Nurse Leaders Focus on Reconnecting with Teams

By Meredith Foxx, MSN, MBA, APRN, NEA-BC, Executive Chief Nursing Officer

With more than a year and a half of the COVID-19 pandemic behind us, nurse leaders at Cleveland Clinic are looking at the road ahead. And what they see is a need to reset and reconnect with their teams.

Following what has been an exhausting 1.5 years, nurse managers (NMs) and assistant nurse managers (ANMs) across the health system are focused on bringing teams back together to support current caregiver needs.

Addressing post-pandemic challenges

To aid nurse leaders, Cleveland Clinic’s enterprise-wide Nursing Retention Council is stepping in. The council is chaired by Fairview Hospital Chief Nursing Officer Mary Beth Thoburn, MBA, BSN, RN, NEA-BC, and encompasses more than 30 nurse representatives from throughout the health system, including chairs and co-chairs of each hospital’s local retention committees.

Before the pandemic, the council, which was established in 2016, was embarking on an effort to reinvigorate its purposeful work to promote and improve retention of nursing caregivers. While retention remains at the center of the council’s work, today, it is helping leaders reconnect with their teams and address challenges that have resulted from the pandemic, such as staff burnout, staff moral distress situations, and an increasing need for recruitment of registered nurses (RNs) and patient care nursing assistants (PCNAs).

In partnership with Cleveland Clinic’s Caregiver Office, including human resources (HR) and the Global Leadership and Learning Institute (GLLI), some of the manager-driven initiatives the council is encouraging are employee stay interviews and skip-level meetings, as well as manager support sessions.

Capturing feedback and enhancing communication and transparency

Stay interviews and skip-level meetings offer helpful insight and important feedback from a team’s caregivers and can be conducted by the managers themselves or by a non-bias third party representative, like someone from HR.

Stay interviews

One-on-one stay interviews allow managers to listen to individual caregiver needs or concerns, acknowledge them, and talk through different solutions or support gaps. They also provide an opportunity to gather feedback about current actions that caregivers deem successful or beneficial. The goal of a stay interview is to assess an employee’s current feelings about their job, team, and organization.

Viewed as critical support tools during times of complex change, stay interviews are ideal for any nurse leader in today’s healthcare climate. Examples of interview questions leaders can ask nurses include:

• This past year, what projects/work energized you? What are you passionate about?
• Is there anything you really enjoyed in your last position/project that you’re not doing now?
• Are there specific recognition efforts that have made you feel valued or that you would like to see implemented?
• What keeps you here? What makes for a great day at work?
• Are there career goals we have not discussed? Do you feel supported in your career goals?
• Are we fully utilizing your talents? Is there anything you’d like to do more or less of?

From the interview, leaders should reflect on what they learned about the employee, what is or is not working well for that person and what tools and equipment they need to do their job. It is also important to look for common themes across caregivers and develop focused action plans around them.

Skip-level meetings

Skip-level meetings help build team trust by creating direct communication between unit RNs and PCNAs and upper leadership. These meetings are led by the manager and include all members of the nursing caregiver team, as well as the nurse leaders to which the manager reports (i.e., nurse directors). By increasing access to higher level decision-makers, these meetings are intended to encourage caregivers to better communicate their personal challenges and needed support.

Managers can use the following tips to lead a skip-level meeting:

• Open the meeting with a way for each person to talk about themselves (i.e., years of service, current role, proudest moment at the organization).
• Have participants share why they got into healthcare/nursing and why they stay in the field.
• Ask questions such as:
  • What initiatives do you believe are working well and why?
  • What are you hearing from patients?
  • What additional support or resources do you need?
  • If you were the team leader, what would you focus on, or do more of, and why?
  • What questions haven’t I asked that you wish I would?

Leaders should make connections using personal and professional stories, appropriately balance inquiry with advocacy, and provide team members the opportunity to influence with open-ended questions. It is also important to follow up on requests and questions that weren’t answered in the meeting.

Building team relationships through informal conversation and discussion

Another initiative the Nursing Retention Council introduced is manager support sessions. These are informal group conversations for novice and experienced nurses to discuss how management can best support the nursing team. Sessions can be held as frequently as the leader deems appropriate.

For example, one nurse manager at Cleveland Clinic Fairview Hospital rotates sessions every other month, meeting with novice nurses one month and experienced nurses the following month. Sessions are held from 6-7 a.m. with in-person or virtual attendance options.

Examples of discussion topics and questions managers may ask during novice nurse sessions include:

• What is going well, what do you enjoy about the unit and nursing?
• Share an example of a great shift that left you feeling like you did a good job at work.
• Share an example of a shift you struggled through.
• Share an example of a problem you faced and what you did or what resources you used to overcome it?
• What are your goals for the next six months?

Managers also ask questions and discuss actions related to unit processes, policies, or care scenarios. For example, a patient needs non-violent restraints. What does the process look like? How do you document this? Who needs to be notified?

In experienced nurse support sessions, good questions for leaders to ask include:

• What keeps you coming back to work each shift? What are the biggest challenges you face?
• How do you manage stress when you’re not at work? How do you stay motivated at work? What can make your job less stressful?
• What contributes to a good shift?
• What’s an idea you would put in place if you could do it tomorrow?
• How do you think newer nurses could be better prepared or trained? Share how you precept new nurses. What training style works best? Is there anything you find yourself repeating often during new nurse training?
• What are your goals and/or unit goals for the next six months?

It is beneficial for managers to also glean insight from experienced nurses on education, recommended refresher courses/meetings/classes or competencies, respect and professionalism and specific areas of success or improvement.

Contributing to retention goals

Although the Nursing Retention Council’s suggested initiatives have just started being implemented throughout health system nursing units, initial feedback from NMs and ANMs has been positive. In addition to addressing current caregiver support needs, the council expects the manager-driven initiatives will also help boost employee engagement and retention.