Motivation: 3 key ingredients to creating an environment where nurses thrive.

Last year I posted a video about motivation by Daniel Pink on my Facebook page.  I am fascinated by human behavior, particularly in what motivates people to reach or fail to reach their full potential.  Daniel’s theory on motivation made sense to me and I’ve used components of his theory in my work as a nurse entrepreneur. Traditional motivation (carrot and stick) is commonly used in organizations.  Incentive bonuses, performance evaluations with monetary compensation and rewards for good ideas are the mainstay motivational techniques to get employees to do more work.  However, according to Daniel Pink, this traditional approach isn’t working.  Studies have shown that when the task is simple and straightforward, carrots and sticks work.  However, if the task involves any cognitive skill, then the opposite happens – the higher the incentive, the lower the performance. The following 3 factors are the key ingredients that allow people to thrive: Autonomy – People want to be self-directed and believe that they can make independent decisions that benefit both the company and themselves.  It’s important in healthcare because 95% of all patient care decisions are made at the point of care.  Good decisions are dependant on organizations that support self-directed employees.  Mastery – Humans thrive when they feel a sense of accomplishment through mastery.  The urge to improve develops human talent, sparks creativity, and propels innovation. Purpose – There is an innate drive in all humans to be a part of a...

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Tips for New Nursing Grads: Play the “What if” game.

I can remember being a new nurse and feeling completely overwhelmed with the gazillion things I needed to know.  It was one thing to get A’s in class but completely different to actually take care of patients. How can you possibly remember all of the care and potential complications for every surgery, disease, medication, and procedure?  It wasn’t until I stepped out of the clinical setting for a while and then returned as a neuroscience nurse that I figured it out. I had been out of the acute care setting for 8 years when I decided to return to the bedside and accepted a job as a clinician on a very busy tertiary neuroscience step-down unit. Our patient population included people with acute strokes, head traumas and brain tumors.  I felt like a new nurse all over again. Although I knew how to be a nurse, I didn’t know how to be a neuro nurse. I felt a lot of pressure to be a quick learner and to do very well since I was a seasoned nurse. What helped me to become a really good neuro nurse was playing the “what if” game.  When I rounded with the neurosurgeons, I would always ask them questions about the diagnosis and surgery.  For example, if I were taking care of a patient with a pituitary tumor, I would ask, “What is...

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Revive Your Passion for Nursing and Prevent Burnout in 4 Easy Steps

I was in Saratoga Springs New York last weekend teaching a medical surgical certification review course through AMSN (  The preparation course is basically the highlights of everything you learned in nursing school and throughout your nursing experience in 2 days (minus the specialties).  Although it is exhausting, when I do the course, they are always the best 2 days of my week.  I just love seeing nurses that take their role seriously and are committed to improving their clinical knowledge and professional practice, gathered together in one place. One of the best compliments I received came from a nurse last weekend.  She told me that she had been feeling burned out in her role as a nurse lately but that the course and apparently my enthusiasm re-energized her.  She thanked me for making her feel passionate about being a nurse again and that she couldn’t wait to go back to work on Monday.  Wow.  Although I was taken aback by her compliment (didn’t feel worthy of such transformation), it made me think about the passion it takes to be a nurse and how quickly the pendulum can swing to burnout. I can remember the very first paycheck I received as a new nurse.  This was my first full-time job so when I opened the paper envelope and saw the dollar amount I couldn’t believe my eyes.  Nine hundred...

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Tips for New Nursing Grads: A successful orientation in 4 easy steps.

The first few months of your first job as a nurse can be overwhelming.  Many new nurses I talk with tell stories of fear and stress.  Although starting a new job is stressful for anyone, starting a new job as a nurse takes it to a whole new level.  Nurses are responsible for human lives.  This added stress could push some new nurses over the edge if they don’t start their first job in a nurturing, safe environment.  New nurses fear 2 things:  The first is harming a patient.  They are essentially practicing independently without the safety net of their nursing school instructor. It’s much easier to catch mistakes when you have somebody watching every move you make! The second fear they have is their preceptor.  “Will my preceptor like me?  Do they want to be a preceptor?  Do they know how to be a preceptor?” I can remember being a new nurse worrying about my preceptor.  Was she going to be nice or was she going to be mean?  I worried more about that than anything. My tip for this week is all about building a relationship with your preceptor.  Studies show that the relationship with your preceptor is the single biggest predictor of your success – at least early in your career.  The better the relationship, the more confident and competent you are as a new nurse....

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Supporting our Unsung Heroes: Preceptors. The Future of Nursing Depends on Them.

Preceptors have the toughest job in the hospital.  They are responsible for teaching new nurses how to become the nurses we want to work with in a crisis, care for our families and represent our profession.  Yet we do little to support them.  When I say support, I don’t mean money – I mean support.  Typically preceptors maintain the same work expectations (nurse to patient ratio, being in charge, etc) as the other nurses on the unit without an orientee.  Even worse, sometimes it’s assumed that since they have somebody with them, they can take on even more!  In reality, they should actually have less to allow time with the orientee for skill development and relationship building.  To make matters worse, I have talked to numerous preceptors that said they’ve never been educated on the key elements of being a preceptor.  The assumption is since they are training new employees how to be nurses, being a nurse is the only training they need. We need to stop beating up our preceptors, many of whom are still learning how to navigate through the complexities of being a new nurse themselves.  We need to support them and give them the time they need to truly develop new nurses into the ones we can be proud of. What to do?  If you are a preceptor struggling to know how to precept, focus on...

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Tips for New Nursing Grads: Active versus Passive Rounding

     The role of the nurse is changing.  We are no longer considered the physician’s handmaiden.  However, in many hospitals, I see nurses still taking a passive approach to the delivery of health care.  They don’t participate in rounds, don’t challenge physician’s orders that don’t make sense and aren’t always involved in the plan of care for their patients.  Then they complain that nurses aren’t respected or recognized for the work they do.      I can remember working as a clinician on a neurosurgical/trauma step-down unit.  One of my responsibilities was to round with the physician team.  It was my job to get involved and participate in physician rounds.  However, at first I didn’t always feel that I contributed in a meaningful way that was recognized by the physicians. I basically felt like an outsider.  Until one day while rounding with Dr. Ochoa, a trauma physician and his group of residents.  I joined rounds late and only caught the closing remarks to the patient when they started to leave the room and gather in the hallway. They all stood in a semi-circle around the physician who was against the wall.  I happened to be on the outside of the circle as Dr. Ochoa started to discuss the patient.  Then to my surprise, he stopped and said, “Excuse me” while separating 2 of the physicians standing in front of...

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Nurses Becoming Heroes – One heroic act at a time: Managing pain

In my experience, nurses really struggle to medicate their patients for pain.  I’ve heard them comment that the patients are either drug seeking or that they don’t seem to be in THAT much pain.  My aunt had major reconstructive surgery on her foot after she fell, crushing almost every bone.  Her initial surgery didn’t work and they had to go back in.  She was in a lot of pain.  She told me that most of the nurses gave her a hard time when she asked for pain medication.  They would either roll their eyes, tell her it wasn’t time yet (with an attitude) or that they were really busy and would get it when they could.  It got to the point that she wanted to go home just so she could be in control of her own pain relief.  This went on for the 3 days she was there.  I felt bad for my aunt but tried to find reasons to defend the nurses.  Maybe they were short staffed.  Perhaps they were behind the scenes trying to get her more pain medication but couldn’t get the doctor to budge.  It made me think about the many times I also overheard nurses complain about patients that complained about pain – like it was an inconvenience for them.  I can still remember the movie, Terms of Endearment.  The scene where Debra Winger was...

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Tips for New Nursing Grads: 3 steps to get involved early in your career.

Oh, if I could go back to when I was a new nurse.  The things I would do differently!  I have been a nurse for a little more than 20 years but I really didn’t get it until I had been practicing for almost 8 years.  I was a good nurse – I didn’t call off, I took good care of my patients, helped other nurses, was kind and respectful to all staff from housekeepers to attending physicians but that’s pretty much where it ended.  Once I was done with work, I punched out and went home to be a mom, wife, neighbor, sister, etc.  I didn’t really embrace my role as a nurse until I punched in the next shift.I realize now that nursing isn’t a Monday thru Friday punch in and punch out job. It’s a professional career that requires an infusion of nursing practice beyond the walls of our healthcare institutions.  So, what would I do differently if I could go back?  I would get involved right from the beginning. To get involved as a new nurse, follow these 3 steps:Step 1: Join a professional nursing organization and attend a local chapter meeting.  This is the best way to get involved with minimal risk.  Look for information regarding local chapter activities in your area.  Talk to your preceptor, educator or unit manager about professional organizations that...

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Professional Nursing Practice: 3 Steps to Awesome Autonomous Practice

What does autonomy mean and how does it influence nursing practice?  Autonomy means practicing with independence – free to make decisions that benefit others.  According to the literature, it is the most important factor to increase productivity, improve quality of care and boost job satisfaction.  People who believe they have a voice and are involved in decision-making are more engaged and more productive in their work.  If you or your department isn’t practicing to its full potential, start with autonomy.  These 3 steps will put you on the path towards autonomous practice: Step 1:  Become a solutionary.  People complain about problems all the time.  They spend an incredible amount of energy complaining to their boss or to each other.  Instead of complaining, come up with a solution and then pitch it to your supervisor.  Ask your co-workers for ideas.  You are in the best position to create solutions to the problems you deal with every day in health care. Step 2:  Get involved.  Join a committee, council, journal club or community project where your voice as a nurse can be heard.  There are over 3.1 million of us in this country.  Just imagine the improvements we could make if we all just got involved. Step 3: Improve your communication skills.  Autonomous nursing practice requires us to communicate both verbally and in writing in a way that demonstrates our competence and knowledge...

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Professional Practice: Preparing for you promotion

One of the things I love about nursing are all of the many opportunities we have.  We can be a bedside nurse, educator, manager, researcher, teacher and the list goes on.  In every case, going from one opportunity to the next requires some level of preparation.  What I see too often are nurses that want to do something different; they want to advance their position but don’t know where to begin.  If you really want to move to that next level or try a new role, it requires preparation.  Follow these 3 easy steps to make sure you are prepared when the next opportunity knocks at your door: Step 1:  Tell somebody.  So many times I hear nurses get upset because they missed out on an opportunity because they failed to let somebody know that they were even interested.  For example, if you are considering a position in education, tell someone that is in that role.  They may find opportunities for you to get involved on a small scale now.  When a position opens up, it may be easy for you to be a good choice. Step 2:  Find a mentor.  Decide what position you want and then find somebody who is successful in that role.  Take them out to lunch and ask if you can interview them.  Find out what they did to get their position.  You can...

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Renee Thompson
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