Nursing Workplace Culture: Change Begins With You

By Keith Carlson, BSN, RN, NC-BC

Workplace culture in nursing and healthcare is so important to job satisfaction, staff retention, and patient outcomes. Culture isn’t always talked about, but nurses are negatively and positively affected by workplace culture. The thing is, you can choose to change a workplace culture that’s dragging you down, and you always have the choice to leave if it just feels impossible. 

Wikipedia defines workplace culture as:

“Organizational culture encompasses values and behaviors that contribute to the unique social and psychological environment of an organization…..Organizational culture represents the collective values, beliefs, and principles of organizational members and is a product of such factors as history, product, market, technology, strategy, type of employees, management style, and national culture; culture includes the organization's vision, values, norms, systems, symbols, language, assumptions, beliefs, and habits.”

Your Workplace Culture

What’s the culture like in your workplace? Do people naturally cooperate and collaborate? Are the leadership and executive teams available and transparent? What values and principles does your organization express? 

An employer’s mission looks great on their “About” page, but it takes leadership to bring those values to life -- unless, of course, employees take the culture into their own hands. 

If bullying is tolerated or silently condoned in your workplace, the organizational culture is toxic If leaders ignore the value and importance of individual contributions, that’s another sign of an unhealthy workplace. 

Healthcare Workplace Subcultures

If you work in a large hospital, each individual unit has its own subculture. Beyond that, various groups of staff -- nurses, physicians, aides -- also have subcultures of their own.

Have you ever walked into a new unit and realized that something feels different? You may have noticed that when you come to work on this particular unit, things just feel good; you see that nurses help one another, laugh and smile frequently, and camaraderie and cooperation are just how people go through their day. This may seem like a dream, but for some, it’s a reality. 

You’ve also probably walked onto units where you feel like you have to watch your back at every moment; the aides are unhelpful, the nurses whisper and gossip, and no one ever offers help to anyone else, unless they’re members of the same clique. 

In a negative culture, a so-called “queen bully” might rule the roost and set the tone for everyone. Sadly, management may be so intimidated by her that they consciously turn a blind eye, allowing her to be free of any oversight or control. 

Subcultures are also permeable. Let’s say that bullying and incivility between nurses are silently tolerated on a particular unit. Certain nurses are bullied or harassed regularly, and other nurses appear to be immune to the bullying, play a complicit role, or they themselves are also bullies. When the aides observe the nurses sniping at each other, this behavior trickles into the team of aides and their internal power dynamic -- bullying than “infects” the aide team and undermines the overall culture. In this case, incivility becomes the norm.

Bullying got you down? See what you can do about it.

Be The Change You Want To See

If your workplace is negative and discouraging, the first thing you have to realize is that it probably won’t change without you taking action. Aside from the hiring of a progressive, forward-thinking nurse leader, changes in culture often begin from the ground up -- and that means you. 

If you’re a charge nurse and you notice that the morning report is tense and uncomfortable, you can choose to alter the culture of that meeting by initiating a few minutes of personal sharing. 

Maybe knowing that your colleague’s brother-in-law just died or your other coworker’s dog was hit by a car would help you feel compassion towards them in the course of the shift.

As a CNO or DON, you can shape organizational culture as you lead by example. Your style of communication stimulates others to copy your behavior. 

We can’t just wait for the culture to change, and we can’t rely on leaders to make it happen. Yes, a positive workplace culture can be created from the top down, but it can also be created by those in the trenches. If two nurses decide to take on the bullying culture in their workplace, they can stir up enough support to actually alter the organization’s culture and get a bully fired. 

 

Change From The Inside

Consultants and outside professionals can be brought in to initiate organizational culture change, but changing the culture from the inside is so powerful when you can do it yourself.

As a nurse, you can alter workplace culture from the inside. You can take inspired action, recruit allies, and bring the rest of the organization along for the ride. This isn’t easy, but you can exercise your own personal power and create a cultural transformation in your workplace. 

Next Up: The Culture of Safety: No Innocent Bystanders

Keith Carlson, BSN, RN, NC-BC is a Board-Certified Nurse Coach, award-winning blogger, nurse podcaster, speaker, and author. Based in Sante Fe, New Mexico, Nurse Keith’s work has appeared in a variety of online and print publications.