How do more tenured nurses feel about value based care? It’s a question that challenges any person in a staffing and management position. The ideas of value based purchasing, raising HCAHPS scores, and patient satisfaction aren’t new for staff members in a hospital setting. For the nursing staff on the front lines, however; the concept is more complex. New nurses who join the team are adapting to many new concepts and processes, and these tactics and requirements for value based care are usually accepted as part of the job.

The more tenured staff member, though, might be less adaptive. Veteran nurses tend to be skeptical and strive to find a reason for the change beyond just appeasing administration. They want to ensure positive outcomes, so they know they are not just wasting their time on a new process. Put simply, they need to know it is good for their patients. So, what can the administration do to get this important sector of the nursing staff on board with value-based care?

Current Value Based Care Tactics That Help

For starters, there are widely accepted patient care tactics that already support value-based care initiatives:

• Regular rounding times
• Bedside shift reports
• Considering discharge needs at the time of admission

All three of these tactics work to improve patient safety, enhance communication and reduce errors. At the same time, they lower anxiety levels and improve patient and family satisfaction. Whether new or tenured, nursing staff members should have no problems using these tactics to bolster quality patient care and the patient experience.

Using Communication Boards

A relatively newer approach worth considering is the use of communication boards. These boards are not new, but they have a tendency to be underutilized. They can easily be ignored unless nursing management and administration are intentional about ensuring their correct use. If you are sensing push-back or apathy from staff members on utilizing communication boards, the best approach is education. Training should be reviewed on why they are used, but more importantly, it must be explained how it can change a patient’s outcome. Put simply, it reduces stress levels for both the patient and family members while improving communication between nursing staff going in and out of the room. Communication boards list everything from the patient’s room, to their schedule, to their medications, to names of their care team. Reiterate to your staff members that consistently using the communication boards will not only improve care team communication, but it will set expectations and calm anxieties for their patients.

Courtesy and Respect

Just the mention of this topic is likely to get eyes rolling, especially among more tenured nurses. Courtesy and respect are concepts often confused with the idea of “being nice”, but there is a big difference.

When patients enter a hospital, they lose all power. They can easily feel that they are unable to make decisions for themselves and are stuck somewhere they really don’t want to be. Treating them with courtesy and respect isn’t about being “nice” – it’s about letting them know that they still matter. Courtesy and respect then translate into making patients a part of their own care team. Once you bring them on board, they feel more comfortable to:

• Ask questions that they might not have otherwise
• Offer information they may have kept silent before

You give them back some of their power by making them part of the team.

To some staff members, value based care can feel like extra work or something that is just meant to check a box for administration—and from this perspective, it’s an understandable attitude. It is up to administrators and nursing managers to demonstrate to staff members how these initiatives will not only improve the patient experience but how these same tactics can improve overall care and patient outcomes.

Proper onboarding of new nurses is key to retention, job satisfaction, and engagement in complete patient care. Nurses who are comfortable in their environment, and feel supported by management, will become a critical part of the care team. These nurses have “bought in” to your hospital’s nursing culture and mission, and they feel empowered to provide the best possible healthcare to their patients. Excellent nursing care leads to improved patient outcomes, increased patient satisfaction, and higher HCAHPS scores. Solid nurse onboarding will engage new staff members — aligning them with your mission and vision in order to achieve your patient care and satisfaction goals.

Achieving Buy-in to Workplace Nursing Culture: 5 Steps

An analysis of a recent (2015) Press Ganey nursing survey, which received input from more than 200,000 nursing professionals, reveals five crucial elements that you must develop to spur nurse engagement:

1. Patient-Focused Mission
   Nurses want to do meaningful work—it’s why they went into nursing. They want to help their patients, provide the best care possible, and they want to feel supported while they do it. As an administrator, you can do nothing more important for your staff or your patients than to create a patient-centered mission and vision for your entire organization. And while one of your goals may be to improve HCAHPS scores, it CANNOT be your main focus. The mission and overarching goals of your hospital must be focused on patient care, and empowering your staff to deliver that care — nurse engagement, quality care, patient satisfaction, and improved HCAHPS scores will all develop from there.
2. Respect and Appreciation in the Workplace
   Nursing is a difficult job, and it is only made harder without a nursing culture of respect throughout the hospital. Mutual respect and teamwork are essential for great patient care. Nurses who feel that they are valued by their administration, and by their fellow staff members, are motivated to perform at the highest level. Make sure your organization finds opportunities to appreciate the staff and promote respect. Host events that thank staff members for their efforts and accomplishments. Offer meaningful recognition programs that notice and appreciate the nursing staff’s dedication to “go the extra mile”. Survey your staff to gauge their satisfaction and take action in areas where you have opportunities to improve. Working in an environment of mutual respect and demonstrated appreciation on a daily basis fuels positive patient outcomes and increases patient satisfaction.
3. Supportive and Comfortable Work Environment
   A comfortable, clean, and updated physical workspace helps encourage and enable the nursing staff. A haphazard, disorganized and unkempt workplace leads to overstressed staff – and naturally, this can translate to the kind of care they provide. Paying attention to creating a positive mental workspace is also key. Nurses who anticipate respectful, supportive colleague and hospital management relationships will be excited to join your organization. The more obviously you model these traits, as well as provide training and counseling to achieve them, the happier and more engaged your nursing staff will be. Clearly articulate that management’s role is to take care of and support the nursing staff, so the nurse can concentrate on caring for the patient.
4. Fair Pay
   Although not at the top of the requirement list for successful nursing, a fair pay structure is foundational to new nurse buy-in, and for nurse retention over time. Competitive pay demonstrates support and respect for the nursing staff, and it serves as a foundation upon which you can build your reputation and nursing culture.
5. Attractive Career Paths and Development Opportunities
   One way to show that you appreciate and respect your nursing staff is to provide them with opportunities. Overwhelmingly, nurses want to use all their hard-won skills to the fullest, and they seek to develop new ones. Nurses want to advance in their careers and to have a greater impact on the patients they serve. Truly motivated and engaged nurses are not seeking dead-end jobs – they want to feel that becoming part of your organization includes future opportunities. They want to refine their abilities to an expert level, gain new skills and assume new responsibilities over time. Don’t just tell your nurses you support them, but show it in practice with financial support and opportunities to progress up the career ladder and to attain advanced certifications.

Melding the Five Elements for Nurse Buy-in

These five tips for achieving cultural buy-in are strongly interrelated, so even focusing on one of them will help advance your progress with the others. When a new nurse is considering joining your organization, whether a Millennial who is new to the profession–or an experienced nurse further along on the career path, articulate your patient-centered mission clearly. Tell them who you are and let them know the strength of the organization they are joining. Show them how you will provide the support they need so that they can deliver the best care possible.