these essential keys. The 2nd key is shifting from selflessness (being last on the list) to self-care.

A shift is defined as a change, transfer or transformation; to exchange one thing for another; to provide for one’s own needs (or the needs of the organization); a change in attitude, judgment or emphasis;

We define the shift in this 2nd key as shifting from caregiver to practicing extreme self- care. Awareness of the shift is the 1^st step.  Then focus on specific actions that queue you in to consciously making the shift each and every day.  The average tendency is to take care of everyone else first before yourself. This is stereotypically even truer of women than men.  As a nurse, you ARE THE caregiver.   But, you can’t give what you don’t have! 

Strive to fill yourself up to overflowing by adopting personal practices in all areas of your life that support your physical and mental well being.  Denounce the “old school” beliefs that the “cup is half full or half empty”.  By filling yourself up to overflowing you create reserves so that when you give of yourself, your time and efforts you are not depleted, spent and burned out.

Personal Practices are daily healthy habits that support you in every area of your life.  (Examples: exercise, drinking water, good nutrition. sleep, yoga, reading, fun, music,…) Create a personal practice journal to keep track of your new action steps that support you in creating these reserves.   [Watch for the monthly personal practice tip in this newsletter]

Extreme self care may involve areas such as healthy, consistent daily nutrition that provides your body with what it really needs to thrive, sleep sufficient to restore and refresh you, fun to take you away from it all, time for spiritual reflection and allowance for beauty and joy in your life.  Create connection for yourself by developing and sustaining significant relationships with family, friends, significant others or pets. Be purposeful about spending time with nature.  Rejuvenate yourself. Exercise, participate in sports, garden, pick flowers, go fishing or go on a picnic.  You’ll be surprised how quickly you bloom!

A key piece to shifting from selflessness to self-care is giving yourself credit.  Self-talk is the conversations we all have with ourselves.  Be aware of the language you use in your self- talk.  Too many times we are VERY judgmental and focus only on the negative. Shift your language to positive words that reward your efforts and accomplishments and not your perceived shortcomings.

“If you keep on doing what you’ve always done, you’ll keep on getting what you’ve always got!”

-          Anonymous

Insanity is doing the same thing over and over and expecting different results.

Internalizing and practicing the Six Keys to Nursing Success is critical in moving nurses from surviving to thriving!  The August issue of the Shift Change newsletter will explore the 3rd key to nursing success.  Until then, practice the 1^st and 2^nd keys and report your ideas and successes in the comment section below.

The Six Keys to Nursing Success Series: 1st Key – Shifting From the One Up Position to Equal Partnership

The Six Keys to Nursing Success Series

1^st Key- Shifting From the One Up Position to Equal Partnership

There are 6 essential keys for nurses to embrace to move from surviving to thriving in nursing:

1. Shifting from the “one- up” position (as the expert, mentor, caretaker) to equal partnership
2. Shifting from selflessness (being last on the list) to self-care
3. Creating work/life balance
4. Establishing boundaries
5. Identifying and learning to live their passion
6. Discovering and integrating personal values into your life

This begins our nursing success article series with the overview of each of these essential keys. The 1^st key is shifting from the “one- up” position (as the expert, mentor, caretaker) to equal partnership.

A shift is defined as a change, transfer or transformation; to exchange one thing for another; to provide for one’s own needs (or the needs of the organization); a change in attitude, judgment or emphasis;

We define the shift in this 1^st key as shifting out of the professional role as a nurse, into your personal role outside the profession.  Awareness of the shift is the 1^st step.  Then focus on specific actions that queue you in to consciously make the shift each and every day.

These two ideas came from Duke nursing students during a Shift Change Coaching presentation of the 6 keys.  1. Changing out of your scrubs expediently upon completing your workday is one strategy.  2. Turning on your favorite music as you drive home from work to shift you back to a state of calm and enjoyment is another effective technique. What would be a good choice for you to achieve this shift?

Also be aware of the unique shift from “one up” (others looking up to you) as a nurse to equal partnership.  LEARN TO SHIFT!  People look to nurses for expertise, patient teaching, comfort, strength, calmness, caring and patient care. Other relationships such as the coach/client relationship (for us), romantic relationships, family relationships, friends and professional relationships require mutual respect and striving to be equals.

Staying in your “one up” role constantly creates exhaustion quickly and does not create a balanced life.  Having those in your life who you look up to is also essential.

Who are your mentors, teachers, parents or others in your life where you are in the “taking in” role, the receiver if you will instead of in constant giving mode?

You may be asking, “How will this shift benefit the nurse, the nurse’s family, the patients, the organization – the profession?”

Nurses utilizing this shift experience:

• Increased energy
• Recharged enthusiasm
• Amplified passion for work and personal life
• Greater productivity
• More reserves created (time, energy)
• Ability to stay in nursing profession longer
• Prevention of burnout
• Increased fulfillment with career and life
• Smooth transition from student life to professional nursing
• Clarity in choosing nursing specialty

What happens if the nurse and profession do not shift?  Staying in the “one up” mode leads to burn out and nurses leaving the profession.  Decreased quality of care, greater facility liability, increased “call outs” and higher health care costs for staff are other repercussions of failing to make this shift.

Internalizing and practicing the Six Keys to Nursing Success is critical in moving nurses from surviving to thriving!  The July issue of the Shift Change newsletter will explore the 2^nd key to nursing success.  Until then, practice the 1^st key and report your ideas and successes in the comment section below.