We often dwell on the negative aspects of nursing, trying to raise awareness and create positive change. In doing so, however, we create a blind spot. What about all the abiding positive aspects of nursing that contribute to high retention of this indispensable work force?
“I think that in nursing research, as in many other applied science disciplines, there is a natural tendency to focus on addressing problems,” says Robert Sinclair, PhD, a professor of industrial-organizational psychology at Clemson (SC) University. “[That] leads to a focus on reducing negative and stressful aspects of work, rather than recognizing and increasing positive aspects.”
Though noting that nursing research should certainly address such negative factors and attempt to improve them, Sinclair became intrigued with the idea of the other side of the coin. What positive aspects of nursing could be identified and leveraged to keep the field viable in the face of shifting demographics? The result was an ongoing research collaboration called the Oregon Nurse Retention Project (ONRP), which was founded in 2007 to look at the critical stressors and positive work experiences that influence nurses’ retention. We reached out to Sinclair via email and he provided the following responses to Hospital Employee Health.
HEH: Despite the well-documented challenges and stress, you note that surprisingly little research has been done on the positive work experiences of nursing. This side of the story seems more important than ever with the shifting demographics of nursing and the need to retain and recruit nurses. Can you speak a little to why you think this positive aspect has not been more emphasized and why you decided to document this aspect in your work?
Sinclair: This tendency is certainly not bad, as applied research should focus significant effort on addressing important problems at work. My research really just explores the added value of focusing on positive events at work. [My colleagues and I] at the ONRP read the literature at the time and realized that research was mostly focused on why nurses leave their jobs and there was comparatively less research focused on why nurses stay. We were also in close discussion with the Oregon Nurses Association at the time; they expressed a similar strong interest in better understanding nurse retention and helped us realize the need to focus on the positive aspects of nursing, not just the negative. For example, they pointed out that some events we might have thought of as negative were often described by nurses as positive, one example being a nurse who helped a patient die with dignity. We thought that looking at nurses’ daily work lives in terms of the specific positive experiences they have at work might help us understand why nurses stay on the job, despite having many highly demanding experiences and difficult interactions with patients and coworkers.
HEH: You mention there may be an evolutionary aspect to the tendency to focus on negative experiences.
Sinclair: At a deeper level, interest in negative events is probably a function of human nature. A research review1 showed that negative experiences are thought to be more influential on peoples’ perceptions of other people, of situations, etc. And some research suggests that it takes several positive experiences to overcome one negative experience in a particular situation.
Some psychologists propose that this is grounded in evolutionary principles — that it is more important to focus on negative stimuli because they contain more “survival value” than positive stimuli. Simply put, attending to threats, demands, etc., helps us survive. I think this natural interest in identifying and solving problems probably has played a role in researchers’ and managers’ interest in addressing negative concerns.
HEH: Can you provide a few examples of positive work experiences based on the scientific literature as well as your own experiences and research?
Sinclair: The ONRP research team conducted both qualitative and quantitative research on this topic. In the qualitative research, we identified these six broad categories of positive events based on nurses’ descriptions of the best event that happened to them at work each week over a series of 12 weeks:
- Making a difference: Instances where nurses had a positive effect on patient outcomes.
- Programs and processes: Essentially, hospital systems working well.
- Professional development: Learning new skills or increasing knowledge.
- Coworker support: Receiving needed help from others.
- Helping others: Being able to support coworkers with their problems.
- Feeling appreciated: Being thanked and recognized by others for their work.
Some examples of nurses’ descriptions of specific events include:
- “A complicated discharge went very smoothly. All care needs and equipment needs were in place at the time of discharge and all questions were answered to family’s satisfaction.”
- “I helped a new nurse whom I have been orienting to the floor successfully start a difficult IV on an elderly male patient. Due to my coaching — but not touching anything — she got it on the first try. The best part of it is the confidence she has built.”
- “A trauma patient I had taken care of the previous week came back to our unit with a thank-you card and chocolates, and thanked each one of us personally for the care she had received at our hospital.”
HEH: Can positive work experiences be used to offset the negative effects of nursing (stress, etc.) in some kind of systematic way?
Sinclair: Yes. There are a few ways a positive event might offset some of the negative effects of nursing. First, our research shows that positive work experiences contribute directly to various positive outcomes that might be weakened by negative experiences. So far, we have found that experiencing more positive events lead to higher levels of work engagement, occupational, and organizational commitment, as well as lower turnover intentions.2,3
Second, experiencing positive events may protect people from experiencing the harmful consequences of negative events. Although we have not focused as much on this question, our initial evidence shows that experiencing more events in which one receives support from coworkers helps protect workers from the negative effects of workplace stressors. This finding is consistent with a very large literature on the health benefits of social support. Third, positive events could reduce the chances that nurses experience negative health outcomes such as burnout and depression.
However, we also have found that negative events (i.e., stressors) tend to have a much stronger influence on the negative outcomes. So, experiencing positive events may be important for enhancing nurses’ engagement and commitment, but to avoid negative health outcomes it is also critically important to reduce stressors.
HEH: Is this something that could be directly incorporated into an employee wellness program?
Sinclair: I have had various conversations about these findings with nurses over the years who have talked about the need for programs and processes that encourage nurses to see the positive sides of their jobs and some hospitals are engaged in efforts to do just that, such as through asking nurses to write about and publicly share their positive experiences. Our findings indirectly show that encouraging nurses to write about their experiences can have work-related mental health benefits, and some participants even thanked us for the opportunity to write about their experiences.
Some hospitals are experimenting with other ways to publicly share positive events at work. There are challenges in these efforts, such as protecting patient confidentiality and ensuring that nurses trust management enough to share their experiences without concerns about possible repercussions. I do not think the organizational science is definitive on what works just yet, but I expect we will continue to see more research documenting effective policies and practices in the near future.
- Baumeister, RF, Bratslavsky, E, Finkenauer, C, et al. Bad is stronger than good. Review of General Psychology, 2001;(5):323-370.
- Sinclair RR, Sliter M, Mohr CP, et al. Bad versus good, what matters more on the treatment floor? Relations of positive and negative events with burnout and engagement. Research in Nursing and Health, 2015;(38):475-491.
- Sinclair, RR, Mohr CP, Davidson, S., et al. The Oregon Nurse Retention Project: Final Report to the Northwest Health Foundation. 2009; Unpublished Technical Report (www.onrp.webnode.com).