By Christina Dempsey, Chief Nursing Officer
Abraham Maslow’s Hierarchy of Needs is in every nurses’ toolbox for setting patient care priorities. New research suggests it may also be a valuable template for setting nurse engagement priorities.
In the mid-1940s, Maslow conceptualized human needs as a pyramid with five levels in ascending order, with physiologic needs at the base, followed by safety, belonging, esteem and, at the apex, self-actualization. Maslow posited that humans aim to meet needs at the lowest levels before moving up to those at each higher level. He described achieving the highest-level, self-actualization, as “becoming all that one is capable of becoming in terms of talents, skills and abilities.”
Nursing students are taught to apply this motivational theory when prioritizing care decisions, first addressing problems that interfere with patients’ physiologic and safety needs, before moving on to those that impede their sense of belonging, their self-esteem and, ultimately, their ability to achieve personal goals.
Applying this model to nursing practice would suggest that when nurses do not feel that their work environment needs are being met, they will be less motivated and less likely to progress to the higher-level functions. The results of cross-domain analyses reported in Press Ganey’s 2016 Nursing Special Report illustrate this, focusing specifically on nurses’ fundamental need for safety and an appropriately resourced work environment.
The report, “The Role of Workplace Safety and Surveillance Capacity in Driving Nurse and Patient Outcomes,” looks at the relationships between characteristics of the nurse work environment and organizational performance across nurse, patient, patient experience and payment outcomes and demonstrates that in order to provide optimal care (surveillance capacity is part of that), nurses must feel safe in the environment in which that care is provided.
Organizations whose nurses give top ratings on a workplace safety composite measure perform significantly better across multiple outcomes than those whose nurses perceive the safety of their workplace to be suboptimal.
For example, organizations with top scores on a composite measure of nurse-rated workplace safety had a 52% lower rate of RN-perceived missed care, a 27% higher rate of job enjoyment and a 22% higher CMS Overall Hospital Quality Star Rating than those with the lowest scores.
Positive associations between nurse perception of surveillance capacity—their belief that their units are sufficiently resourced to allow them to optimally observe, monitor, collect, interpret and synthesize patient information in order to make informed care decisions—and patient and nurse outcomes, although the associations were not as robust as the safety relationships.
The findings send a clear and important message to nurse leaders: your nurses will do their best, most cost-effective, patient-centered work if they feel their physical and emotional safety is an organizational priority—so make it an organizational priority. Adopt evidence-based practices such as adherence to guidelines for safe patient handling and mobility, adequate unit staffing, assignments based on patient acuity, uninterrupted meal and rest breaks, and work shifts of reasonable duration.
With their need for workplace safety fully realized, nurses can be well on their way toward reaching the top of their professional pyramids.