Coffee Break - Renee Thompson_24 (1)

EP 24: Nurturing New Nurses: Essential Strategies for Creating a Respectful Work Culture in Healthcare

Summary: 

Creating an environment where continuous feedback thrives, and interprofessional bonds flourish is paramount for nurturing the success and well-being of new nurses.

In this episode, host Dr. Renee Thompson dives into the critical topic of protecting newly graduated nurses in the workplace. She discusses the alarming turnover rates among new graduate nurses and emphasizes the impact of their treatment by coworkers on their decision to leave, urging healthcare leaders to focus on creating a supportive and nurturing environment where new nurses feel safe, supported, and valued. Renee showcases evidence-based strategies for protecting and nurturing new nurse talents, emphasizing the importance of addressing disruptive behaviors and fostering a culture of relentless feedback. She also provides actionable insights such as fostering open communication among team members, equipping preceptors with the necessary skills to protect and mentor new nurses, and nurturing a culture of relentless feedback.

Tune in to discover the pivotal importance of prioritizing the well-being of newly graduated nurses and learn how to cultivate a thriving work culture that nurtures their success!

About Renee Thompson:

Dr. Renee Thompson is the CEO & Founder of the Healthy Workforce Institute and works with healthcare organizations to cultivate a professional workforce by addressing bullying, and incivility. Renee has authored several books and is one of only 30 nurses in the world who have achieved the prestigious certified speaking professional designation. In 2018 she was recognized as one of LinkedIn’s Top Ten Voices in Healthcare for her contribution to their global online healthcare community and in 2022 and 2023 was identified as one of the top 5 Nurse Influencers on LinkedIn.

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Renee Thompson:
Plants thrive and grow in a peaceful, nourished environment, right? Well, it's the same with human beings. But what if that environment is not so peaceful? What if it's toxic? Welcome to Coffee Break: Breaking the Cycle of Bullying in Healthcare – One Cup at a Time. In this podcast, you'll get practical, evidence-based strategies to help you cultivate and sustain a healthy and respectful work culture by tackling an age-old problem in healthcare: bullying and incivility. I am your host, Doctor Renee Thompson.

Renee Thompson:
Hi everyone! Welcome back to another episode of the Coffee Break podcast. Wherever you are, whether you're listening to this or you're watching this on YouTube, I hope you're having a great week, and I hope that you're making progress in your department or organization towards a healthier or respectful work culture. Today, I am really excited to have a conversation with you about your newest graduate nurses. If you hire new nurses in your organization, this is going to be an episode that might save you, let's just say, a lot of time, a lot of aggravation, because I'm not sure that you all know this about me, but before I started my own company to address disruptive behaviors, I was responsible for the new grad experience across a system, a large health system. So, I developed new nurse residency programs, preceptor programs. I was responsible for the student nurse internship programs, the student experience, professional development, and a bunch of other things. I know that population well, and when I became a nurse manager and was trying to hire new graduate nurses, I really saw that experience from a different perspective, really from your perspective, and what the work that we do to address workplace bullying and incivility. This work right now is incredibly important for this new graduate nurse population. And I wanted to talk about what's happening out there right now, and why it's so important that you prioritize protecting these newest nurses. Or if you don't, they're going to leave you. So we're going to talk about today. I'm going to give you a glimpse into what's happening across the country. We're going to talk about some strategies that you can adopt to protect your newest graduate nurses. And then I'm going to let you know about a few resources that we have available for you to take the next step. All right. Studies show that about 31% of our newest graduate nurses are quitting within their first year. And I believe that number goes up to about 48% in their second year. I'm going to tell you, they're not leaving to make $2 an hour or more down the street. They're quitting because of how they're being treated by their coworkers. And recruitment and retention right now are huge priorities for leaders. We hear about this all the time. What are your biggest challenges? Recruitment and retention. You can recruit all you want, and you can bring in as many newly graduated nurses as you want. But if you don't create an environment where they feel safe, supported, and they feel that they belong, they will leave you. Okay, all right. So first, I want to talk about how do you actually protect your newest graduate nurses. When I was in this role, responsible for developing a new nurse residency program and that whole experience of the new graduate nurse, I really took a look at what were their biggest fears when they start working. And actually, the work that I did in my doctoral program, I developed a program to protect and bulletproof senior nursing students before they start their first job. Again, I know this population. Students becoming new graduate nurses fear two things. Number one, they fear that they're going to kill a patient. They actually say that we're afraid they're going to kill a patient. And number two, they fear their preceptors and the people who are working in their department because sometimes they get eaten alive. And even though we've said for years nurses eat their young, and we are working on this, because I always say, now we eat our young, our old, and everything in between, because sometimes the new nurses are the problem. They are still the most vulnerable. So the first thing that I want you to do is think about how do we protect our newly graduated nurses from their coworkers, something that's been happening a lot over the last two years, really, since, about a year or so after the pandemic hit, our clients, our leaders were reaching out to me saying, oh my gosh, I have my experienced nurses in my office almost every day complaining to me about how unprepared these new graduate nurses are. They don't know anything. They can't even do a piggyback. I asked one to insert a Foley catheter, and she looked at me like I had two heads. Oh my gosh, they don't pay me enough to teach these students or teach these nurses. And we know this, we know that they're the least prepared new nurses we've ever experienced. So my approach to this is to tell your experienced nurses, okay, when they come to you, and they're complaining, any time you can admit or acknowledge that somebody is right, do it because it disarms them. So when they say they are so ill-prepared, look them in the eye and say, oh my God, you're right; they are unprepared, but then remind them that it's not their fault. So quit being so mean to them. They learned how to be nurses during a global pandemic when we would not let them in the building; they learned how to take care of patients in a StimLab or virtually. The experienced nurses complaining that these new nurses are not prepared is not helpful, but you got to call them on it. Tell them, yes, they're right. They are not prepared. It's not their fault. Stop being so mean to them. Instead, let's help them. So here's your strategy. Get together with your experienced nurses, and you say to them, all right, in our department, what are the top three skills that you think every nurse here needs to master? Maybe on a cardiac unit or an old cardiac nurse, you better know the difference between sinus rhythm and, say, AFib. Or how about sinus rhythm and V-tach? So say you might need to start there, but it's a little bit more challenging to differentiate between the different blocks. But how about you just start simple? Like they need to know the rhythms, okay what else? But ask them three skills. You will always hear this from me. The brain loves the number 3. It's easy for the brain to act on three things versus four or five, three things. And then, all of your team focus on making sure all of those new nurses can master those three skills, then you pick three more, and so on. But what's happening if you don't do this? Is that the first time a new nurse asks a question, an inexperienced nurse, or they admit they don't know how to do something? If that experienced nurse rips their head off or makes them feel stupid, they will never ask again, and they will wing it. And I'm sure you can imagine the negative impact if you have a group of new nurses who are winging patient care. So this is such a serious matter because it impacts patient safety. So get together with your experienced nurses. Tell them that these new nurses are ill-prepared. It's not their fault. It's not being mean to them. And instead, we're going to help them. And this is how we're going to help them. I had told you earlier that these new nurses fear their preceptors. You and I both know there are a lot of people in the role of the preceptor who should not be preceptors. Unfortunately, there are times when you don't have a choice. You need preceptors to orient these new nurses. I am going to ask you to pay attention and be more selective. You want preceptors who are good role models. You want preceptors who are, oh my gosh, kind, respectful that they actually want to help onboard new employees, especially new nurses. I know myself when I was working per diem, and I would go into, and this was just not that long ago, I would if somebody said, oh, we have a student here, or we have a new person, but the preceptor is not here, who's going to take them? I'll take them. I love helping new nurses, but not everybody does. However, you have to make sure that your preceptors, first of all, are equipped with the knowledge, skills, and tools to make sure their new graduate nurses are protected from their coworkers. Okay, and there are ways that you can do this, but they have to know the difference between bullying and civility and somebody having a bad day. They need to understand the important role that they have in their behavior and how it impacts that new grad experience. And then I always like to work with preceptors to help them protect these new graduate nurses. And I think in terms of some of them, let's say, high-risk moments in anyone's shift report. Shifts report is where I've seen a lot of new graduate nurses be attacked, nitpicked to death, made to feel stupid. So, you have to make sure your preceptors know to stand by them and actually protect them. If an experienced nurse starts nitpicking them to death, that preceptor needs to step in and say, time out here. We're not going to do this. We're not going to play this game. Basically, stop it and then think in terms of how assignments are made. Your preceptor needs to be working with your charge nurse or whoever makes assignments to make sure that during orientation, preceptor and the new graduate nurses in getting dunked on because there's two of them. Okay, oh, yeah. You can take more and more difficult paces because there's two of you. Not true, that's a whole other conversation, but the assignments are fair, especially when that new graduate nurse comes off of orientation. And then we know that, let's just say, some of the people in your department love to make fun of the newbies, love to gossip about the new employees, especially your newly graduated nurses, especially if any of them are struggling, and you really need to make sure you shut down any of that gossip, I think. I swear, people forget what it was like to be new. So far, we've talked about protecting your new nurses, and you protect them from the other people, their coworkers, by reminding them that they learned during a time when they didn't have access to actual patient care. So again, stop being mean to them and instead helping them. And then really focus on your preceptors, making sure your preceptors are equipped with the skills and tools that they need to protect those newest nurses. And then another strategy is, all right, we've talked about having that honest conversation with your experienced staff. We've talked about making sure your preceptors understand the part of their role is to protect those new nurses, but you also need to equip these new nurses with the skills and tools that they need to actually address disruptive behaviors, confront disruptive behaviors. And I look at it from this perspective. They need to know what bullying is and what it's not. Because I'm going to tell you something: constructive feedback is not bullying. But this is very common where a newly graduated nurse receives constructive feedback criticism from their preceptor, and right away they pull the bully card. Oh, I'm being bullied by my preceptor. Yeah, that's not bullying. And in a little while, I'll give you a tip on how you can prevent that from happening. But they need to understand what bullying is, what it's not, how it shows up and what they can do about it. We do a lot with confronting techniques. We have our famous name it, speak it, script it techniques, and in the show notes, I'll actually include a resource for you; it's, scripts to stop disruptive behaviors, and this is a great resource that you can actually download, print, and give it to your newly graduated nurses. Heck, you can give it to everybody on your in your department because it's just, I know myself, I don't know what to say sometimes in the moment when somebody's being mean to me or somebody embarrasses me, but the next day, in the shower, oh, I can think of all sorts of things to say, but by then, it's usually too late. I developed these scripts to help me originally and then realized that a lot of people struggle with knowing what to say in the moment, too. So, it's just powerful scripts to stop bad behavior in the moment. So you can find a link to that in the show notes. We also need to nurture them. There are strategies to help you nurture your newest nurses, and we actually have a resource, and I'll also put in the show notes called Nine Ways to Welcome and Protect Your New Graduate Nurses so that they stay. And I'm going to share one of those strategies with you right now, but the rest you can get in that resource that you'll again find in the show notes. Onboarding your newly graduated nurses doesn't start day one of orientation. It starts way before that. It starts basically as soon as they say I do. One of the most powerful strategies that you can adopt that also addresses one of their biggest fears is have their preceptor call that newly graduated nurse a week or so ahead of time, a week or so before their first day of work. And basically that preceptor is to say, hey, hi Tina, my name is Renee. I'm going to be your preceptor. I am beyond excited that you're going to be working with us. Okay. You're starting on Monday or Wednesday whenever they start. Do you know where you're going? Do you know what to wear? Do you have everything that you need? What questions do you have? It basically alleviates that fear of is my preceptor a bully; my preceptor part of the problem. Does my preceptor want to be a preceptor? So if the preceptor can call ahead of time to say, hey, I'm excited you're going to be here, whoa! That decreases their stress level immediately. And then it really helps them, first of all, to feel welcome. And then also you can answer some questions that sometimes that first day can be a little chaotic, and they may not be sure where to go unless they did some clinicals or worked in that organization. But that's a tip, and there are eight others that you can get in that resource that we'll have the show notes. And then, finally this will help you to address that. I get constructive feedback, and I say my preceptor is the bully situation. You need to establish a culture of relentless feedback for really everyone, but especially for your newly graduated nurses. This was something that when I was responsible for preceptors and new nurses; I would set that intention for feedback. I would meet with my new nurse, and I would say this is; my goal, my intent is to help you to be a successful nurse here. And then I would define what success meant to me. I want you to be the type of nurse that I want to work with at 2:00 in the morning in a crisis situation; you know, you don't have anybody else but yourselves or the type of nurse who I want caring for my precious family. And in order for me to do that, I'm going to give you feedback. I'm going to tell you the good, I'm going to tell you the bad, and if I have to, I'm going to tell you the ugly, and I'm going to need you to be open to it, okay, because remember, my goal, my intent, is to help you to be successful. And then what you do is every day precept was working with that new nurse. You have the preceptor say to that new nurse, at the end of the day, the end of the shift, whenever that is. Hey, here's one thing you did really well. Be specific. Here's one thing I'd like you to work on, be specific. If you present it in that way, there's something that I'd like you to work on, its received easier, and it shows that we all have something we need to work on. So, establish a culture of relentless feedback right from the beginning. So I want you, if you're listening to this and you're a front-line manager, have a conversation with your preceptors about this. If you're in an education role, nursing, professional development, have a conversation with your preceptors about this. If you're an executive role, you get the point. Don't assume that they know this, because, I'm telling you, they don't. But it's making sure that you establish ongoing, relentless feedback as a habit here in our department. Okay, we've talked about protecting them, talked about your preceptors. We talked about equipping them, especially with the knowledge, skills, and tools that they need to confront disruptive behaviors. We've talked about feedback. And then, finally, we've talked a little bit about how to nurture them. The one last thing that I would add to this is, I know we're focused in this podcast on newly graduated nurses, but it's not just protecting them and helping them acclimate to the other nurses in your department. It's really looking at them as part of the entire interprofessional team. I remember when I was a brand new nurse, I was petrified to talk to doctors. I was. Physicians scared me, they intimidated me. And I want you to think about this, when you're in a nursing school, they won't let you talk to physicians, but as soon as you graduate and you start working, call the physician. I didn't know how to do that, and I was intimidated, and it took me a long time to get over that. And what helped me to get over that was really two things: my confidence as I learned, but then it was easier for me when one of the physicians or providers actually was nice to me, or they introduced themselves to me and they made a comment about, oh, you're new here. That's great! We're excited that you're here. So any time you can introduce your new nurses, any new employees to the entire team, not just their coworkers, the other nurses and techs, and your PCTs, but to the entire interprofessional team, it's going to help them to decrease some of that anxiety and stress and feelings of intimidation, because we're trying to flatten this hierarchy just a bit so that every single person on the team plays a valuable role. And to really help them to build a relationship with everybody on the team, especially physicians and providers, will really help them to feel that they are contributing, feel a sense of belonging, and it'll decrease that anxiety that they have and actually communicating with physicians, which all leads to better patient outcomes. It all does. Okay, I'm going to wrap this one up. I've mentioned several times now that I will have some additional resources for you in the show notes. I also want to let you know that as an organization here at the Healthy Workforce Institute, we recently developed a curriculum related to graduate nurses, and it's our Graduate Nurse Anti-bullying Curriculum. This curriculum does not replace your existing residency program. It's designed to augment your existing program with just the content related to bullying and incivility. I'll have a link to that in the show notes if you're interested; someone on our team would be more than happy to hop on a call with you and talk about whether this program is the right fit for you. And as we end, I just want to thank you for listening, for doing your part to cultivate a healthy work culture. It really starts with you, and it starts with, how are you onboarding these new people. And we've talked heavily, primarily about newly graduated nurses, but just copy, paste, and insert any role, any new employee, to your organization. Most of these principles still apply. And so I want to thank you for being here, and if you're enjoying this podcast, if you find this podcast helpful, please review, share, rate, and feel free to make sure that you're incorporating these strategies not only into your department but share these strategies with others in your organization. Thanks so much for being here. Take care, everyone!

Renee Thompson:
Thank you for listening to Coffee Break: Breaking the Cycle of Bullying in Healthcare – One Cup at a Time. If you found these practical strategies helpful, we invite you to click the subscribe button and tune in every other week. For more information about our show and how we work with healthcare organizations to cultivate and sustain a healthy work culture free from bullying and incivility, visit HealthyWorkforceInstitute.com. Until our next cup of coffee, be kind, take care, and stay connected.

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Things You’ll Learn:
  • Creating a safe and supportive environment is crucial for retaining our new nurses, alongside recruitment and retention efforts.
  • Renee Thompson provides strategies to empower both new nurses and experienced staff, fostering a culture of support, kindness, and relentless feedback. 
  • The effort to prevent bullying and incivility extends beyond protecting new nurses; it involves nurturing and integrating them into the entire interprofessional team.
  • Building a culture of relentless feedback is essential for helping new nurses flourish, as honest, constructive feedback empowers them to grow and thrive in their roles.
  • Welcoming and integrating new nurses into the interprofessional team is vital for their success, emphasizing the creation of an inclusive environment where every team member feels valued and supported.
Resources:
  • Follow and Connect with Renee on LinkedIn.
  • Follow the Healthy Workforce Institute on LinkedIn
  • Visit the Healthy Workforce Institute website!
  • To learn more about the Graduate Nurse Anti-bullying Curriculum, click here.
  • To get the 9 Ways to Welcome & Protect your New Graduate Nurses document, click here.
  • To get the Powerful Scripts to Stop Bullying in the Moment  document, click here.
Disclosure: The host may be compensated for linking to other sites or for sales of products we link to. As an Amazon Associate, Coffee Break earns from qualifying purchases.
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