A Practical Framework For Building Engaged Nurses Beyond Residency

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You're listening to the Beyond Nurse Residency Podcast, an educational series where we interview experts on all topics related to the transition of new graduate nurses into practice and beyond.
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I'm your host, Nicole Weathers, Director of the Iowa Online Nurse Residency Program.
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Thanks for joining us.
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Let's jump in.
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A few years ago, I found myself trying to make sense of something we were observing in our nurse residency program.
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We were seeing exactly the kinds of outcomes we hoped to see.
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Nurses were gaining confidence, they were developing competence, we saw growth in communication skills, leadership development, and many of the things nurse residency programs are designed to support.
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But there was one thing that wasn't quite adding up.
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While we were seeing nurses grow as professionals, we weren't necessarily seeing those improvements translate into workforce outcomes.
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In other words, improved confidence and competence didn't automatically lead to improved retention.
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And that really forced us to step back and rethink what we were trying to accomplish.
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Certainly, retention matters.
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Every organization wants nurses to stay.
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But the more I thought about it, the more I came to believe that retention wasn't actually the goal.
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Retention was the outcome.
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What we really wanted were engaged nurses.
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We wanted nurses that felt connected to their work, connected to their teams, invested in their organizations, and positioned to contribute to patient care in a very meaningful way.
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And if engagement precedes retention, then perhaps engagement was the thing that we should be focusing on.
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So as I worked through these ideas, I began sketching out what I was seeing in practice.
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Eventually, it became a visual model of what I believed nurses need in order to become fully engaged.
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Initially, this wasn't intended for publication.
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It was simply a way of organizing my thinking and helping partner organizations better understand what needed to happen beyond just participation in a nurse residency program if they hoped to improve retention.
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And as I dug into the literature, I found that many of these observations were reinforced in existing research.
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The concepts weren't necessarily new, but they were often discussed more independently rather than as part of this larger picture.
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So I began sharing the framework through presentations and webinars.
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And eventually, after a lot of writing and revising a published manuscript.
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Throughout this year on the podcast, I've been working or exploring different concepts of the framework with our guests.
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And today we'll explore the framework itself, the different parts, what initially connected with the two of us, reflect on what we learned through the writing process, and then consider how these ideas continue to show up in practice today.
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So to explore this framework, I have with me my co-author on the manuscript, Hannah Hayes.
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Welcome, Hannah.
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Thanks so much for joining me today.
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Thanks for having me.
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Excited to talk about it today with you.
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All right.
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So before we get too far into things, why don't we start off by having you tell our listeners a little bit more about yourself and the work that you do?
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Sure.
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So I am a nurse and public health professional by background.
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I have both my BSN and my Master of Public Health from UW Madison.
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And I've worked in many different environments throughout my career.
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So I worked in hospital-based settings, I've worked in public health and governmental public health, I've worked in nursing education.
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And currently I work for a federally qualified health center as a nurse, in addition to doing some work that centers lived experience and research.
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But a large majority of my work was for the New To Public Health Residency Program, which is a public health workforce development that was originally created through UW Madison's School of Nursing and is currently housed in a program of the de Beaumont Foundation.
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And the New To Public Health Residency Program is a workforce development program that is designed to support the competence and the confidence of public health professionals as they transition to governmental public health practice.
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And just like how you mentioned with your work, Nicole, it's really intended to be a retention effort.
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And we were seeing very similar things.
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So when I watched your webinar a couple of years ago, I reached out to you because our program was seeing the same things, we were hearing the same things that you're getting these, you know, outcomes of the program, but not necessarily seeing that reflected in retention.
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And I wanted to explore that more.
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And your um the webinar that I watched and the model that you created was really resonating with me.
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Excellent.
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And so through the development of your New To Public Health transition to practice program, that's really where we first connected.
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And so that was kind of a fun project to kind of consult on with you.
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And and you guys have done uh great work with that.
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And I love uh continuing to see that grow.
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So kudos to you for um all the work that goes into that because I know how much um how much it takes to really get something like that up off the ground.
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So um good for you guys for that.
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Um, so let's so we started this year on the podcast talking about engagement to begin with, and then we talked about a lot of the different um pieces of this framework individually.
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And so I think starting this podcast, sort of kind of bringing it back to the beginning a little bit and talking again about what you know about engagement.
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So when you think about engagement and when you think about engaged nurses, what does that actually mean to you?
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Yeah, great question.
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So, first I'll just kind of start with uh what a definition of engagement is so everybody can have that, and then what it means to me.
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So engagement refers to the active participation and involvement of individuals from diverse backgrounds within their organization or within their community.
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And it encompasses a few things.
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It involves creating an environment where all people feel valued, they feel heard, they feel empowered to contribute to decision-making processes, and it really fosters a culture of collaboration and respect.
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And that's Oxford's definition.
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Um, and to me, what I think that really means in short is that it's a where people feel like they can thrive within their specific conditions, within their organization, within the environment that they're at.
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Um, whatever that might be that's individual and specific to them.
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Um, and I think that really aligns well with what we're kind of seeing, like what this model um reflects a little bit too is Mazell's hierarchy of needs, where at the top of the pyramid you have self-actualization, which is, you know, where people achieve their full realization of their potential, their creativity, and their growth.
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And I think that really reflects and aligns well with what engagement is.
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So being engaged at work means someone's excited to be at their work.
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They find joy and purpose in what they're doing, they have meaningful connections, they feel like they have autonomy, um, they can be creative, they can engage in problem solving.
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And I think all in all, they also feel resilient.
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Like if there's a period of adversity, they can bounce back from that, they can feel capable, they feel strong, and they believe in themselves.
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And I think that's what we want, right?
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Like when we really, at the end of the day, when we think about like what does healthcare need and what do we want?
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I mean, that is really what we want.
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If every single nurse showed up feeling that way, thinking that way, can you imagine?
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Yes.
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I think all nurses want to feel that way.
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And I think all supervisors and organizations want their staff members to feel that way because when you have engaged employees, people perform better too.
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And it supports the sex success of the organization.
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Yeah.
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And so I think, you know, the big question is, you know, how do we, how do we get there?
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Right.
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So hopefully we'll uncover maybe some of those things today throughout our conversation.
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But one of the ideas that we discussed in the manuscript is that engagement may actually be sort of this precursor or antecedent to retention.
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So, in other words, retention may be the outcome we're measuring, but engagement is really that experience that shapes that outcome, right?
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Because if I'm thinking and feeling all of those things that you just described there, chances are I'm gonna stay put.
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Why do you think sometimes organizations focus so heavily on retention and maybe pay a little bit less attention to this concept of engagement?
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I think there's many reasons why this could be.
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I think, first of all, thinking about retention, that is like a clear, focused, concrete goal.
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Like you have one clear outcome that you're trying to achieve.
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And if you're thinking more about engagement, that's like so variable.
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What does that mean for each person?
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It's very um, it's less focused.
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So it's maybe a little bit more ambiguous.
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Um, it also takes time, energy, capacity when we have all these other conflicting priorities.
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And, you know, really just to have your engage employees be engaged and as a supervisor, whoever that might be, to support that engagement as well, to do that authentically, it really does take time and intention.
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And I think everybody wants to do that, but we just have so many other things going on all the time in our lives, in our work.
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Um, and retention also matters.
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Why we want retention.
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All organizations want retention as well.
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It increases productivity, you know, it reduces turnover costs, it increases, you know, organizational knowledge.
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Um, and having retention really, you know, it improves morale as well.
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So, but I think that really focusing on engagement is the way to do that.
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Um, investing in engagement can help achieve those retention goals that we all want because we all want um, you know, to be happy in the work that we're doing.
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We want um employees and everybody to work hard, to be motivated, to be part of something that they believe in.
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And research also shows that having a highly engaged workforce can increase innovation, productivity, and reduce those costs associated with um, you know, hiring and turnover.
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So it's just a different way to maybe frame things that you're still going to achieve that same goal, but you're doing that in a different way.
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Right.
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Because when we, you know, retain uh, I mean, the things that we want, right?
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So we we want that financial impact, like you talked about, kind of retaining that knowledge and expertise because when staff leave, institutional knowledge walks out the door.
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We want that stability, we want that continuity of care for our patients.
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And if we want to grow strategically, we need people to stick around.
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And so I think you hit the nail on the head as far as retention is sort of that one sort of tangible, we can easily measure this um thing to kind of focus on, but we don't always take that time to focus on all the other pieces because it is just more difficult.
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And like you said, it is very individualized for each person that kind of walks through our door and works with us.
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So if engagement's the goal, then obviously our next logical question to explore is what creates engagement?
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And that's really, I think, where this framework comes in and what we're try what we were trying to describe and explore with the creation of this framework.
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So maybe now you can walk our listeners through kind of the major components of the framework that we identified and and shared in our manuscript and how they sort of fit together.
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Yeah, so there's three major components of this framework.
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There are the individual components, there are the foundational enablers, and there are also the organizational assets that are brought to the framework.
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So the individual components refer to really what is needed within and by the individual to achieve a successful transition within their role, whether they're new to practice or transitioning to their practice, and what is needed for them to be engaged.
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So those components, um, and Nicole, feel free to chime in anytime.
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So those components are competency, which is like the knowledge and skills that they bring to their work to support safe and high-quality care, um, physical and psychological and professional safety.
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Um, they need to have belonging, which is really feeling connected to the community or their unit, whatever that might be.
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Um, having esteem is feeling competent and accepted and being able to cope with the challenges that they may experience and know that they're worthy of happiness.
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And then um, last we have, and I forgot to say this is all, you know, presented as a pyramid, which I really like, thinking about that Maslow's hierarchy that I talked about earlier.
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Then at the top of the pyramid, um, we have engagement, which is that full investment and commitment with the work that they're doing.
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So we need nurses who know how to do their job, they feel safe doing their job, they feel like they belong to the group that's also working towards this goal of doing their job, and they need to feel good about it.
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And really kind of thinking of those as kind of the key ingredients to achieving engagement, I think.
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I I mean, clearly I feel like it makes a lot of sense.
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And I think one thing that really makes this framework feel a little bit different to me, anyway, was that it just didn't focus on what the nurses need individually.
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So, yes, those are the things that we've identified, but we've also recognized that organizations play a role in creating those conditions that make these sort of components possible.
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So, as we developed the framework, we really realized that identifying competency, safety, belonging, and esteem wasn't necessarily enough.
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That most leaders would look at those concepts and say, and maybe some of our listeners are doing that right now.
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Yeah, this is great.
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Of course, those things matter.
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But the more important question is how do organizations contribute to that?
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Because uh, and I think one sort of caveat to this, and I think one of the things we were seeing in the residency program, and while this model was created, was we do a really good job focusing on competency.
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Like when we were reflecting on this as a team, it was like, yeah, we're hitting that nail on the head with our curriculum and all the things that we have doing through this residency program.
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Safety and belonging, like, yes, we were providing that within our program, but we had a little bit less control about how that was looking and showing up in the organization, even though we were coaching our leaders and our site coordinators with like, you know, we need you doing check-ins and we need you kind of focusing on these things.
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We just didn't have as much control there.
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And then, of course, like the esteem component, I think, is both kind of external.
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Like, are the organizations kind of recognizing the value of participation in this program?
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Are they celebrating the success of this program?
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But then also there's sort of this internal, I think, component to esteem as well, like our own feelings of worthiness.
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And I know we talked a little bit about that last month on the podcast.
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So we went back to the question of yes, our program is helping do some of these things, but it it really needs to go beyond what we're capable of doing within the walls of this nurse residency program.
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So when we think about how organizations create those conditions, that's where those foundational enablers that you mentioned come in, and then also the organizational assets.
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Um, if you're picturing this sort of Maslow's hierarchy of need for our listeners, so this pyramid shape, at the foundation, we identified things like healthy work environments, financial stability, not because those actually create engagement directly, but because they position organizations to support things like our residency program, right, more effectively.
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If nurses are working in unhealthy work environments or organizations lack the resources to create a transition to practice program, it becomes much harder to create some of those conditions that support engagement.
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So that's sort of those foundational enablers.
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And then from there, we started thinking about the different organizational conditions that cultivate the different components of competency, safety, belonging, and esteem.
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Um, and for this, we actually identified what we called organizational assets.
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And we stated these in the terms of like forms of capital, right?
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So for example, we talk about human capital.
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Um, and that, yes, that's about having people in place, right?
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But it also includes how we support the development of that knowledge, those skills and abilities within our nursing workforce so that they can fulfill their role and do so safely.
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We also talk about social capital or those relationships, those connections that exist within the organization.
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Those relationships help nurses feel supported.
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They create opportunities to learn from one another.
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They foster both psychological safety and that sense of belonging.
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And we discussed this concept of psychological capital, which includes things like confidence, hope, resilience, optimism.
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These factors really influence how nurses perceive their own value and contributions within the organization and the healthcare team.
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So the idea is that by investing and strengthening in these different forms of capital, organizations can begin to cultivate the individual components that are needed for engagement.
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And so when we put that all together, the framework really suggests that nurses are more likely to become fully engaged when those foundational conditions are present and when organizations are intentionally building the assets that support those individual needs.
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I think another important sort of point I want to just make for our listeners, because you know, sometimes when we think of Maslow's hierarchy, it's like one thing builds off the next, and that is very, very true, right?
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But I think um these components don't operate independently.
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So in fact, one of the things we talked about in the manuscript was how interconnected they really are.
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So again, kind of going back to some of these examples, human capital can influence both competency but also safety, right?
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As nurses develop greater competence, they often feel more competent and secure in their practice.
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But at the same time, when organizations provide safe staffing, adequate support and resources, nurses have a greater capacity to continue to develop their skills, right?
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If we're constantly running short staffed, I don't even have the time to maybe ask the questions or really spend time developing my skills because we're just trying to get everything done as quickly as possible.
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Same thing is true for social capital.
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So social capital influences both belonging and safety.
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So having a trusted colleague and supportive relationships creates that sense of belonging while also making nurses more comfortable asking questions, speaking up when things feel unsafe, and seeking help when they need it.
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So while we describe these individual components, they're really constantly interacting with one another and reinforcing one another.
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And kind of a gap in one component can actually create gaps elsewhere as well.
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So just kind of keeping that in mind.
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And for anybody who's like, okay, I'm following along, this feels interesting.
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I'm having a hard time visualizing it.
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We will link the manuscript in the show notes of this episode.
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So you can go, you can take a look, the image is actually in the manuscript, uh, and then you can read about some of these things in a little bit more detail.
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And I think too, I just like would maybe conceptualize it as like, you know, those components are what you need, and then those organizational assets or those forms of capital or like how you really operationalize it, how you do it.
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I love that.
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Thanks for pointing that out.
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So now that hopefully our listeners have a little bit of a picture of this framework in their mind, let's go back to the webinar.
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So I had mentioned I started presenting this, I was using it as a tool to really explain to organizations that residency programs are a great tool to do some of these things, but here, but we sometimes have to go beyond nurse residency, which is really actually now that you think about it, where the title for this podcast sort of came came to be is this realization that it goes beyond residency.
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So talk a little bit now through your initial reactions when you first encountered the framework and why it resonated so much with you.
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I think why it really resonated with me is like I said, I was working for the New To Public Health Residency program at the time.
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And we had this great um program.
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And I I really do um firmly believe in nurse residency programs or public health residency programs.
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And we were hearing from some people who worked at public health departments, you know, that they got this program, but the person still left the organization.
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And I knew the resident who participated, they were really passionate about the work that they were doing.
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And, you know, people were like, well, but they still left.
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So this isn't Effective.
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And I would disagree it is effective.
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But you just need those other pieces.
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So we started to be started to do more webinars or orientations with supervisors and more like broadly sharing information about what was needed to support employees as they transition to practice, or more broadly, what was needed to support the public health workforce.
00:22:25.920 --> 00:22:38.720
And something that resonated with me at the time was, you know, a lot of talk post-pandemic was about like resiliency that was needed from nurses, resiliency that was needed from public health workers.
00:22:38.720 --> 00:22:43.200
And I really resonated with the concept of collective moral resiliency.
00:22:43.200 --> 00:23:04.640
That yes, you need resiliency from an individual, but you also need the support from both society and from organizations, institutions, whatever that might be, which is something that can be called collective moral resiliency, that it's needed from all of us, that it's not just one or the other.
00:23:04.640 --> 00:23:07.920
It's not all just on the individual to be resilient.
00:23:07.920 --> 00:23:11.279
You need these conditions that support their resiliency.
00:23:11.279 --> 00:23:27.519
And I really started to take more of an upstream approach, if you will, about like what was needed from organizations to support like the resident, to support the training effectiveness, to really get that retained and engaged workforce that we're all looking for.
00:23:27.839 --> 00:23:29.920
I really appreciate that perspective.
00:23:29.920 --> 00:23:43.119
So kind of two things I I want to just comment on was one, what you just said about it takes more than just individual resilience, because coming out of the pandemic, like that was the focus, right?
00:23:43.119 --> 00:23:49.759
Of we need to make nurses more resilient or we need to help them better cope.
00:23:49.759 --> 00:23:51.759
And I think that's certainly true.
00:23:51.759 --> 00:24:04.240
Like there is a piece of building interpersonal skills that allow you to bounce back from adversity and cope with our completely imperfect healthcare system that we're working within.
00:24:04.240 --> 00:24:13.680
And I believe that to the point where we actually brought in more skills around well-being and interpersonal skills into our curriculum.
00:24:13.680 --> 00:24:15.440
So I think that that is definitely true.
00:24:15.440 --> 00:24:18.480
But I don't think it has to be an either-or, right?
00:24:18.480 --> 00:24:26.880
And I think this framework really does help you think about that a little bit differently, that nurses experience their work within the system.
00:24:26.880 --> 00:24:32.799
The work environment matters, leadership matters, workload matters, relationships matter.
00:24:32.799 --> 00:24:41.200
And so I think for me, it really does help kind of it can be a both and, right?
00:24:41.200 --> 00:24:43.119
It's not necessarily either or.
00:24:43.119 --> 00:24:54.480
And it's really kind of the interaction between that individual and the environment, the condition, the organizational conditions, the system that they're in that really are what we need to be focusing on.
00:24:54.480 --> 00:25:01.920
And then the other thing you talked about was about what organizations were saying after they used your program.
00:25:01.920 --> 00:25:08.400
And I think that is one of the lessons we kept learning too, over and over again in our residency work.
00:25:08.400 --> 00:25:20.559
A residency program can be incredibly valuable, transition to practice program, you know, whatever you want to call it, but it can't carry the entire burden of retention by itself.
00:25:20.559 --> 00:25:26.960
And I think that so many times organizations, you know, want that to be the case.
00:25:26.960 --> 00:25:32.160
They they want to say, well, they say, you know, residency programs, transition to practice programs help with this.
00:25:32.160 --> 00:25:38.480
And they they certainly do, but it can't be the magic bullet, it's not the magic bullet solution, right?
00:25:38.480 --> 00:25:42.480
The uh we need to create meaningful learning experiences.
00:25:42.480 --> 00:25:53.599
We we can build confidence, we can provide support and connection, but ultimately, nurses leave the residency classroom and go back to that environment that they're working in every day.
00:25:53.599 --> 00:26:02.240
And if what they're experiencing in practice isn't aligned with what we're building in the residency program, that can be really difficult to overcome.
00:26:02.240 --> 00:26:16.240
And I think that's one of one of the main driving forces with us even creating this framework was because it really helped us broaden the conversation beyond the nurse residency program itself.
00:26:16.240 --> 00:26:27.759
So one of the things that I really appreciated working with you, Hannah, on this manuscript was that it really pushed the framework beyond sort of my own experience and my own assumptions, right?
00:26:27.759 --> 00:26:34.000
And so as we worked together on this, what did you kind of come to appreciate most about the framework?
00:26:34.240 --> 00:26:39.200
I think what I really appreciated most about the framework were those forms of capital that were needed.
00:26:39.200 --> 00:26:45.440
So I'm speaking to like that collective moral resiliency that it's not just all on the individual.
00:26:45.440 --> 00:26:49.759
Um, and like you said, um, you know, it certainly is on the individual.
00:26:49.759 --> 00:26:59.119
Like the individual needs to achieve that engagement, but you need a supportive environment and conditions to allow that individual to grow and to thrive.
00:26:59.119 --> 00:27:07.599
And I really liked how you conceptualize those forms of capital as what was needed to support those components along and up the pyramid.
00:27:07.599 --> 00:27:10.720
Um, so that's just really what stood out to me.
00:27:10.720 --> 00:27:18.799
Um, and there's so many things that organizations can do to support um raised residents as they transition to practice.
00:27:19.039 --> 00:27:22.960
Yeah, I mean, I think one of the things we know is leaders are incredibly busy.
00:27:22.960 --> 00:27:32.079
And if the framework only helps people understand what the problem is, but doesn't help them think about what to do next, it's not going to be all that useful, right?
00:27:32.079 --> 00:27:37.839
So um earlier this year, I actually had the opportunity to talk with nurses about this framework.
00:27:37.839 --> 00:27:44.160
And one of those consistent themes that came up was okay, this makes sense, but now what?
00:27:44.160 --> 00:27:56.880
Um, and so I really appreciated in the manuscript that we tried to move beyond simply kind of describing engagement and started identifying some practical strategies that leaders could use to support it.
00:27:56.880 --> 00:28:06.480
So if I remember correctly, that might not have been something we had originally written about, but after kind of getting feedback from the editor, we did include it.
00:28:06.480 --> 00:28:15.200
Um, so we it in the manuscript, there is a nice little table that talks about um for each of the different um components.
00:28:15.200 --> 00:28:20.400
So for competency, safety, belonging, and esteem, we have a list of different strategies that you can use.
00:28:20.400 --> 00:28:27.759
Some of which we have sort of put an asterisk by that indicate, and this fits really nicely into a residency program.
00:28:27.759 --> 00:28:42.960
So just about each one of these components, there are specific strategies that really tie in nicely to what you're doing in residency, but there's also a number of strategies that could be used sort of outside a residency program as well.
00:28:43.279 --> 00:28:49.759
Yeah, I think so many times that you have this literature, we know this information, and then it's like, what do you do about it?
00:28:49.759 --> 00:28:55.440
And I really appreciated that we, um, the editor, you know, encouraged us to like, what do you do about this?
00:28:55.440 --> 00:28:56.079
What can you do?
00:28:56.079 --> 00:29:00.960
It's so we do list um strategies to operationalize the framework.
00:29:00.960 --> 00:29:06.240
And then we also have different ways that you can evaluate um the strategies that you're doing.
00:29:06.240 --> 00:29:13.839
And something that we did within the manuscript too was we modeled this off a little bit off of something that's called the Kirkpatrick model.
00:29:13.839 --> 00:29:24.319
So um the Kirkpatrick model is an evaluation framework that has historically been used to assess the effectiveness and impact of training and educational programs.
00:29:24.319 --> 00:29:27.759
It's something that the new to public health residency program uses.
00:29:27.759 --> 00:29:30.160
It's also a pyramid, ironically.
00:29:30.160 --> 00:29:32.400
So you have um four different levels.
00:29:32.400 --> 00:29:40.880
You have um reaction, you have learning, um, moving up, you have behavior, and then you have level four, which is results.
00:29:40.880 --> 00:29:50.079
So, you know, moving up the pyramid, it becomes a little bit harder to achieve like the evaluation, but it's more sometimes often viewed as more important.
00:29:50.079 --> 00:29:59.119
So we have um in our evaluation metrics of how you can really assess the strategies that you're using to operationalize the framework.
00:29:59.119 --> 00:30:11.519
We have what are different um strategies or evaluation metrics for participation and reaction, which is just like, did people find um what you did to be useful or relevant to what they're doing?
00:30:11.519 --> 00:30:19.119
We have learning, um, you know, did they gain the new skills and confidence that was required or desired of them?
00:30:19.119 --> 00:30:22.480
The behavior, are they applying it to their job?
00:30:22.480 --> 00:30:24.079
And then you have results.
00:30:24.079 --> 00:30:29.119
If you achieve the intended outcome of the program, um, what would that might be?
00:30:29.119 --> 00:30:36.400
Such as oftentimes um for, you know, programs such as this, it's retention, like the ultimate, ultimate um goal or result.
00:30:36.400 --> 00:30:50.799
And but we have that even broken down further within the different um strategies to build or achieve different forms of capital to afford um to um move along those components of the framework.
00:30:51.119 --> 00:30:57.759
Yeah, and I think that's like you said, really important because leaders are busy, NPDs are busy.
00:30:57.759 --> 00:31:02.079
If any guidance we can give people on, okay, so how do we actually use this?
00:31:02.079 --> 00:31:03.680
I think it's gonna be helpful.
00:31:03.680 --> 00:31:06.880
Um, and I've always been a big fan of Kirkpatrick's model as well.
00:31:06.880 --> 00:31:09.519
We use that in our residency program as well.
00:31:09.519 --> 00:31:17.440
Um, and it's so easy to focus on the smile, you know, what we call kind of like the smiley faces of like, did they like it on level one?
00:31:17.440 --> 00:31:21.680
And a little bit more difficult sometimes to focus on those higher levels of the model.
00:31:21.680 --> 00:31:27.039
So I guess I never put two and two together that they are both pyramids, but that's that's interesting.
00:31:27.039 --> 00:31:57.680
Another thing I've really come to appreciate is that while this framework was originally developed in context of nurse residency and to think about nurses transitioning into practice, the more I've thought about it and the more we've written about it and the more I've talked to people about it, I've really found myself seeing these things everywhere, whether we're talking about experienced nurses, educators, faculty, leaders, any professionals really in almost any field, people want a lot of these same things.
00:31:57.680 --> 00:32:05.039
They want to feel capable, they want to feel safe, they want to feel like they belong, they want to know that their contributions are valued.
00:32:05.039 --> 00:32:09.359
And and those don't just disappear after the first year of nursing.
00:32:09.759 --> 00:32:12.799
No, everybody wants to feel engaged in the work that you're doing.
00:32:12.799 --> 00:32:21.119
You know, if you're feeling engaged, you're taking pride in the work that you're doing, you're feeling committed and connected to the organization's mission and goals.
00:32:21.119 --> 00:32:22.559
It gives you a sense of purpose.
00:32:22.559 --> 00:32:23.599
You feel fulfilled.
00:32:23.599 --> 00:32:30.079
So everybody at whatever stage of their career wants to feel engaged in the work that you're doing.
00:32:30.079 --> 00:32:46.319
So while this was intended for people who are transitioning to practice or um who are new to practice, I think that this applies all the time, that you really want to focus on this engagement at all aspects and um stages of someone's career.
00:32:46.640 --> 00:32:53.359
And one of the interesting things that, so earlier this year, we actually did a focus group.
00:32:53.359 --> 00:32:59.200
So we got a couple groups of nurse leaders, MPDs, and then also frontline nurses.
00:32:59.200 --> 00:33:06.880
Um, and we had them take a look at this framework and we got their feedback in an effort to sort of verify this with active practicing nurses.
00:33:06.880 --> 00:33:13.680
And one of the frontline nurses had said, you know, I think all of these components are for sure important.
00:33:13.680 --> 00:33:24.799
She was somebody who was a little further into her practice, and she said, So for me, I could see where like competency and safety were really important to me as a new nurse when I was first starting.
00:33:24.799 --> 00:33:31.440
But now that I've been here for five years, seven years, I don't remember how long she had been in the profession.
00:33:31.440 --> 00:33:42.640
She said, you know, I'm kind of less worried about those things because I've already developed, you know, my competencies and I've been in sort of the same specialty for that duration of time.
00:33:42.640 --> 00:33:50.799
So now for me, it's more of sort of the esteem piece that is a little bit, you know, more of my priority, I guess.
00:33:50.799 --> 00:34:01.359
So it was interesting to hear her talk about how, yes, applicable across the continuum, but the emphasis or the importance of each of these might vary based on where you're at.
00:34:01.599 --> 00:34:09.840
And thinking about what you mentioned before to Nicole, is like this, you know, being in that pyramid form, it's intended to move up sequentially.
00:34:09.840 --> 00:34:20.000
It's not that those other pieces don't reinforce um one another or like play in different directions, but really kind of thinking about how you move up that framework.
00:34:20.000 --> 00:34:21.360
So that makes a lot of sense.
00:34:21.679 --> 00:34:30.480
So since publication, where have you seen some of these concepts showing up in practice, either in your own work or in the experiences of others?
00:34:30.880 --> 00:34:32.159
Well, it's interesting.
00:34:32.159 --> 00:34:44.559
So um I currently work for a federally qualified health center and I kind of went back to clinical practice after being in a different type of work, which was public health workforce development.
00:34:44.559 --> 00:34:51.599
And I'm still engaged in um different, you know, um different public health work and initiatives.
00:34:51.599 --> 00:34:54.800
Um, but I'm working as a nurse now.
00:34:54.800 --> 00:34:56.400
Um, and that's been interesting.
00:34:56.400 --> 00:35:16.320
So even just thinking about like how I am developing or moving up these different, um, like engaging with these different forms of different components of the framework, that I need my own competency, that I need to feel safe and secure, and how those have played out um within the organization that I work for as well.
00:35:16.320 --> 00:35:18.960
Um, so I've had really supportive leaders.
00:35:18.960 --> 00:35:28.960
Um, I also have, you know, the organization that I work for, I do really feel like they want to support the full engagement of um, you know, the staff who work for them.
00:35:28.960 --> 00:35:32.800
So I've been seeing how it's been like, I think I take a different lens, right?
00:35:32.800 --> 00:35:37.119
Like I'm a quote unquote new nurse in this way to this role.
00:35:37.119 --> 00:35:40.239
I have, you know, been a nurse for many years now.
00:35:40.239 --> 00:36:00.239
Um, but I'm also just like seeing how like the strategies that the organization is using to maybe like achieve some of these forms of capital or like achieve like the components of the pyramid, um, you know, for me as a nurse or for like my colleagues that I work for.
00:36:00.480 --> 00:36:00.800
Yeah.
00:36:00.800 --> 00:36:12.400
Well, so um one of our program coordinators, Jess Osepka, actually just wrote a blog that we have on our website about um beyond the new grad, why belonging matters for every new nurse.
00:36:12.400 --> 00:36:16.960
So that was one of the components that we unpacked earlier this year.
00:36:16.960 --> 00:36:25.440
And she said, you know, when I was listening to that, I just thought, wow, this like this is so I feel so many of these things.
00:36:25.440 --> 00:36:26.960
And I'm not even new, right?
00:36:26.960 --> 00:36:30.960
I am the charge nurse or the supervisor on a shift.
00:36:30.960 --> 00:36:38.559
But sort of this idea of loneliness and belonging, I mean, it shows up for me when I walk in the doors there.
00:36:38.559 --> 00:36:44.559
So um I, I, I, she definitely sort of sees that in her practice.
00:36:44.559 --> 00:36:55.679
Uh, another place where I've sort of found myself revisiting this framework is through some work that we're doing for organizational readiness.
00:36:55.679 --> 00:37:06.559
So historically, we've assessed readiness of a for a residency program with organizations that come to us and we focus on implementation questions like, you know, do you have the support?
00:37:06.559 --> 00:37:07.679
Do you have the preceptors?
00:37:07.679 --> 00:37:09.119
Do you have the resources?
00:37:09.119 --> 00:37:18.639
And more recently, I've actually started looking at that sort of readiness assessment more through this lens of this framework.
00:37:18.639 --> 00:37:26.320
So for each component, do organizations have sort of the ingredients they need to be prepared for this?
00:37:26.320 --> 00:37:35.599
So do they do they allow nurses the time and support to participate from like a financial stability piece?
00:37:35.599 --> 00:37:39.840
Is professional development a valued part of the organization?
00:37:39.840 --> 00:37:43.599
Sort of looking at sort of the idea of a healthy work environment.
00:37:43.599 --> 00:37:50.079
Do they have structures in place that are developing or helping to support that competency development?
00:37:50.079 --> 00:37:58.400
Um, do they, you know, so really kind of going up the pyramid and then asking organizations, where are we starting?
00:37:58.400 --> 00:38:08.400
Not that doesn't mean that we can't implement a residency program, but it really helps us have a pulse on, you know, again, do they have some of these key components in place?
00:38:08.400 --> 00:38:20.559
Because if we don't even have the key components in place for them to engage in the residency program, then we're not going to have the key components or we're not going to be able to work towards that ultimate goal of retention.
00:38:20.559 --> 00:38:23.440
And the program isn't going to do what's intended, right?
00:38:23.440 --> 00:38:33.119
Because if we from the very beginning are not allowing protected time for our nurses to work on this, it's not going to work for you, right?
00:38:33.119 --> 00:38:34.639
The program is not going to work.
00:38:34.639 --> 00:38:39.760
If we aren't helping build those connections, we're going to have a gap there, right?
00:38:39.760 --> 00:38:46.000
And we're going to be missing out on some of those important components of engagement.
00:38:46.000 --> 00:39:03.280
So for me, this framework has become um less of maybe a model, even and more of like this lens that helps me just ask better questions, whether we're talking about engagement in a specific program or engagement in an organization.
00:39:04.000 --> 00:39:04.719
Definitely.
00:39:04.719 --> 00:39:16.400
And just thinking about like how you are going to, you know, if you have these different um components right away, you're probably going to be much more effective.
00:39:16.400 --> 00:39:25.760
Like the success of the residency program and of the resident is just going to be so much more greater versus like if you're already starting behind.
00:39:25.760 --> 00:39:34.480
And I think that's where the framework really emphasizes to like those foundational enablers that are already like needed, like just at the bottom of the pyramid.
00:39:34.480 --> 00:39:40.079
What do you need in place to even just support this moving forward?
00:39:41.039 --> 00:39:48.880
So what's one or maybe more things you feel people still misunderstand about engagement?
00:39:49.920 --> 00:40:07.119
I think for me, engagement, um, if you're really trying to support the engagement of your nurses, it needs to be a very intentional um effort to be done authentically.
00:40:07.119 --> 00:40:12.880
And it needs to be unique and individualized to many different staff members.
00:40:12.880 --> 00:40:20.320
Um, so I think that there's different ways that you can do that, but it's not like a one-size, like catch-is-all approach.
00:40:20.320 --> 00:40:30.400
Like you really need to take the time to meet with each individual that you're working with, um, find out what's important to them.
00:40:30.400 --> 00:40:33.440
Um, you want to make sure that you can support them in their goals.
00:40:33.440 --> 00:40:35.920
So first you need to ask, like, what are your goals?
00:40:35.920 --> 00:40:38.239
Like, what do you need within the workplace?
00:40:38.239 --> 00:40:46.880
It might be nice to know like what are their personal circumstances and how you can support that because people are going to bring like where they're coming from to their work.
00:40:46.880 --> 00:40:50.639
Like that um creates a big impact.
00:40:50.639 --> 00:41:01.840
If they're having health problems or if they're having relationship problems outside of work, they're going to bring that to the work that they're doing and trying to like mitigate that as much as possible within work is important.
00:41:01.840 --> 00:41:07.519
Um, really being deliberate about creating a culture of belonging is so important.
00:41:07.519 --> 00:41:10.480
As you mentioned, like you're gonna have those gaps.
00:41:10.480 --> 00:41:23.360
Um, if people don't feel connected to like the people they're working with, you know, they're gonna have a hard time even feeling maybe safe to like ask questions, to make sure that they're being competent within this.
00:41:23.360 --> 00:41:25.599
So it all moves back and forth.
00:41:25.599 --> 00:41:32.480
Um, you know, people want to feel heard, they want to share their ideas, and they really want to feel valued in the work that they're doing.
00:41:32.480 --> 00:41:43.039
So I think it's important to recognize and value them as an individual versus just this um, you know, broad, all-encompassing approach.
00:41:43.039 --> 00:41:55.440
So, really, in short, I think that it needs to be a very individualized, unique, um, and intentional effort and when we're really thinking about how do we support engagement.
00:41:56.000 --> 00:41:57.199
That is really interesting.
00:41:57.199 --> 00:42:02.480
And I love that you you bring that up because I think, yes, it's it needs to be individualized.
00:42:02.480 --> 00:42:06.480
Another piece of that is it's definitely multifaceted, right?
00:42:06.480 --> 00:42:14.000
It's not one single intervention or one single pizza party or one single recognition program that's going to create engagement.
00:42:14.000 --> 00:42:16.159
Um, and I think the framework speaks to that, right?
00:42:16.159 --> 00:42:18.480
It's coming from multiple different components.
00:42:18.480 --> 00:42:29.280
Um, but along kind of the same lines of that, so I presented this framework um this year at the Association for Nursing Professional Development annual convention.
00:42:29.280 --> 00:42:33.280
And I had somebody come up to me afterwards and was like, okay, this is I really like this.
00:42:33.280 --> 00:42:34.159
This is great.
00:42:34.159 --> 00:42:37.679
So how are we, you know, measuring engagement?
00:42:37.679 --> 00:42:41.599
How do we decide that our nurses on our unit are engaged?
00:42:41.599 --> 00:42:45.679
And, you know, I it took me a minute to kind of think about that.
00:42:45.679 --> 00:42:50.480
And I'm like, well, you know, you can measure things like, are they, you know, going back to school?
00:42:50.480 --> 00:42:52.480
Are they continuing to develop professionally?
00:42:52.480 --> 00:42:54.960
Are they become a precept or charge nurse, etc.?
00:42:54.960 --> 00:42:56.800
Like monitor those things.
00:42:56.800 --> 00:43:02.480
And if if they're doing those things, I think part of that is showing that they are engaged.
00:43:02.480 --> 00:43:09.039
And then um, kind of that stuck in my brain for kind of a long time, that question.
00:43:09.039 --> 00:43:13.519
And I had the great opportunity to sit down with Donna Wright.
00:43:13.519 --> 00:43:20.320
I don't know if you know who Donna Wright is, but she's sort of the competency guru in the NPD world.
00:43:20.320 --> 00:43:31.039
Um, and she was on one of our earlier podcasts, and she has a really unique approach to competency where it you don't just verify competence through like a skills checklist, right?
00:43:31.039 --> 00:43:36.960
Or it's not always return demonstration, but there's a lot of different ways that you can show that you're competent.
00:43:36.960 --> 00:43:53.119
And that really sort of inspired me to kind of rethink this idea of what engagement looks like because I think we could really model a lot of that and and take a lot away from the way Donna talks about competency.
00:43:53.119 --> 00:44:02.000
To first of all, um, you know, somebody doesn't come in and say, uh, these are the These are the important competencies, right?
00:44:02.000 --> 00:44:09.440
But you talk to the people on the unit and they help identify what are the competencies that we need to be focusing on for our work.
00:44:09.440 --> 00:44:11.119
They're sort of the experts in it.
00:44:11.119 --> 00:44:16.639
So I think that was kind of my first aha was like talking to the people on the unit.
00:44:16.639 --> 00:44:19.360
What does engagement look like on this unit?
00:44:19.360 --> 00:44:26.800
What are the things that we want to see nurses doing to kind of contribute to you know improved patient care here, right?
00:44:26.800 --> 00:44:32.559
Like how do we want to see nurses showing up fully invested?
00:44:33.119 --> 00:44:43.679
And that's so funny you mentioned that too, because just this week at the organization that I work for, we actually had meetings as we're transitioning to the Donna Right competency assessment model.
00:44:43.679 --> 00:44:54.239
So like our I work for um like maternal child health, and we met as a team and identified like HR asked us, like, what are these competencies?
00:44:54.239 --> 00:44:56.400
How are we going to evaluate these competencies?
00:44:56.400 --> 00:45:02.559
So we're actively like initiating this model of practice in the work right now that we're doing.
00:45:03.039 --> 00:45:05.920
And I think this could be mirrored though around this engagement, right?
00:45:05.920 --> 00:45:07.280
So what does engagement look like?
00:45:07.280 --> 00:45:08.719
And then guess what?
00:45:08.719 --> 00:45:17.199
When when it comes time to like show that I'm competent, every single nurse gets to show they're competent in a different way, potentially, right?
00:45:17.199 --> 00:45:24.159
Or they have a group of, you know, you can select from these five um ways to show that you're competent.
00:45:24.159 --> 00:45:26.719
And I think we could apply this to engagement.
00:45:26.719 --> 00:45:31.519
Like, okay, so this is what we've decided as a unit, engagement is going to look like for us.
00:45:31.519 --> 00:45:36.880
And now you get to decide for yourself how am I going to engage?
00:45:36.880 --> 00:45:44.000
So I am really able to leverage my own strengths, the things that interest me, the things that I bring to the table.
00:45:44.000 --> 00:45:47.280
And I think that in itself is going to help, right?
00:45:47.280 --> 00:46:02.559
Like, not everybody has to be the preceptor, not everybody has to be the charge nurse, not everybody has to get involved in committees or, you know, work on evidence-based practice projects or or do whatever it is that we've identified as the thing that kind of marks them as engaged.
00:46:02.559 --> 00:46:05.679
But there are different ways for me to show that.
00:46:05.679 --> 00:46:13.440
And I think it takes really everybody's strength, sort of contributing in a positive way to really help us move the needle.
00:46:13.760 --> 00:46:14.159
Yes.
00:46:14.159 --> 00:46:32.000
And I also think that there are some valuable resources that exist too that are maybe adjacent to engagement, not necessarily using that term, but for example, the there's a surgeon general um document and framework for workplace mental health and well-being.
00:46:32.000 --> 00:46:40.719
And that has a lot of things too that are focusing on kind of like those aspects that are core to engagement, um, core to well-being.
00:46:40.719 --> 00:46:47.840
So there are different tools, resources, frameworks, um, evaluation, evaluation metrics that can be used as well.
00:46:47.840 --> 00:46:51.119
And that's a really good one that's from the government.
00:46:51.440 --> 00:46:51.840
Perfect.
00:46:51.840 --> 00:46:52.880
Thank you for sharing that.
00:46:52.880 --> 00:46:55.920
I don't think I was um aware of that one.
00:46:55.920 --> 00:46:59.039
Okay, Hannah, we have had a great conversation.
00:46:59.039 --> 00:47:02.480
Um, thank you so much for uh joining us.
00:47:02.480 --> 00:47:04.800
But before we go, I do have one more question.
00:47:04.800 --> 00:47:08.800
And I asked this of pretty much every guest, I think, that comes on the podcast.
00:47:08.800 --> 00:47:20.159
But if there was one thing that you wish more healthcare organizations understood about engagement, and one thing that you wish they were doing differently, what would that be?
00:47:20.719 --> 00:47:30.159
I think just really investing in the staff that you have in the ways that they need it.
00:47:30.159 --> 00:47:36.239
So asking them what they need and how you can support them goes a long way.
00:47:36.239 --> 00:47:37.920
Just meeting with those people.
00:47:37.920 --> 00:47:43.199
And we always talk about in nursing that you're supposed to meet the patient where they're at.
00:47:43.199 --> 00:47:51.519
And I think the same thing applies here, just meeting um your nurse, your staff member, whoever that might be, where they're at.
00:47:51.519 --> 00:47:57.119
And supporting engagement is going to support the goals of the workforce.
00:47:57.119 --> 00:48:04.960
It's going to be a more happy work environment, it's going to be more productive, it's going to support the success of the organization.
00:48:04.960 --> 00:48:10.079
Um, and it's also going to really support like the communities that we live in as well.
00:48:10.079 --> 00:48:20.800
If you have a happy, engaged staff members, like that's going to like even, you know, be reflected outside of work too in the community that we live in.
00:48:20.800 --> 00:48:32.400
And I really think that supporting that um supports the well-being of everybody of our community, and it's going to improve health outcomes and support equity in the long run.
00:48:32.960 --> 00:48:33.519
Excellent.
00:48:33.519 --> 00:48:36.880
Well, thank you, Hannah, so much for being here with me today.
00:48:36.880 --> 00:48:39.440
It's been a pleasure to talk about this.
00:48:39.440 --> 00:48:44.000
Thank you for all the work that you put into helping me write this manuscript.
00:48:44.000 --> 00:48:48.159
I don't know that it would have come to be without your encouragement.
00:48:48.159 --> 00:48:56.480
I think you said, you know, I think more organizations, more programs could benefit from sort of thinking about and seeing this model.
00:48:56.480 --> 00:49:02.800
So uh I'm not sure if I would have been uh published and put out into the world without your encouragement.
00:49:02.800 --> 00:49:04.320
So thank you so much for that.
00:49:04.559 --> 00:49:06.800
And thanks for letting me be a part of it, Nicole.
00:49:06.800 --> 00:49:13.599
I think you're doing really awesome work, and I'm really impressed that you're like sharing this more broadly because it is so important.
00:49:13.599 --> 00:49:15.280
So thank you so much.
00:49:16.880 --> 00:49:24.719
Wait, before you go, I want to make sure you know all about our suite of resources you can use to support your new graduate nurses.
00:49:24.719 --> 00:49:35.199
This includes our Academy, a coaching program designed for organizations as they prepare for the implementation and ongoing sustainability of a nurse residency program.
00:49:35.199 --> 00:49:41.679
Work one-on-one with residency program experts to make sure your organization is residency ready.
00:49:41.679 --> 00:49:55.760
Our Clinician Well-being course is an asynchronous online course that aims to enhance the well-being and resiliency of healthcare professionals, equipping them with the necessary psychological capital to navigate challenges inside and outside of work.
00:49:55.760 --> 00:50:05.039
Supporting nurses is another asynchronous online course for preceptors, mentors, and coaches to learn the skills they need to support any new hire.
00:50:05.039 --> 00:50:12.800
Both of these offerings can be used as a standalone professional development opportunity or to augment any nurse residency program.
00:50:12.800 --> 00:50:18.639
And we can't forget about the program that started it all, the online nurse residency program.
00:50:18.639 --> 00:50:26.960
This includes a comprehensive curriculum designed to support new graduate nurses applying all the knowledge they learned in school to their practice.
00:50:26.960 --> 00:50:36.480
We focus on professional skills, personal well-being competencies, and new graduate nurses even get the opportunity to create real change in their own organization.
00:50:36.480 --> 00:50:43.840
Offered completely online and in a blended format, this program is highly adaptable to all clinical practice settings.
00:50:43.840 --> 00:50:49.840
You can learn more about all of these programs and more of what we offer using the links in the show notes below.