There has never been broader discourse about nursing than now, and yet, nurses are still feeling unheard and frustrated. Recently two of my younger nurse colleagues termed this gaslighting. Despite being a more recent term, gaslighting was the 2022 word of the year, and describes when a person goes through a negative experience and is made to believe that their feelings about the experience are not real.
One colleague described how we violated nurses’ trust with insufficient support and safety, while the other explained how employers ignored pleas for better pay as we brought in hordes of travel nurses. In both cases, many nurses responded by simply leaving the profession.
Let’s be honest: times are tough in nursing. However, that does not give us the right to invalidate what nurses and the whole of health care are going through. When nurses are leaving the profession in droves, it can be difficult to know how to proceed, especially when staffing is short every day, finances are worse than tight, and people are simply exhausted after all the things that we have been through the past couple of years. How do we navigate through these particularly challenging times when the odds are stacked against us?
In times like these, I always find myself re-reading a paragraph from the original study that identified the characteristics of Magnet hospitals. It describes that clinical nurses in Magnet hospitals “have an image of themselves as influencing decisions and being in relative control of their own practice” (McClure, Poulin, Sovie, & Wandelt, 1983, p. 103). Somehow, in these organizations, the voice of the nurse was not only heard but listened to in a way that honored their expertise and gave them power and influence. I often wonder if nurses are leaving because they feel like things have spiraled out of control and they are powerless to influence things to get back on track.
All hope is not lost, though.
The solution is more than just listening to nurses. It’s about providing nurses the autonomy to make their own decisions, practice their authority, and cultivate an environment where nurses are empowered to take back control of their professional practice. It’s recognizing the difference between providing input and making a decision. Input is giving advice to inform decision-making which can either be listened to or ignored by the person making the decision. Authority is having control over the decision itself.
Clearly, some decision-making authority belongs to managers—what salary to pay, who to hire or fire, and what resources to provide. Wise managers garner input from their team to help inform the wisdom of their decisions. If the input isn’t respected or believed, it often leaves the person providing the input with the experience of being unheard. This doesn’t mean that all input can be acted on. A legitimate response is, “I hear you, I understand your point, and here is what I can and cannot do with that information.”
At the same time, wise managers recognize and support the notion that nurses need autonomy and authority to bring the best out of the nursing practice. They ensure that nurses have the authority to make the clinical experience better, applying recent research to improve care, streamlining care delivery, and ensuring a supportive clinical practice.
As we navigate out of these challenging times, one key component is to be clear about where professional nurses have authority for decision-making and where they work interdependently, providing input to others who make the final choice. Legitimately listening (beyond the frustration) to the intelligence, commitment, and professionals that they are when they are providing input and maximizing all of the authority and autonomy for nurses to make decisions about their clinical practice, which they themselves own.
The future of healthcare relies on a strong, healthy, and engaged nursing workforce. To get there, we need nurses to bring their full professional expertise not only to delivering patient care but to redesigning the systems of practice that enable them to bring their best selves to their work. Only then can we transform nursing into a profession where people can make a difference and be among the healthiest members of society.
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Marla J. Weston, PhD, RN, FAAN, is a registered nurse and former CEO of the American Nurses Association. Currently, she serves as the senior advisor for Practicing Excellence’s Nursing Experience Project (NEP), an app-based skill-building solution created by nurses, for nurses.
