Here’s a fact about nurse engagement that might surprise you: nurse engagement isn’t about longevity or tenure; it’s about nurses feeling vital to the mission and vitality in their life and work. When the latter happens, nurse retention usually takes care of itself.  

As any healthcare leader knows all too well, keeping any team of individuals engaged in one of the most demanding and high-stress work environments—especially two-plus years into one of the most trying times in the history of modern healthcare—is no easy task.

But it can be done.  

Nurse engagement starts with shifting your focus away from nurse engagement strategies that center on external incentives like compensation. External incentives might have a positive impact in the short term, but they lack sustainability in the long term. Instead, we suggest concentrating on internal incentives such as offering nurses a voice in practice governance and career development opportunities.  

Investing in sustainable nurse engagement strategies that support each nurse’s individual career aspirations and personal preferences will empower nurses in ways that are shown to reduce strife and staff turnover leading to reduced errors, improved patient safety¹, lower staffing costs, and improved patient satisfaction.  

The best part? Once these strategies are in place, your new, more intrinsically rewarding culture will hold an intangible value that, unlike compensation, is not easily replaced.

In this post, we dig into why nurse engagement is at an all-time low, why compensation isn’t an effective catch-all antidote, and meaningful strategies to engage your nursing staff.  

What is Nurse Engagement?

Nurse engagement is often discussed in terms of commitment to and satisfaction with the job. But engagement also includes nurses’ commitment to their employer and to their profession.² These parameters are reflected in the Gallup organization’s definition of engagement as “the involvement and enthusiasm of employees in their work and workplace.”³ But engagement is more than satisfaction with the latest pay increase or serving on committees, as noted by Schaufeli and colleagues, who define employee engagement as “a positive, fulfilling work-related state of mind that is characterized by vigour, dedication, and absorption. Rather than a momentary and specific state, engagement refers to a more persistent and pervasive affective-cognitive state that is not focused on any particular object, event, individual, or behavior.”⁴ In other words, engagement is a long-term proposition. 

Why care about nurse engagement? Engaged employees are optimistic, innovative, like to learn, go above and beyond expectations, and are both team- and solution-oriented. They share credit and accept responsibility. Given these traits, it’s not surprising that good employee engagement is good business. Engaged employees promote better business outcomes in organizations of all sizes and in all types of economic situations.³ An engaged staff can help reduce errors, patient safety incidents (such as mortality and falls), and staff turnover, while improving profitability, productivity, and customer satisfaction.⁴ On the other hand, unengaged employees can result in lower customer satisfaction, increased errors, and burnout.

Why is Nurse Engagement at an All-time Low?

According to a 2016 study published in the American Nurses Association’s Online Journal of Issues in Nursing, 15 out of every 100 nurses were considered disengaged⁵. The study also found that each disengaged nurse's reduced productivity cost an organization $22,200 in lost revenue annually. Meaning a100-nurse hospital was at risk of losing $333,000 per year while a 15,000-nurse system could lose $50 million a year.

At the time of the study, the 2010 healthcare reform, an aging Baby Boomer population, and fewer nursing program applications were driving the nursing shortage. America had 3 million nurses at work—the largest segment of healthcare workers in the nation—and it was one of the fastest-growing occupations in the country. Nevertheless, the number of registered nurses was not enough to meet demand.  

By 2022 the Bureau of Labor Statistics anticipated more than 1.2 million vacancies would emerge for registered nurses—a crisis not only for hospitals but also for already overwhelmed and disengaged nurses.

Then came 2020.  

While the toll of the pandemic on the public at large continues to be tallied by the number of cases, deaths, and recoveries, the toll it has taken and continues to take on nurses is more difficult to quantify.  

One year into the pandemic, we conducted a study of more than 1,000 nurses, 80 percent of whom reported they were providing direct care to COVID-19 patients in their current role, and learned that, between March 2020 and March 2021:

• 66 % had experienced feelings of depression
• 64% had experienced compassion fatigue toward patients
• 51% had experienced feelings of trauma, extreme stress, and/or PTSD
• 41% had experienced a moral injury (or similar result of ethical dilemmas, such as rationing patient care)

One year into the pandemic, 46 percent of the nurses surveyed were questioning their commitment to their jobs, and their profession.  

Of those 46 percent, 18 percent confirmed they were actively looking for a job outside of nursing, 46 percent said they were not actively looking but planned to within the next year, and 7 percent were planning to leave the workforce altogether.  

Disengagement during the pandemic might be an anomaly, but its retreat is not likely to reverse or eradicate the despair so many nurses report feeling about their work—or the impact of that feeling. Depressed nurses? Traumatized nurses? Exhausted nurses? Imagine, as a patient, seeing or sensing hopelessness in the caregivers you see first, last, and most frequently during your stay.  

And now, imagine being that caregiver, overwhelmed and outnumbered, giving energy and empathy alongside your clinical skills 12+ hours a day, multiple days a week—while knowing the most experienced generation of your fellow nurses are headed toward retirement, half of your current colleagues are discontent, and each year you stay you may have fewer colleagues to support you.

Is it any wonder that our survey also found that on a scale of one (lowest) to 10 (highest), nurses rated their current mental health and well-being at an average of 5.7? A rating that moved from 7.9 prior to COVID-19?

Congratulations if you have managed even a minute of standing in your nursing staff’s shoes, because the secret to nurse engagement—employee engagement of any type, really— begins there.

Nurse Engagement Strategies: Why Compensation is not the Answer

The top mistake we see hospital leadership make in efforts to assess nurse engagement is equating nurse engagement with nurse tenure. But the top mistake we see hospital leadership make to improve nurse engagement is assuming that raising compensation is the solution.  

In fact, we’ve found several other solutions that are far less costly and far more effective. Think about it: When you are overwhelmed with the rigors of your role—much like nurses assessing, executing, managing priorities, and trying to meet the (often conflicting) needs of others—what do you most need? What would make a difference? An increase in salary might temporarily make the situation more palatable. It might even make you feel more valued. But it doesn’t provide a release valve or improve your day-to-day circumstances.

That’s why focusing on compensation is a losing long-term game—for hospitals and nurses.  It has the initial impact of a reward, but it won’t serve or even affect the demonstrated needs of your nurses, their patients, or the hospital. Yes, achieving higher compensation is gratifying, but it isn’t intrinsically rewarding nor is it financially sustainable for your hospital.

(Take note: This doesn’t mean refusing raises or justifying low or unfair compensation; compensation must remain competitive. But recognizing the limits of compensation and prioritizing instead recognition of each nurse’s internal motivation and what they need both as nurses and humans will cost less and pay off indubitably more.)

What Motivates Nurse Engagement?

You may not be able to change the nation’s nursing shortage, the aging population, or increased patient complexity and need. You can’t reverse the myriad effects the pandemic has had on the healthcare system or promise to prevent another one. And you can’t magically reignite a nurse’s professional passion.

But you can ensure your nurses feel vitality in the quality of their work—i.e., real nurse engagement—and effect change in their hospital environment.  

If you recognize that nurse engagement does not equal a nurse staying in the same job 20 years, but rather, a nurse who is fulfilled, productive, and motivated to deliver high quality care  you are halfway there. The following strategies drive that type of real nurse engagement in which nurses feel genuinely fulfilled and engaged in their work.  

Incorporate more Staffing Flexibility

‍One of the most impactful ways leaders can impact nurse engagement is rethinking existing staffing models. Does your current model work for your nurses? If it doesn’t, then it won’t work for your patients or hospital. Current nurse staffing systems are often antiquated and inflexible.  

Patient complexity, acuity, stability; the number of admissions, discharges, and transfers; professional nursing and other staff skill level and expertise; the availability of technical support and other resources aren’t static. So why must your nursing team be?

The ANA contends that it shouldn’t be, stating that “Staffing levels in a value-based health care system should not be fixed because day-to-day hospital requirements are constantly in flux.”  

The fact is, inadequate or taxing schedules are a catalyst for stress and burnout, both of which are shown to directly impact overall job satisfaction and levels of engagement.

In other words, rigidity benefits no one. Flexibility benefits all. If you doubt it, consider how many nurses your hospital has lost to more flexible (and, admittedly, often better paying) nursing travel gigs.  

Offer more Individual Control

The change-making factor here is not only flexibility but also control. Nurses who feel locked into a rigid schedule and/or staffing model will feel little sense of control over their situation, leaving them feeling trapped, cynical, and disengaged. That’s a recipe for losing nurses entirely, or worse, retaining a cynical and disengaged nursing team. Giving nurses more control over their schedules is imperative to reducing stress and burnout, the levels of which are directly tied to job satisfaction and nurse engagement. This requires reflecting on what is and is not working for nurses regarding patient load/ratios, shift length, overtime, and their ability to rest and reset. Beyond that, it requires offering more flexible schedule options and empowering nurses to have a voice in their schedule. Consider using nurse scheduling technology that allows nurses to take a more active role in their schedule.

Provide Career Advancement Opportunities

Consider what your leadership is doing to support nurses in their education and career trajectory. Are your nurses able to practice at the top of their license? Are those who are interested in achieving higher levels of education and training given the opportunity or, better yet, supported in doing so? Are there barriers to their academic progression that leadership could impact by providing resources (or guidance to attaining) scholarships and educational assistance, or professional mentorships?  

Nurses who feel locked in a specific role or limited in their education level or career trajectory are likely to feel unmotivated and disengaged. When you offer nurses the opportunity to pursue higher levels of education and/or to advance within your organization, nurse engagement inevitably improves. Not only that, but you also foster a more engaged culture within your nursing team, drive better patient outcomes, and help assure your hospital’s ability to retain engaged nurses.  

Listen to, and Implement, Nurse Feedback

One complaint we hear repeatedly is that overwhelmed nurses feel stuck, like they are simply a coin-operated machine or a cog in a wheel. All too often, we tell nurses we appreciate them by posting encouraging signs, delivering cupcakes to the unit, or saying thank you. That only goes so far. Showing nurses that they matter by making fundamental system changes in response to their feedback goes much further. Start by asking nurses what is going well and what isn’t, and act based on their feedback. Doing so shows your organization’s leadership is engaged, and that, in turn, stimulates nurse engagement.

Connecting with nurses, asking questions, listening, and responding are vital to building an environment of trust. Studies show that a work environment that encourages nurses to share input about their values promotes nurse engagement⁶. In short, when nurses have a voice and that voice is heard, validated, and valued, they are more likely to trust your leadership.  

Trust and honesty empower nurses in a multitude of ways. Nurses who trust their leaders are less likely to doubt the authenticity of leaders’ intentions or behaviors⁷. Leaders who honestly and transparently engage with frontline staff are consistently found to have stronger, more credible relationships with their nursing staff.  

These authentic leaders are better able to engender honesty, hope, and optimism among their team, reducing cynicism and—importantly for hospitals—the tendency to disengage on the job or from the job.⁸

Encourage a Culture of Transparency

It is vital that nurses feel safe to share input—good, bad, and especially, mistakes or errors—without fear of retribution. It improves process optimization and patient safety.⁹

Further, nurses who are actively encouraged to speak up—not just about their complaints, needs, and goals but also about their values and ideas about processes and improvements—tend to demonstrate increased levels of work engagement and job satisfaction, key drivers in improved patient care.  

Expect to multiply that impact by including nurses in shared decision-making. As the first, last, and most frequent touchpoint for patients and their families, and the common link between a multitude of other stakeholders, nurses are a vital resource of on-the-ground insights for your hospital.  

Ask yourself these questions:  

• Do you see effective and transparent communication within your nursing team and between it and the other teams with which it works?  
• Are nurses encouraged to give input about their values, goals, and experiences?  
• Are they—not only at leadership level—involved in decision-making that affects their processes, patients, and work?  
• Is your nursing leadership present and accessible? (Do your nurses’ view leadership as present and accessible?)  
• Do your nurses feel they can speak up, even about mistakes and errors, without fear of retribution?  
• Are there leaders, structures, or processes in place to support and encourage transparency and communication?  

If your answers are yes, you are on a path to a meaningfully engaged nursing staff. If not, you know where you need to begin building a more supportive and engaged culture.

Flexibility and Individualized Empowerment: The Future of Nurse Engagement

In summation, there is no quick fix to improve nurse engagement. But rethinking what nurse engagement means—remember, it’s not nurse tenure; it’s a nurse who feels vital to the mission and vitality in their work and life—is a start.  

Recognizing and treating nurses as individual humans—rather than indestructible heroes—is how leadership can begin connecting with and engaging nurses.

Finally, taking action to structure a work environment that is flexible to their individual needs, responsive to their goals, and both encourages and validates their voices, will improve nurse engagement. In turn, nurse turnover, patient safety¹⁰, staffing costs, and patient satisfaction will improve.

Improve Nurse Engagement with Trusted Works

Trusted Works gives you a bird’s eye view of your entire workforce—internal, external per diem, local, and regional float—to understand performance, spend, and trends across source pools. Use Works to let nurses pick better shifts for their unique needs based on pay, benefits, schedule, floatability, and geography. Enabling flexibility prevents burnout and departure from the bedside. Learn more about how Works can help your hospital improve nurse engagement, streamline your source-to-pay process, and optimize labor costs at https://works.trustedhealth.com.

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¹ www.ncbi.nlm.nih.gov/pmc/articles/PMC6263830/

² https://doi.org/10.3912/OJIN.Vol21No01Man02

³ https://www.gallup.com/workplace/285674/improve-employee-engagement-workplace.aspx#ite-357458

⁴ https://www.gallup.com/workplace/321032/employee-engagement-meta-analysis-brief.aspx?thank-you-report-form=1

⁵ https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No1-Jan-2016/Nurse-Engagement-Contributing-Factors-for-Success.html

⁶ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8326221/

⁷ https://pubmed.ncbi.nlm.nih.gov/29464858/

⁸ https://pubmed.ncbi.nlm.nih.gov/24256497/

⁹ https://pubmed.ncbi.nlm.nih.gov/30339122/

¹⁰ www.ncbi.nlm.nih.gov/pmc/articles/PMC6263830/