Promoting a Healthy Work Environment- Leadership Interventions for a Medical-Surgical Unit

Promoting a Healthy Work Environment- Leadership Interventions for a Medical-Surgical Unit

The scenario presents a concerning situation on a medical-surgical unit involving lateral violence directed at Tina, a new nurse from the Philippines after she made and documented a medication error. Several problematic elements emerge, including Tina being severely reprimanded for the error, George, another nurse, belittling her about it, George spreading information about the error across the unit, resulting in gossip and teasing, and ultimately, Tina resigning due to prolonged bullying. This situation demands several leadership interventions to foster a healthy work environment marked by respect, psychological safety, and zero tolerance for bullying.

Team Member Respect, Value, and Security

All team members within a unit, regardless of role, experience level, or background, deserve an environment where they feel respected, valued, and secure. The behaviors demonstrated toward Tina in this case represented the opposite—disrespect, undervaluing, and targeting. Respect involves showing consideration, dignity, and care toward others and their perspectives (Asif et al., 2019). Valuing team members is conveyed by recognizing their humanity, skills, and contributions. When respect and value are present, team members feel psychologically safe to fully engage, share ideas, ask questions, report concerns, and support each other without fear of embarrassment or retribution (Smith et al., 2020).

Establishing a Safe, Caring, and Ethical Culture

Leaders play an instrumental role in cultivating the culture of a unit, including how errors and mistakes are handled. Rather than responding with punishment, shaming, or blaming when an error occurs, leaders should pursue a caring, empathetic, and ethical approach focused on transparency, system improvement, accountability balanced with support, and promotion of psychological safety (Ayan, 2023; Smith et al., 2020). Specifically, unit leaders should model humility, fallibility, and authentic caring when errors arise to shift away from toxic patterns of denial, secrecy, fear, or threat inherent in some medical cultures. They can acknowledge that competent, dedicated nurses can still make mistakes due to human factors and flawed systems. Wise leaders treat errors and near misses as invaluable learning opportunities to illuminate improvement areas versus just pinpointing an individual to blame (Ayan, 2023; FAAN & FAAN, 2022). This involves gracefully receiving input about mistakes and concerns, enacting root-cause analyses to elucidate contributing issues, and implementing changes to prevent future occurrences.

Additionally, leaders must replace punitive reactions that evoke fear and shame with just culture accountability processes balanced by abundant counseling support, sometimes called second victim programs (Smith et al., 2020). These provide emotional aid, peer reassurance, coaching, and rehabilitation for providers negatively impacted by an error while still maintaining proportional responsibility. This prevents defensive postures where some nurses hide near misses and serious errors to self-protect. Championing non-punitive reporting promotes transparency, data to spur change, and willingness to admit fallibility without career sabotage. Vital components also include clear policies of zero tolerance for behaviors that harm culture and psychological safety, like bullying, teasing, gossiping, pointing fingers, or lateral violence against those involved in errors. Allowing these behaviors signal complicit acceptance of unprofessional conduct that will permeate all aspects of unit operations (Smith et al., 2020). By contrast, leaders can enforce strict prohibitions on retaliation or interpersonal violence against those making or reporting mistakes.

Overall, an ethical environment around errors is one marked by humanity, compassion, transparency, data-driven improvement, balanced accountability, rehabilitation support, enforcement of dignified conduct, and sustaining psychological safety overall (Ayan, 2023; FAAN & FAAN, 2022). If Tina had experienced this type of culture, she would have felt safe revealing her mistake, obtained counseling instead of severe reprimanding, participated in analyzing system factors and improvements to prevent future medication errors, and been supported through collaborative, caring processes instead of enduring shame, bullying, and career derailment due to one human lapse.

Leadership Role in Improving Team Member Support within a Diverse Nursing Workforce

Diversity across nursing continues expanding in terms of gender, race-ethnicity, national origin, language, religion, sexual orientation, ability, and other elements of identity or experience (Loftin et al., 2021). This growth enriches healthcare with wider perspectives but also requires leaders to be attentive to inclusion. Leaders must shepherd respect, dignity, trust, and psychological safety within heterogeneous teams (Smith et al., 2020). Intentional support for international nurses like Tina facilitates successful transitions, countering potential marginalization or discrimination. Formal onboarding introducing cultural backgrounds combats assumptions or stereotyping from prevailing staff. Training on implicit biases and lateral microaggressions makes subtle behaviors visible for correction (Loftin et al., 2021). Robust mentorship models help navigate workplace differences. Celebrating accomplishments publicly affirms contributions.

Once united on a team, ongoing cultivation of trust and inclusion prevents ostracization when challenges emerge. Team building to share personal stories, home cultures, family values, spiritual traditions if desired, perspectives on nursing, barriers overcome, and similarities discovered can profoundly shape compassion (Loftin et al., 2021). Psychological safety to take risks, ask questions, report issues, and know leaders will intervene against microaggressions is vital. Additionally, during unit meetings, the manager could have used the incident as a teaching moment about human fallibility, the oft-complex web of causal factors in errors, the need for transparency and peer support versus gossip, existing reporting procedures to illuminate issues, and reaffirming team commitment to sustaining a just culture. Issuing consequences for bullying while activating established support networks could have contained lateral damage across staff relationships and culture. Instead, a lack of leadership allowed toxicity to spread.

Engaging All Team Members

Every team member contributes to unit culture, making engagement around healthy workplace principles and conduct critical. Nurse leaders should conduct training on recognizing and reducing lateral violence while implementing rounds to reinforce values of dignity, respect, diversity, and psychological safety. Structures like peer support programs, mentoring for new graduates, counseling services, reporting hotlines, and open-door policies provide confidential options for escalating concerns before they become overwhelming (Asif et al., 2019). Ultimately, the scenario highlights how one person’s actions can initiate a cascade of harm, showing why everyone must feel responsible for sustaining a supportive, ethical environment.

Leadership Interventions

First, the manager should have recognized the medication error as a system issue versus individual failure and enacted a root cause analysis to prevent future occurrences. Reprimanding Tina showed a lack of just cultural understanding (Smith et al., 2020). Second, after discovering George’s bullying, the manager should have issued formal consequences showing zero tolerance for lateral violence, forced gossip, or retaliation. Allowing this toxic culture to spread signaled complicit acceptance of unprofessional behaviors (Asif et al., 2019). Finally, realizing Tina resigned under distress, the manager should have reached out to provide support, sought her input on improving the unit culture, and conveyed that all nurses deserve psychological safety regardless of mistakes. This may have demonstrated caring and set the stage for an appeal if Tina wished to return.

Conclusion

Establishing healthy work environments requires multifaceted leadership strategies supporting psychological safety, professional conduct, diversity, and transparent error management. Though complex behaviors were entrenched in the unit in this case, dedicating to formal cultural change through modeling, enforcement policies, training, and engagement can transform teams. Leaders must take an active role in prevention and intervention when lateral violence or disrespect emerges while embracing human fallibility as part of supportive growth.

References

Asif, M., Jameel, A., Hussain, A., Hwang, J., & Sahito, N. (2019). Linking transformational leadership with nurse-assessed adverse patient outcomes and the quality of care: Assessing the role of job satisfaction and structural empowerment. International Journal of Environmental Research and Public Health, 16(13), 2381. https://doi.org/10.3390/ijerph16132381

Ayan, G. (2023). Ethical Leadership in Nursing Management. Journal of Education and Research in Nursing, 20(3), 292–296. https://doi.org/10.14744/jern.2021.21221

FAAN, J. J. F., PhD, MBA, RN, & FAAN, C. M. A., DNP, MSN, RN, CNE, CHSE-A. (2022). Nurse leadership and management: Foundations for effective administration. Springer Publishing Company.

Loftin, C., Newman, S. D., Gilden, G., Bond, M. L., & Dumas, B. P. (2021). Moving Toward Greater Diversity. Journal of Transcultural Nursing, 24(4), 387–396.

Smith, C. R., Palazzo, S. J., Grubb, P. L., & Gillespie, G. L. (2020). Standing up against workplace bullying behavior: Recommendations from newly licensed nurses. Journal of Nursing Education and Practice, 10(7), 35. https://doi.org/10.5430/

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In a Microsoft Word document of 4-5 pages formatted in APA style, consider the following scenario:
Tina is a new RN from the Philippines, working on a medical-surgical unit. She is enthusiastic and an excellent nurse. One day, Tina administered the wrong medication to a patient and documented it in the patient’s electronic health record. The error was discovered by George, a nurse on the night shift, who completed an incident report. The next morning, Tina was called into the nurse leader and manager’s office and reprimanded for the error. In the days that followed, George belittled Tina whenever he saw her. George told several nurses about Tina’s error and they began teasing her. Often, Tina would walk into the breakroom to find staff gossiping about her. Tina began feeling depressed and hated to go to work. After several months of being bullied, Tina resigned and went to work at another hospital.

Promoting a Healthy Work Environment- Leadership Interventions for a Medical-Surgical Unit

In your paper, discuss the leadership improvement plan within this unit, including the topics below related to incorporating a healthy work environment:
• Describe the need for team member respect, value, and security.
• Discuss a safe and caring culture by demonstrating effective use of strategies to reduce harm to self and others, as well as zero tolerance for bullying or lateral/horizontal violence.
Explain the leadership role to improve team member support within a diverse workforce.
• Discuss the importance for all team members to actively engage and support a healthy work environment. Identify three (3) leadership interventions that should have occurred within the case scenario above.
Support your responses with examples and information from library resources, textbooks and lectures.
On a separate reference page, cite all sources using APA format. Please note that the title and reference pages should not be included in the total page count of your paper.