In a profession often subject to bullying, workplace violence, and burnout, ensuring psychological safety is paramount. Many roles on the healthcare team can promote this cause, from administrators to preceptors. Nurse leaders are uniquely positioned to encourage employees to share ideas, voice criticisms, and support one another.

Research shows that 85% of nurses have been verbally harassed at some point during their careers. When these workplace behaviors are overlooked or unchecked, nurses feel psychologically unsafe and are less apt to ask questions or engage with co-workers. This could subsequently lead to errors in diagnosis, patient falls, and delayed medication administration.

According to a recent study published in Nursing Management, the following strategies can promote psychological safety in the workplace:

Create Opportunities for Dialogue and Reduce Perceived Barriers

Organizational Strategies:

• Develop agency-specific videos and/or electronic newsletters to communicate updates and make outreach to frontline staff.

• Schedule open meetings for staff across all shifts with upper-level administrators.

• Round on units regularly to promote engagement between organizational leaders and frontline staff.

• Utilize an electronic suggestion box for both anonymous and signed comments and feedback.

• Consider creating an ombudsman position.

Nurse Leader Strategies:

• Be visible on the unit.

• Establish daily unit rounds and/or huddles with interdisciplinary team members.

• Implement an open-door policy during certain hours and across all shifts.

‍Foster a Professional Practice Environment That Emphasizes Collegiality, Civility, and Accountability

Organizational Strategies:

• Annually disseminate relevant human resources policies and discuss updates during staff meetings and with new employees.

• Develop organizational policies (such as zero tolerance) that address disruptive behaviors.

• Create an interdisciplinary task force that includes frontline staff to develop policies and strategies for handling unprofessional conduct.

• Use the internal website’s home page to post relevant social media messages, reminders, or quotes.

Nurse Leader Strategies:

• Role model positive and supportive language.

• Learn staff members’ names.

• Role-play difficult situations in leadership meetings to prepare for unit issues.

• Celebrate staff achievements at staff meetings and through electronic messaging.

• Provide opportunities for informal activities.

• Nominate staff members for a DAISY Award or similar awards.

Promote Shared Governance and Encourage Staff Feedback

Organizational Strategies:

• Create a nursing organizational structure that supports shared governance.

• Review upcoming interdisciplinary team projects and events at leadership meetings.

Nurse Leader Strategies:

• Educate staff about shared governance during staff meetings and through electronic messaging.

• Pay staff members for their participation in shared governance meetings and projects.

• Work with staff members’ schedules to improve attendance at shared governance meetings.

• Provide opportunities for shared governance representatives to report information back to unit staff.

Model Openness and Fallibility

Organizational Strategies:

• Promote transparency by providing the frequency and trending data of safety events and near-misses on the internal website.

• Establish formal morbidity and mortality rounds.

‍Nurse Leader Strategies:

• Review errors at staff meetings to reinforce the principles of a just culture.

• Acknowledge your own mistakes, questions, and concerns during team meetings.

• Practice self-reflection techniques (such as journaling) to consider leadership skills that need improvement.

• Post information about key nursing quality indicators on unit bulletin boards.

• Develop unit initiatives that support transparency.

Collect and Review Data on Employee Performance Metrics

Organizational Strategies:

• Closely monitor retention, absenteeism, and turnover rates across units because poor results may indicate a negative working environment.

• Communicate findings from collected organizational data and ensure managers know how to interpret it.

‍Nurse Leader Strategies:

• Include discussions about workplace culture during annual reviews with staff members.

• Develop “good catch” programs to give positive recognition to staff members who report errors and near-misses.

• Conduct exit interviews with staff members to learn more about the unit culture and contributing factors that led to their resignation.

Develop Transition Support Programs for Novice Nurses

Organizational Strategies:

• Establish nurse residency programs.

• Include communication skills-building sessions during orientation.

• Provide avenues for new hires to discuss their orientation process with human resources and support personnel.

• Offer longer unit orientation programs with an assigned preceptor.

Nurse Leader Strategies:

• Meet with novice nurses at predetermined/scheduled times to discuss their transition experience.

• Schedule both joint and individual meetings with the preceptor and novice nurse to discuss progress, questions, and concerns.

• Ensure that preceptors are appropriately prepared and interested in the role and align patient assignments appropriately.

Provide Opportunities To Enhance Education

Organizational Strategies:

• Support/require educational offerings on enhancing inter-professional communication and offer continuing education credits for participation.

• Develop annual training modules for employees to review updated policies, protocols, and strategies to improve the professional practice environment.

• Provide resources for nurse managers to attend professional conferences focusing on leadership development and psychological safety.

Nurse Leader Strategies:

• Post recent position statements that discuss the importance of a just culture on the unit board.

• After attending professional workshops and conferences, present what you learned at staff meetings.

• Encourage frontline staff to attend professional conferences and report back to co-workers on content specific to psychological safety.

• Create in-person or online journal clubs to share articles and position statements.

Along with implementing these strategies to ensure psychological safety, hospital staff should always be on the lookout for disruptive behaviors, including incivility, bullying, or violence. If detected, employees should collaborate with one another to repair unhealthy environments and positively transform their workplace relationships and the quality of patient care.