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Building Psychological Safety and Belonging in Your Unit

October 20, 2022
October 20, 2022

This blog is taken from a recent HealthStream webinar titled “Building Psychological Safety and Belonging in Your Unit.” The webinar was moderated by HealthStream’s Beth Pfeifer, Product Marketing Manager and featured Cindy Cain, DNP, RN, CNS, CCRN-K, Clinical Practice Specialist for the American Association of Critical Care Nurses (AACN).

The term “quiet quitting” is one of the latest workplace buzzwords. Quiet quitting really looks like a loss of engagement and results in employees setting boundaries around their work duties – essentially setting a “work-to-rule” policy that limits their activities to just those in their job descriptions to avoid working longer hours and extra assignments. The webinar focused on practical tools to help healthcare leaders embrace strategies that will help strengthen staff engagement, retention and satisfaction.


Building Psychological Safety and Belonging – Why Is it Harder Right Now?

Cain began by acknowledging that quiet quitting can be a double-edged sword. Some see it as a means of self-care – people are simply pulling back and giving themselves time to heal and that eventually they will re-engage. “Conversely, there are those that see it as quite alarming as it points to a level of disengagement that we have not seen in a very long time,” said Cain.   

Regardless of how quiet quitting may be perceived, there are some undeniable consequences to ignoring the importance of psychological safety and belonging. Cain cited the recently published AACN National Nurse Work Environment Report1. Although not surprising, the results indicated that improvements in the work environment are critical.   

  • The healthcare staffing crisis has become significantly worse.
  • The number of nurses expressing an intent to leave their current positions has increased.
  • Satisfaction with being a nurse has declined.
  • Nurses reported feeling unsafe and undervalued.


Psychological Safety and Belonging – What is it and Why is it Important?

Healthcare leaders manage multiple priorities, so why should building psychological safety be one of those priorities? Simply put, psychological safety and belonging are critical to the safe and effective delivery of healthcare. Psychological safety results in: 

  • Increased interpersonal risk taking – nurses feel comfortable speaking up, asking questions, sharing ideas and expressing dissenting points-of-view.
  • Improved team learning – nurses feel comfortable asking questions which results in learning opportunities for the entire team.
  • Increased creativity and innovation – nurses feel comfortable expressing new and different points of view which fosters creativity in an environment that is sometimes too busy or stressful to embrace innovation.

In a unit where nurses feel like they belong, they will have a feeling of security and support along with a sense of acceptance and inclusion. When psychological safety is combined with belonging, nurses feel like they can bring their authentic selves to work which results in improved performance and higher levels of engagement.


Creating Psychological Safety and Belonging – It Starts With Authentic Leadership

Leadership matters when creating psychological safety and belonging. Leaders need to be transparent and willing to admit mistakes when appropriate. Leaders will need to be patient, vulnerable, and accepting of different points of view.

In addition, Cain gave some specific recommendations on how managers can help to build psychological safety and belonging on their units.

  • Provide meaningful reward and recognition. Cain stressed the importance of managers getting to really know their team as meaningful reward and recognition will be different from one person to the next. Have a plan to provide both individual and team recognition. 
  • Provide regular, honest feedback.
  • Respond to all staff concerns in a timely fashion.
  • Empower your staff to make decisions when it is appropriate for them to do so.

Leadership matters when creating psychological safety and belonging, but employees should contribute too. They should be encouraged to praise their colleague’s work as appropriate. They should also be urged to provide timely and honest feedback for their colleagues and their leaders, and be willing to thank them for their contributions. Like their managers, they should also be respectful of everyone’s opinions.


How to Assess the Health of Your Work Environment

AACN has established some standards to help leaders assess the health of their work environments. You can begin with an assessment to evaluate the health of your unit. The assessment will help you evaluate: skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition, and authentic leadership.

Cain also recommended psychological safety assessment tools from both Google and Magnet. In addition to these tools, she recommended that leaders take the time to better understand their own leadership styles through the use of leadership style assessment tools. Results from tools that assess team and leadership strengths can help inform the process for building psychological safety and belonging.

1 https: //doi.org/10.4037/ccn2022798