Don't throw the baby out with the bathwater

Figure“DON'T THROW THE BABY out with the bathwater,” a German proverb first recorded in 1512, alludes to the practice of disregarding what's essential or valuable when trying to eliminate what's unwanted. This phrase is particularly relevant given the many changes currently happening in the US that dramatically impact individual households, lifestyles, and employment. Although the impact of changes in the healthcare sector is extensive, my focus for this article will be the implications of eliminating or rolling back diversity, equity, and inclusion efforts. Consider Maslow's Hierarchy of Needs, the psychological theory we all learned in nursing school.1 The theory posits that individuals are motivated and experience greater fulfillment as they progress through the levels. What happens to acceptance and belonging when a culture of inclusion disappears? We risk undermining employee engagement and retention. In 2024, Press Ganey analyzed feedback from 2.2 million healthcare workers to understand the state of the employee experience.2 According to the survey, 33% of healthcare workers aren't engaged, and those disengaged are twice as likely to leave the organization. Moreover, leader engagement has declined more than 3.7% during the past 3 years. Employees who report weaker relationships with their leaders are 44% more likely to leave the organization than those who are engaged. As we tackle employee engagement and look at our turnover statistics, I'd encourage organizational leaders to adopt the following pillars of belonging. 1) Being welcomed. Feeling genuinely welcome to a unit or department is critical. If employees only feel welcome during onboarding, they miss out on deeper connections. The formality of onboarding often limits relationship-building except with a residency cohort, preceptor, or charge nurse. There may not be a formal onboarding process for managers and directors. These roles are often siloed in their division or service line. Therefore, consider how every staff member welcomes each newcomer. Be curious and find out why the individual chose your hospital and unit. Celebrate every new employee in the same way that you'd welcome the new chief of any discipline or a new baby or family member. 2) Feeling known or seen. I recently talked to a manager who said that it wasn't necessary to know his staff. He added, “I'm their manager, not their friend.” Engagement starts with, “Do you see me and hear what's important to me?” Embrace the principles of human-centered leadership and seek to connect and know employees. 3) Being included. Although it's important to know the mission, vision, and values of the organization, employees want to be engaged in efforts to achieve those values and organizational goals. Ask employees if they want to be involved in quality and transformational efforts. Engage the employees closest to the work. Let them know that their thought partnership and voices matter. 4) Being supported. Although the show of support may vary from department to department and from person to person, having the support of your manager, director, and organization is essential. Can you support me in achieving my goals, dreams, and development? This support goes beyond mandatory education and competencies because it's tailored to the individual's personal and professional growth. 5) Being connected. Maslow refers to the desire for connection, belonging, and affiliation as a social need. As a leader, how do you facilitate the development of relationships? What connections are encouraged across departments, shifts, and disciplines? Have these relationships enabled employes to be effective, have a resource or a friend at work, and gain social capital? As we comply with mandates and executive orders, please don't throw out inclusion and belonging as core tenets of retention and engagement.