December 201210 Nurse Leader

Which Matters: EmployeeSatisfaction or EmployeeEngagement?

Katherine Vestal, RN, PhD, FAAN, FACHE

L e s s o n s L e a r n e d

In healthcare delivery today, there is no end tothe number of metric outcomes that the

organization and thus the leaders must meet toprove that the care and the results are excellent.The ability to measure outcomes is becomingmore and more precise, which is a good thingfor patient care and results. But as we measureand correlate more variables, the pressure toconstantly improve is increasing. We can nowreport data and outcomes that give a reasonablepicture of how the organization is really doingand create clearer goals for leaders.

It has long been believed that employeeswho are satisfied in their roles will deliver bet-ter results than those who are not. Clearly, thereare nurses who are happy enough to work in agiven situation but simply go through themotions to get through the day. They seldomparticipate in organizational teams for improve-ment, shared governance activities, or profes-sional groups that are focused on improvingfuture outcomes. They are pleasant and con-tribute to the day-to-day running of the clinicalcare, but are they engaged in the futureimprovements of the organization?

There is now evidence to show that it takesmore than satisfaction to drive the kind ofresults that the organization needs. It actuallytakes employees who understand and are com-mitted to the goals of top performance for theunit and the organization. It takes more thanjob satisfaction to get the aggressive improve-ments desired by organizations. This is analo-gous to the challenges of merchants who, notonly want you satisfied with a product, but alsowant to ensure that customer loyalty results inyour using the product well into the future.

Most organizations now expect thatemployees will be satisfied with the workplacebut really want to extend the relationship to afar more complex result, where the employeeis actually committed to seeking and achievingthe goals that have been set for the enterprise.This relationship is a critical business issue.Engaged employees are deeply committed to,

involved, and invested in their work. It is acombination of a clear understanding of whatconstitutes outstanding results and a willing-ness to go the extra mile to achieve them.Success requires job accomplishments, engage-ment with colleagues, and a culture that makesit all meaningful.

Annually, we measure employee engagementand try to determine how we can improve thescores by actually making changes in how thestaff relate and contribute to the organization.Because the measurement of engagement iscomplex, we depend on tools and staff partici-pation to gather data that can be correlated andreported to inform the leaders of the degree ofstaff who are, in fact, engaged.

The engagement scores are then consideredwithin the context of the work unit and areoften seen as a result of either good or badthings that have been operant in the work-place. For instance, in the case of low engage-ment scores, it may be said that it is becausethere has been a lot of nurse turnover, or a lotof off service, or complex patients. The list ofreasons that the scores might be low is end-less. On the other hand, if the scores reflect ahigh degree of engagement, it may be thoughtthat the leaders are effective, or a new build-ing is giving the scores a lift, or that the vari-ous initiatives that are ongoing have given thestaff a sense of involvement. Because the actu-al drivers of engagement scores are often diffi-cult to pinpoint, the leaders make plans toimprove or maintain levels based on a widevariety of variables.

Consistent with most leadership challenges,there are basic actions that will form thefoundation of building employee engagement.Like most leadership lessons, if the foundationis sound, many additional actions will supportconstant improvements; if the foundation isweak, it is hard to build upon to achieve theneeded results. Consider the following foun-dational elements that become the basis ofbuilding engagement:

• Make the outcomes that areneeded very clear and ensurethat each employee understandsthem and can relate them totheir work. In many cases, thatmay involve actual role play ofwhat is needed or scripting ofconsistent ways to communicate.This is especially true for preciseclinical outcomes that are need-ed and may involve some teach-ing or development.

• Ensure that both the unit goalsand the organizational targets arewell understood at the outset,and report results in a meaning-ful and timely way. Postingresults in the staff break roomnever ensures that the staff willlook at them or process themeaning of the reported data. Itmay well be that each staffmember needs to have a person-al conversation with a unitleader to review the results andthe actions needed.

• Build a strong and consistentset of relationships with eachstaff member. This sounds easybut is quite challenging in largeunits, units with turnover, orunits where the leaders areoften not present because ofoff-unit commitments. Thecollective leaders, such as man-agers, advanced clinicians, andeducators, must have an inte-grated plan to build and sup-port relationships. This plan willcertainly involve a commitmentto using each employee interac-tion, no matter how short, tosupport the outcomes that areneeded and how that employeecan make a difference.

• Help the staff keep work inperspective. No matter howoutstanding employees are,there is usually a feeling thatthey are overworked and haveno personal capacity to domore if asked. That sense ofbeing overwhelmed oftenextends to issues of work-lifebalance, creating the possibilitythat they will disengage atwork to gain more control over

their lives. This perceptionrequires leaders to pay constantattention to the volume andtype of work that is expected,and find ways to reduce thistension so that the nurse canlead a more balanced life.

• Create a winning environmentfor the team, and support it withconstant recognition and appre-ciation. If the work unit is underconsiderable stress from patientissues, staff turnover, or othercrises that impact them, get helpin developing a multifacetedrecovery plan that will bring theunit back into some equilibri-um. Involving the staff in plan-ning and following through onrapid changes, and results willgive the team a sense of movingforward quickly to improve theunit, build their sense of engage-ment, and strengthen their com-mitment in the future of theworkplace.

• The leaders must find ways toshow that they are engaged in alloutcomes of the organization.Constantly tying results to theoverall picture of the enterprisewill reinforce the role that eachstaff member plays in the out-comes. It is easier to feelengaged if the dots are connect-ed in such a complex workplace.

In truth, these foundational blockswill go a long way to support theoutcomes of the business unit farbeyond employee engagement. Butwithout a specific plan to engage theworkforce in a personal and profes-sional way, it can often be lost in thedemands and expectations of caredelivery. The evidence that linksengaged employees with betterresults, lower turnover, and betterconditions in the workplace are wellknown. So is the relationship betweengreat leadership and engaged follow-ers. And so are the needs to engageprofessionals in meaningful ways sothat they feel successful and opti-mistic about their future.

Employee engagement is so muchmore than a metric. It is the glue thatholds the organization together as it

moves from one set of challenges toothers. It is a critical factor that links toall expectations of the organization. So,look at the data that you have, considerwhat actions as a leader you can taketo improve nurse engagement, andmake that a clear goal with tangibleactions that will benefit everyone.

Katherine Vestal, RN, PhD, FAAN,FACHE, is president of Work Innovations,Inc., in Lake Leelanau, Michigan. She canbe reached at kvestal@aol.com.

1541-4612/2012/ $ See front matterCopyright 2012 by Mosby Inc.All rights reserved.http://dx.doi.org/10.1016/j.mnl.2012.09.009

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