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Magnet® Culture and Leadership

Research and Empirical Outcomes

Doucette, Jeffrey N., DNP, RN, CENP, NEA-BC, LNHA

Journal of Nursing Administration: October 2018 - Volume 48 - Issue 10S - p S1–S2
doi: 10.1097/NNA.0000000000000662
Guest Editorial

Vice President, Magnet Recognition Program® and Pathway to Excellence®, American Nurses Credentialing Center, Silver Spring, Maryland (



Welcome to the 2018 Journal of Nursing Administration Magnet® Supplement. This year, we focus on healthy work environments and the Magnet framework for safety and satisfaction. While many people might wonder how these 2 things go together, the fact is that they cannot be separated. When you ask a healthcare provider about safety, you are most likely to get a response that is focused on the elements that create a safe environment for patients—medication alerts, fall prevention, the reduction of hospital-acquired conditions. While these are important, I would argue that the most important aspect of a culture of safety must be focused on creating a safe environment for the provider. If you have not noticed the recent rise in violence against healthcare providers, you have not been paying attention. If we cannot create environments where caregivers feel safe, they cannot fully devote their concentration and attention to patients and their families to, in turn, deliver high-quality outcomes. This relates directly to feelings of engagement and satisfaction for both caregivers and patients alike. Many states have enacted laws increasing the level of offense for assaulting a nurse, but most have not gone far enough. In order to address these issues, many organizations are taking matters into their own hands. Recently, I saw a post making the rounds on social media. It was a picture of a sign at CHI Franciscan Health declaring “Our hospital is a healing environment. Aggressive behavior will not be tolerated.” The sign lists examples of aggressive behavior such as “physical assault, verbal harassment, and abusive language,” among others. They take things even a step further by declaring a zero tolerance policy by stating, “Administration supports staff in pressing charges for aggressive behavior they encounter while caring for patients.” This approach must extend beyond just visitors and patients but must also include lateral and interprofessional aggression, which is sadly still common in healthcare. The bottom line—we need more organizations to take this type of a strong stand against violence.

Second to creating a safe environment for caregivers, we must continue our work to improve and sustain safe environments for patients and their families. As nurses, we own the care delivery process and should be actively involved in all aspects of creating a culture of safety. This begins with each one of us role modeling the behaviors we would expect from our care providers if we were the patient. It is time to declare an end to shortcuts, workarounds, and overreliance on technology. We all see these negative safety behaviors every day, and we must take a stand to eliminate deviations from accepted practice and protocols. If the established policies are not working, use your voice and work to change them. And while this may seem so simplistic, we need to think! I hear too often that our reliance on technology has contributed to a significant decline in critical thinking. Highly engaged clinicians rely on both technology AND their ability to critically think through situations in order to create the safest and most highly reliable patient care environments.

Finally, it is time that we all take accountability for our role in creating a highly engaged nursing work environment. It is everyone’s responsibility to contribute to a healthy work culture. We do this by bringing our best selves to work every day. Ensuring you have had good rest and are well nourished and hydrated helps to keep you more mentally and physically engaged throughout your work day or night. If you are a person who goes to work every day thinking that something is wrong with everyone else and you are unhappy all the time, maybe it is time for some difficult self-reflection; perhaps the problem isn’t everyone else. Managing stress and practicing mindfulness are critically important aspects to maintaining a positive attitude. We must also accept that we are all leaders, and each day we are given many opportunities to lead from where we are in the organization. Being a leader isn’t about a title or position, it is about a state of mind that says you will call out the negative behavior, you will be accountable for your actions as well as hold others accountable for theirs, you will not ignore shortcuts and safety concerns, and you will take a stand for yourself, your patients, and your coworkers.

Creating a healthy work environment focused on safety and engagement is everyone’s responsibility. I hope you will take the time to explore this supplement and learn new strategies to address some of the most complex problems you face each day. I challenge you to put behind the negativity and hopelessness that can be so easily transferred and lead yourself, your team, and ultimately your organization to a new and better place.

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