A Nurse Manager Transforms Her Unit’s Culture & Performance

February 22, 2018

Jan was on the verge of giving up trying to transform her poorly functioning unit. The culture on her unit was toxic, resulting in the highest turnover rate, lowest staff engagement and poorest patient satisfaction scores in the hospital. And patients were at risk, with hospital acquired infection rates two times higher than average.

After struggling for 18 months, none of the recommendations she had gotten from her boss, HR or external consultants had improved her unit’s performance. In fact, the work environment had become even more negative as the staff who had been disciplined by Jan were openly expressing their anger toward her and spreading their misery to their coworkers.

Her Director of Nursing had heard about positive psychology – the study of optimal functioning. She suggested that Jan work with a coach specializing in improving performance by creating a positive work environment. Jan’s response: “These people are crazy!! Being positive with this staff is impossible. They’re showing up late for their shifts, bullying the new nurses and making offensive comments to patients and their families. How will becoming more positive make any difference?”

But Jan and her boss were desperate to turn the unit around. So Jan began to learn about PROPEL – six positive psychology practices that enhance the wellbeing of the leader and staff. Jan put together a PROPEL team consisting of a handful of volunteers who shared her desire to improve conditions for staff and patients alike. They learned the skills of optimal functioning for themselves. Then they used PROPEL to positively influence the behavior of the vast majority of their coworkers, effectively isolating and eventually eliminating the most toxic staff members.

The following year Jan and her staff received an award for being the most improved unit in the hospital having achieved remarkable results:

PROPEL Study Results:

  • HCAHPS scores improved by 43%
  • RN Satisfaction increased 84%
  • Staff Engagement rose 81%
  • RN Retention improved by 49 percent
  • Surgical Site Infection rate decreased 55%
  • NDNQI: RN/MD Interaction improved 14%
  • RN Call Out/FMLA down 75%
  • Total Annual Cost Saving = $816,000

You may be thinking, how can I become an effective change agent capable of achieving results like this? Read on! Like Jan, you can learn the PROPEL skills to inspire and influence others.

The first PROPEL principle for improving performance – yours as well as your staffs – is to ignite Passion. When you envision a positive outcome that you have a Passion for achieving, you will activate the ‘executive functioning’ part of your brain. Once the left pre-frontal cortex has a vision of a positive outcome it recruits other parts of your cerebral cortex to help it create solutions and strategies for getting there.

The next PROPEL principle, Relationships, focuses on enabling people to remain resilient during the change process by garnering support from other people. You’ll discover how to cultivate positive relationships with key individuals who share your vision and forge them into a highly effective team.

The third PROPEL principle will enable you to remain resilient when facing challenges by being a more Optimistic thinker. How you think about problems determines whether you will have the gritty determination to persevere through the trial-and-error process required to improve performance.

The fourth PROPEL principle, Proactivity, enables you to convert your negative reactions into positive actions. Numerous studies show that achieving success comes from knowing what personal qualities empower you and your staff to be at your best. Twenty years of research has proven that proactive people attain the highest level of success because they know and use their strengths when facing challenges.

You will need to be able to continually replenish your Energy, which you will learn how to do when you master the fifth PROPEL principle. Developing habits for renewing your energy will give you the ability to take good care of yourself. You cannot take good care of others if you do not take care of yourself.

The final PROPEL principle – Legacy – is about learning to make a meaningful difference in other people’s lives. The highest level of life satisfaction comes from feeling deeply gratified with having acquired the ability to empower other people to achieve remarkable results.

Read a detailed account of how Jan and her staff empowered themselves and developed a positive, high-performing unit in PROPEL to Quality Healthcare: Six Steps for Improving Patient Care, Staff Engagement and the Bottom Line. Click the link below to order the book:



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