Culture Isn’t a Side Project—It’s the Foundation

Creating a positive culture. 

Transcript

Choehns: 0:01

Good afternoon and welcome back to Leading Nursing Together, the podcast where we talk honestly about what it means to lead with the heart, courage and collaboration in today's nursing landscape. I'm your host, Michelle Hoen, Tanner's Chief Nursing Executive. Let's face it, the nurse place culture is still a persistent challenge in nursing, whether it's cliques, favoritism, bullying, or just plain vindictiveness. Many of us have experienced these behaviors, not only from our colleagues, but from our patients, our families, and our broader team. Let's be honest, COVID-19 pandemic has only amplified those struggles. Today we're gonna dive into a tough but essential conversation on how do we build cultures that heal instead of harm? Creating a cohesive, positive environment isn't just about making work nicer. It's about retaining great people, reducing burnout. Showing up as our best selves in a profession that demands so much of us. A positive culture doesn't mean forced smiles or ignoring issues. It means supporting nurses who are facing burnout, moral injury, and trauma. And let me say, if you've ever worked in a challenging environment where people. Make a difference, you know, the impact of a supportive team. Unfortunately, not everyone gets to experience the positivity and a great culture, but when you do, it is something you wanna protect and you never forget. I wanna share a moment with you, one that kind of struck me to my core. And this was when I was really trying to build that culture of positivity. I would walk in every morning with a smile, speak to all of my team members, make sure everybody had everything that they needed, and I sincerely meant it, but one day. A nurse on my unit needed to receive a coaching memo for callouts and tardiness. During this private conversation, I explained the policy, my expectations, and I generally felt like we had a respectful, productive exchange. But as soon as she left my office, she walked into the nurse's station and started venting about how unfair I was being. I immediately asked her to come right back into my office. From that point, I reminded her our goal here is to be collaborative and committed. I asked her if she liked her job. I asked her if she felt supported by me. I asked her if she felt supported by her coworkers, and she said, yes, absolutely. And then I asked, well, then why are you complaining? Her answer was simple, that she was upset with herself and wanted to justify it out loud. We ended up having an additional conversation in agreement where we both talked about what our expectations were, how we both cared about our unit, and we wanted to protect the culture that we built, which means if we had. Something that we didn't agree with or that was upsetting us, that it was much better to come talk to me about it first before venting with our coworkers to possibly create a negative culture, and that reminds me, leaders have to address disruption directly. Compassionately because culture is what we allow and or what we correct, and ultimately, if you don't do anything, your culture could suffer. Fostering culture isn't easy. It takes intention drive and motivation. You're bringing together people with different backgrounds, values, and communication styles, all in a very high pressure environment. Leaders need the tool to deal with this disruptive behavior head on because that lets you have a clear. Vision on what we tolerate and what we don't tolerate, because ultimately what we permit, we promote. We've learned that positivity has to come from leadership and the team. Toxic energy spreads fast, but when you model professionalism, consistency, and respect, you set that tone. Take shared governance, for instance, when we implemented hourly rounding at one of the places that I worked at, it wasn't an option for us. We had to do it. We had to make it successful, and really and truly as leaders, we were told that if it didn't get it done, they would find someone who would get it done instead of. Going to my staff and saying, now we just gotta handed down a directive and we gotta make sure it gets done, and if you don't get it done, there's gonna be punishment. Instead, I looked at my team and said, this is something that we need to do, but it's gonna help all of us. So we need to figure out together how we can roll this out and make it successful on our unit. That's what we did. We took the time and shared governance to go over all the rules to understand what their scripting was, to make that positive difference. Then my staff helped design the rollout, the education, and even the scripting. And you know what? It worked because they took ownership. They knew. That if it didn't work out, I would have their backs and so they had mine. Think bedside shift report, exclusive team huddles, or even decluttering a break room culture is felt. It's not just written in a handbook, so let's go back and talk about that toxic environment, because the toxic environment does more than just make it difficult. It also frustrates all the people around it because it can honestly cause real harm. We should have zero tolerance that. our nurses Are bullying or causing disruption on their unit. And the other piece of it is we need to enforce it. We can't sit and watch someone who can not stand up for themselves or they're brand new and watch people bullying them. We have to step in. We have to make sure that everyone around us understands that will not be tolerated. So let me give you another great example. I took over a unit that was very. Toxic, it had a lot of bad traits to it. It was one known as one of the worst units in the hospital and it, it really dealt with a lot of the fact that the manager really did not have any rules or regulations that she had anybody follow. And I came in and I was being told by a lot of different people or texts, don't do anything that can never be found. I asked the charge nurse, have you asked them to do this stuff? And she said, yes, I do. But every time I ask'em, they seem to disappear. And I said, well, the next time that happens, please let me know and I will speak to them myself. And so the charge nurse came to me and she said, you know, we were having all these call lights go off, but we can't find. Any of the texts today. And I said, okay, well what I'd like for you to do is I want you to go down one hallway. I want you to check in every room and I'm gonna go down the other hallway and I'm gonna check in every room. And we did, and we found out that we could not find the texts we called. They weren't answering. I just sat down in the nurses' station and waited for them to show up. Sure enough, 60 minutes later, all three of'em walked through the door and told me that they were on lunch. And I said, well, funny thing about it is I haven't been able to find you since 10 30 and it is now 12 o'clock. That was an awfully long lunch break, I want you guys to come into my office. I pulled all three of them into my office and I told them that we couldn't do that, and that wasn't. My expectation for'em, and they said, well, what are you gonna do? We know you can't fire us because there's just not enough people and they've put a hiring freeze on. And I said, well, I'll tell you this. I would rather work short than to have attitudes like that, so all three of you are on administrative leave until I can pull up all the records. Sure enough, when I started drilling down on it, not only. Were they off my unit? They were out of the hospital for about an hour, of which all three of them were still clocked in. After speaking to hr, we terminated all three of them. But I tell you what it did for my culture, it changed my culture. Right around because what they realized was I was gonna have their back. I wasn't going to listen to excuses. I wasn't gonna say, oh yeah, you're right. I can't hire anybody. I decided that if I couldn't have texts that were dependable, then I didn't want those techs at all. The funny thing about it is my nurses rallied around. They all agreed with me and we all worked together until we could hire the right people on our unit. So culture does matter, and the manager who creates that culture, it matters even more. One way to create that safe, healthy environment is through innovation. Great leaders empower their teams to try fail, adjust, and grow. Here are five traits that drive innovation in nursing leadership, divergent thinkers. We need to be open. Allow them to think outside of the box, create new ideas. Let them know that any idea matters. Risk taking, while that sometimes. Sounds like a bad word sometimes. As long as it's safe and calculated and put in a environment in which we control, then it can be very positive. Failure tolerance, learn from our setbacks. We don't have to be perfect every time. Not everything has to work, but at least we tried and then we learn from those mistakes. Try to adapt from change. That is probably one of the hardest things to do, is adapting to change, because change is a scary thing. But if we can do that adaption, you will have your unit be able to grow and create. An environment that is healthy and positive. And then of course, last but not least, is autonomy. You need to give your staff a little bit of autonomy to let them try to let them fail, to let them grow, but you can't walk away. You have to be there to guide them. You have to be there to show them when they failed, the reason why they failed, and how to learn from that failure. Be there to support them, and then they will have your back. Innovation isn't just about accepting ideas. It's about supporting those ideas. It's about supporting them with time, resources, and responsibility, just remember that leadership is everything when it comes to culture. It sets the tone. It models the behavior. It influences how the team responses under pressure. Great leadership prioritizes psychological safety, where people can speak up, admit mistakes, and share ideas without fear. It means clear, consistent communication and being visible and accessible. It means investing in your people, recognizing their wins, mentoring future leaders and helping them grow the road to better culture in nursing is not easy. But it is absolutely positive. So here's just a few things that I want you to challenge yourself with this week. Assess your team's culture. Confront what is toxic. Empower your team through training, shared decision making and consistent support. Celebrate innovation, even the smallest stuff, and most importantly, lead with courage and heart. Culture isn't a side project. It is the foundation of everything that you do. Let's build something we can be proud of. Until next time, keep leading nursing together.