Nurse Managers: The Formula for Building Strong Teams

April 1, 2021
April 1, 2021

By Traci Hanlon MN, RN, Consultant at Creative Health Care Management

I believe Nurse Managers have the toughest job on the planet. They are accountable for operations, budget, staff satisfaction, patient satisfaction, staffing, quality outcomes—heck, all outcomes! The buck stops with them. It is not acceptable to give in to excuses such as “I didn’t have time,” or ”I forgot.” The reality is that their leadership can make the difference between a team that thrives and a team that dies. Teams that are disengaged and dissatisfied with their work are literally dangerous to patients. We know this from the research that reports that mistakes in interpersonal communication account for approximately 60 percent of all medication errors, and that every year 2 million (1 out of 20) patients contract a hospital acquired infection; 90,000 of these patients die. In the case of each of these infections, there was likely someone at some point who witnessed a team member not following protocol or not washing his or her hands. The Silence Kills study, conducted by VitalSmarts and AACN, point out that most nurses (64 percent) when confronted with a colleague who takes a short cut or does not follow protocol, do not speak up. Those are some tough statistics to be responsible for; and yet, nurse managers ARE responsible. For this reason (and others), it’s essential for nurse managers to cultivate high-trust cultures on their units. (Maxfield, D., Grenny, J., McMillan, R., Patterson, K., Switzler, A. (date). Silence kills: The seven crucial conversations for healthcare. Provo, UT:VitalSmarts.)

How does a nurse manager build a team where trust is so strong that teammates feel empowered to hold one another accountable for speaking up? Where skilled communication is a top competency alongside technical skill? Where teamwork is so engrained in the fabric of who individuals are that any patient’s call light is everyone’s call light?

The secret formula is an acronym I call KAER.

K stands for Kindness.

It is imperative that nurse managers embrace an authentic leadership style where transparency and kindness are guiding principles. Mangers who don’t walk their talk and treat employees as a means to an end will generate a culture of mistrust. Mistrust will lead to policies only being followed when the manager is on the floor. The true test of an authentic leader is what her staff are doing and saying when she is not there.

AE stands for Articulated Expectations.

Too often we think we have communicated clearly about what we expect from others, but what I find is that this is often where managers (myself included) miss the boat. We may tell our team members what we want or expect, but when one person does not meet the standard we set, and we do not follow through with consequences, we inadvertently set a new standard. The new standard is: “Yeah, she says we have to do x, y, and z, but nothing happens when we don’t, so it’s not really that important.” Michael Cohen says it beautifully when he says: “What we accept is what we teach.” When it comes to communication, I expect 100 percent of all communication with all people to be kind and respectful 100 percent of the time. The trick here is that my team and I had to define, in specific terms, what was considered kind and respectful and what was considered disrespectful communication. I let my team lead this. Top of the list? Eye rolling was considered to be disrespectful as was excessive complaining about a patient assignment. With this clear definition in place, when someone slipped, I helped to remind them what we agreed to as a team: that we would all communicate with kindness and respect and what that meant. I used a little tool called Commitment to My Co-workers, which outlined the basics of how we would all communicate, and then the team added things they felt were important. When I saw a pattern of someone not meeting that agreement, I followed up with consequences 100 percent of the time. The outcome? Our team held kind and respectful communication as a high priority and the expectations around that behavior were articulated and people were held accountable for sticking to them.

R stands for Respect.

Some people tell me this word speaks for itself, but I find that people hold onto the belief that you can’t respect someone if you don’t like them. I believe this is not true, and a belief I had to hold up and ask my team to examine very carefully. Respect is not about liking someone; it’s about recognizing their humanness.  At the very least, we can learn to separate a person’s behaviors from who they are as a person, and respect them as a human being with the same rights and needs we have.  Although I can’t mandate respect, I can mandate kind and respectful communication; asking my team to examine their beliefs around this value was the first step in helping them build a mindset that would ultimately set them up to address issues with people in a kind and respectful manner.  It’s true that there are some people who have the personality only a mother can love, but within all of us lies the capacity to have compassion for another human being and in the face of their unacceptable behavior, find the courage to ask ourselves, “What is going on with this person?” What piece of information do I not have that would lead me to understand why this person acts the way she does? It’s when we hold a compassionate space for each other that we get to know them and perhaps understand their pain in a way that allows us to see them not as a villain, but as another human being who needs our support and friendship. When we come from kindness, we are able to hold each other accountable for unacceptable behavior in a way that is less likely to be seen as an attack and more likely to be seen as a mutual agreement to help each other succeed. Let’s face it; we all have bad days where we slip up. I’m grateful for a team of people who care for me enough to gently and respectfully remind me when I do slip and help me bring my best self forward.


Traci Hanlon MN, RN is a consultant with Creative Healthcare Management and specializes in preceptor, nursing orientation, and transition to practice program development.