Patient Safety First DECEMBER 2004, VOL 80, NO 6

P A T I E N T S A F E T Y F I R S T

Em and

D lovee m o ra le I

paiient safety n today's health care environ- ment, many employers are con- cerned about employee morale and make efforts to support high I levels of staff satisfaction. Most

health care organizations conduct regu- lar staff satisfaction surveys and address the findings through staff meetings, salary and benefit improvements, and strategies to resolve other identified issues. Despite these efforts, many nurs- es can describe a time when they person- ally experienced an episode of low morale or worked with colleagues who were unhappy in their work situations.

SHARING UNHAPPINESS Many nurses have worked with a

colleague who always seems to be hav- ing a bad day. Such colleagues are known to grumble about working con- ditions, their coworkers, management team members, physician colleagues, assignments, or work hours. These individuals not only are unhappy with almost everything in their work lives, they seem to enjoy sharing their misery with anyone who will listen.

Usually, these employees are not willing to offer constructive criticism or suggestions for positive change. In fact, their focus often is on gathering sup- port for their negative views. Further- more, when they have identified a problem, they often expect someone else to fix it. These individuals do not seek solutions to problems and, in fact, may not believe they even can be part of the solution.

may not like their jobs; however, instead of actively pursuing another role or position, they return to work each day with a pervasive sense of unhappiness. These individuals often seem to enjoy trying to ensure that their coworkers are equally unhappy.

Individuals with low morale simply

THE EFFECTS OF LOW MORALE ON PATIENT CARE

Low morale can contribute to nega- tive outcomes at both the patient care level and the department level. A mem- ber of the health care team experienc- ing low morale may perform at a lower standard of practice than usual. Ima- gine a circulating nurse saying, "Don't bother with counts. We're just too busy, and nobody cares if we do them." This is an example of how low morale can negatively influence patient care and quality outcomes. A dissatisfied nurse may cut corners or not pay attention to details while providing care. This may be as simple as not veri- fying a patient's consent or surgical site or not paying attention to tourniquet time. A gener- al malaise about work can contribute to a lower standard of practice and may greatly increase the potential for errors.

Department-level problems can occur when a staff member calls in sick for a "mental health day," leaving a depart- ment understaffed. This type of behavior can limit a clinical department's abilitv to provide care

Suzanne C Beyea, RN

ne a circulating nurse saying, "Don't

bother w'th counts. No one cares if we do

them." This is an example of how low morale can

negatively influence patient cure and quality

outcomes.

3 1

and may lead to delays in surgery. In some environments, understaffing may limit a department's ability to provide care in a manner consistent with prac- tice standards. In some departments, nurses relate experiences of having one circulating nurse for two OR suites or procedures when normally there would

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Patient Safety First DECEMBER 2004, VOL 80, NO 6

be one nurse per procedure. Excessive sick days can result in other nursing staff mem- bers working overtime, which can lead to fatigue and poten- tial errors. One team mem- ber’s negativity and low morale can contribute to an entire department developing low morale and an overall lowering of standards of care and safety practices.

A REAL PROBLEM? In certain clinical situa-

tions, legitimate reasons exist for staff members to be unhappy and experience low morale. Nurses and other staff members may be required to work overtime, work in understaffed departments, have excessive on-call require- ments, or lack adequate sup- plies and equipment to pro- vide care. Managers may be unresponsive to workers’ con- cerns or fail to address them in a timely manner. Under these conditions, nurses may perceive the work environ- ment as unsupportive, hostile, or unhealthy.

Nurses and their colleagues should carefully assess the reality of their situation. Are they working in an environ- ment that has potential to im- prove? Are there changes that can be made with the support of colleagues or managers that will contribute to more positive outcomes? Are they contributing to the morale problem, or are they part of the solution?

Regardless of whether low morale stems from a legitimate issue directly affecting employ-

I n dealing with low employee morale, one must identi&

the problem, confront negative coworkers, take

responsibility for one’s own attitude, and be part of the

solution.

ees or the spreading of nega- tivity, it must be addressed. Resolving issues of discontent entails 0 identifying the nature and

source of the problem, 0 dealing directly with nega-

tive coworkers, 0 taking responsibility for

one‘s own attitude, and 0 being part of the solution, all while continuing to pro- vide quality patient care.

Identify the problem. If a team member believes a par- ticular situation could-or should-be better, he or she first must determine the nature and source of the spe- cific problem. Does a problem actually exist, or is it simply perceived based on the com- plaints or dissatisfaction of others? Are colleagues unhap- py because of unsatisfactory working conditions, or because they do not like the work they are doing and the related responsibilities?

Deal with negative co- workers. The next question staff members must ask them- selves is how to deal with coworkers who make negative comments. Do they add to the

negativity, or do they respond with a more positive com- ment, such as, “I choose to view this issue in a different way and see it as an opportu- nity for improvement”?

Sometimes, a staff member complains to others about a member of the team, but does not address the issue with that individual. Staff mem- bers should feel empowered to encourage the person who is complaining to talk to the individual with whom he or she has a problem. Consider the following example. Nurse Jones believes that Nurse Smith takes long lunch breaks and disappears when it is time to clean a room. Nurse Jones complains about this to any staff mem- ber who will listen, but she has never discussed her con- cerns with Nurse Smith. In this situation, everyone in the department, except Nurse Smith, is aware of Nurse Jones’ feelings. Nurse Jones’ colleagues should encourage her to voice her concerns to Nurse Smith to resolve the situation. Resolving the problem may improve Nurse Jones’ morale and potentially the morale of those who have had to listen to her complaints.

When nurses take owner- ship for unit morale instead of allowing negativity to grow, all members of the health care team benefit. Staff members benefit by cre- ating a healthy work envi- ronment. By extinguishing or redirecting negativity, staff members support leaders’

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DECEMBER 2004, VDL 80, NO 6 Patient Safety First

efforts to develop and main- tain effective communication processes. Most importantly, when staff members are not focused on the negative, they can devote their time and energy to providing high- quality patient care. When the focus is on patient care, the entire system benefits.

Take responsibility. Each staff member must take per- sonal responsibility for his or her own morale. This requires honest examination of one’s attitude toward his or her work environment. No one should blame personal unhappiness on a work situa- tion. If a clinician is truly unfulfilled at work, it is his or her responsibility to explore other employment opportuni- ties. Sometimes, an employee needs to recognize that a position is not a good fit in terms of work hours, expecta- tions, or physical demands.

No health care organization can provide an employee with the perfect job.

B e part of t h e solution. If unfavorable work conditions exist, employees should con- tribute to effecting positive change by working with col- leagues and supervisory staff members on pertinent issues. Taking the attitude that ”nothing I do will make a difference” prevents progress and is self-defeat- ing. If staff members have concerns, they should address them promptly with the appropriate individuals. No one should allow con- cerns to remain unaddressed or unresolved.

MAINTAINING QUALITY PATIENT CARE

Most importantly, a staff member’s bad day or morale issue should not affect the quality of his or her work or

attitude toward patients, patients’ family members, or coworkers. Patients deserve competent, caring clinicians who are committed to their work and to providing high- quality care. Furthermore, staff members should never share their negative feelings with a patient. Clinicians must take pride in the work they do and in the care they provide.

It is easy to sit back and let projects fail or contribute to negativity. A professional nurse’s first priority is to provide safe, high-quality care regardless of his or her morale. Low morale should never result in lower clinical standards. *:*

SUZANNE C. BEYEA RN, PHD, FAAN

DIRECTOR OF NURSING RESEARCH DARTMOUTH-HITCHCOCK MEDICAL CENTER

LEBANON, NH

New Guide Can Help Communities Prepare for Epidemics hysician-scientists a t NewYork-Presbyterian/ P Weill Cornell Medical Centefs Department of

Public Health have created a nationwide planning guide for community-based response t o bioterrorism and infectious diseases, according t o a Sept 29, 2004, news release from the medical center. The guide was written for a wide audience, including public health and emergency management planners, community organizations, and the media. An accompanying computer planning model wi l l help communities ensure tha t a l l Americans have needed medications and vaccines i n the event o f a natural epidemic or bioterrorist attack.

The guide, t i t led Community-Based Mass Prophylaxis: A Planning Guide for Public Health Preparedness, provides a framework for understand-

ing the components o f an epidemic outbreak re- sponse, including surveillance, stockpiling, distri- bution, dispensing, and follow-up care. It also pro- vides a plan for conducting medication-dispensing operations using specifically designating dispens- ing clinics.

This project was funded by the Agency for Healthcare Research and Quality (AHRQ). The guide i s available on AHRQs web site at http://www.ahrq.gov /research/cbmprophyvcbmpro. h tm.

New Guide Helps Communities Prepare for Vaccine and Drug Dispensing i n the Event of Bioterrorism or Other Public Health Emergency (news release, New York: NewYork-Presbytenan/Weill Cornell Medical Center, Sep t 29, 2004).

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