Change used to come in short bursts, but now it’s continuous. As the health care industry pivots to accountable care organizations and prepares for population health, the pace of change is accelerating. Despite record levels of burnout and labor shortages, there’s more pressure than ever to deliver greater clinical quality and a better patient experience at a lower cost. And yet, despite these obstacles, nurse leaders at a number of organizations are excelling through the use of strategies for high engagement. Here’s how they do it.

1. They connect to the why.

In health care, we are good at explaining what to do, but not as skilled at explaining to our employees why we want them to do it. We excel at measuring, analyzing and sharing data, but not necessarily in ways that compel our nurses to do things differently.

Try this: Next time you find yourself attempting to communicate why doing a behavior most of the time is not as good as always doing it, lead with a meaningful example everyone can understand. For instance, with a 1 percent error rate, 12 newborns would be given to the wrong parents every day and 291 pacemaker operations would be performed incorrectly this year. Our responsibility is to take complex information and translate it to help staff nurses on the front lines understand that their choices have a negative or positive impact on clinical care for patients.

“Explain the why over and over … as much as it takes,” suggests Jill Seward, national director of nursing/CNO for Hazelden Betty Ford Foundation in Center City, Minn. “Tie it back constantly to how it serves patients and excellence in care." Seward says that some of the most profound moments of her life were at the bedside of patients, so she’s a stalwart believer in connecting back to the sense of purpose, worthwhile work and making a difference that drives almost every nurse into the profession. “We work in addiction medicine, where meditation is really important to our patients,” Seward adds. “So we decided to start our shift changes with a meditation that reminds us that our work really does change lives and keep us patient-centered."

2.They communicate with full transparency.

"It isn’t always easy, but one of the best ways to instill a sense of urgency and to motivate new behaviors is by consistently sharing actual organizational performance compared to peer organizations and goals, even when it’s painful.

“When we first started focusing on HCAHPS performance, just one of the eight composites was green, i.e., above the 50th percentile,” explains Beth McCraw, CNO at Jennie Stuart Medical Center in Hopkinsville, KY. “We started sending that out weekly to the whole organization and they were all as embarrassed as I was. While it was uncomfortable at first, everyone appreciated sharing in the journey of our growth." Today, at Jennie Stuart, eight out of nine HCAHPS domains are above the 50 percentile, with four above the 75th and one above the 90th.

3. They are responding to the nursing shortage.

According to the Bureau of Labor Statistics, 1.2 million vacancies will emerge for registered nurses between 2014 and 2022. In fact, the shortage is anticipated to be twice as big as when Medicare and Medicaid were introduced in the 1960s. In short, recruiting and retaining great nurses has never been more important.

“Our goal is to keep great nurses at the bedside so we incentivize that through our professional nurse advancement program,” notes Becky Montesino-King DNP, RN, NEA-BC, CENP, vice president/CNO, Baptist Hospital of Miami and Baptist Children’s Hospital, Miami, FL. “Nurses can earn a 10 percent pay increase when they advance from proficient to advanced and then expert status." Baptist also creates its own pipeline of nurses through its Scholars Program, offering scholarships at local nursing programs for nursing students. New graduate nurses are guided into nursing practice through an 18 week nurse residency program that incorporates mentoring and precepting.

4. They engage front-line nurses.

It’s easy to talk about employee satisfaction, but what about engagement? How will you ensure your nurses are giving the kind of discretionary effort that ensures highly engaged patients? Because that’s what will be required to reduce costs, improve care, and manage chronic disease in the world of population health that’s coming.

"One thing we do is widely share and celebrate stories of nurses and other employees who have gone above and beyond — as well as patient letters — at our leadership meetings, Practice Council and Board meetings,” explains Lisa Vail, RN, DNP, NEA-BC, vice president of patient care services and CNO at Bryan Health in Lincoln, NE. "I also handwrite about 30 very specific thank you notes myself every month,” she adds. “When I round on my direct reports, I collect names of staff who have made a positive difference. I also write a congratulatory note to every nurse who graduates as well as every one who gets certified. The entire leadership team sends a hand-signed sympathy card if a family member dies. I think it’s important to have these kinds of touch points. It’s important for our team members to know that we’re humans that care."

5. They stay inspired and inspire others.

How do you stay inspired when you are tired? High-performing CNOs know that sharing their own passion fans the flame.

"The first Thursday of every month, I introduce myself to a group of new nurses during their orientation by sharing a bit about what drives me to provide great care and asking them to do the same,” says McCraw. “I share that they will take care of my family, friends, and neighbors so it’s important we hire passionate people.”

The consistent theme with high-performing CNOs is that they are able to connect to passion. As author Beth Revis says, “A leader isn’t someone who forces others to make him stronger; a leader is someone willing to give his strength to another so he may have the strength to stand on his own.”

Lisa Reich, RN and Diana Topjan, RN, MSN, DM,C-ENP RN, are coaches at Studer Group.