Spirit at Work in Long Term Care

Spirit at Work in Long-term Care

Abstract

The authors discuss the moral distress that surfaces around responding to last-minute sick calls in a long-term care (LTC) facility. Presented within the context of Spirit at Work (SAW), the scenarios and solutions are applicable to both front line staff and management.

At 12:30 pm, on the Sunday of a summer, long weekend, a nurse scheduled for the 3:00 pm shift calls in “sick.” Knowing that no replacement is available, I still must ensure safe nursing services for 140 long-term residents. In addition, I must also provide care to my own assigned residents. Pondering potential solutions, I reflect on a similar situation that occurred during my orientation to a staff position in this facility. On that occasion, a nurse working overtime “covered” the first half of the next shift.

Because long-term care staff, already carry an extreme care burden additional hours can increase the physical, mental, emotional and spiritual strain to the point of exhaustion. Such circumstances jeopardize both client care and staff well-being.

Having experienced the exhaustion and moral dilemma that accompanies decision making in these situations as I left work that day I knew I had placed another nurse in a similar circumstance. I had asked an already fatigued nurse, to provide care to many unfamiliar residents on an unfamiliar unit. I knew also that the nurse who had agreed to work the overtime would face moral challenges. I also knew that the circumstances of the work and the work environment would not enhance her feelings of personal and professional worth.

Throughout Canada, the US and elsewhere, nurses are reporting ever- increasing levels of job dissatisfaction1 Studies reveal that “nurses are working with more complex patients, have fewer available resources, and have reduced opportunities to take time off.” 2 The Canadian Institute for Health Information (2001) noted that nurses claim their ability to provide quality care is affected. Marck, Allen & Phillipchuk3 described the work overload experienced by nurses in Alberta, stating that nursing administrators and staff report feelings of “moral distress when they cannot find adequate numbers of qualified staff to deliver safe care.”

A nurse experiences moral distress when she/he is constrained from moving from moral choice to moral action.4, 5Such distress is associated with feelings of frustration, powerlessness, guilt and anger.6 According to definition, moral distress is experienced when the “Spirit” at work wanes.

The concept of “Spirit at Work” (SAW) is derived from study of team dynamics within management and organizational theory. It is viewed in terms of both workplace spirit and individual SAW. Authors view SAW as having the cognitive, spiritual, interpersonal and mystical dimensions of: engaging work, “profound feelings of well-being, an awareness of alignment between one’s values and beliefs and one’s work, and a sense of being authentic.”7

SAW shows a strong resemblance to the concept of spirituality in that it displays themes of: existential reality, transcendence, connectedness and power/force/energy.8, 9, 10 This individual SAW, because it focuses on the positive feelings individuals have about their work and the “desire of employees to express all aspects of their being at work and to be engaged in meaningful work,”11 is different from organizational spirit at work which generally refers to a positive workplace culture. 12 Individuals with high SAW find their work meaningful and purposeful and report a deep connection with others at work.13, 14Conversely, when SAW is low, these attributes are missing, and individuals may experience personal distress or burnout which is characterized by “emotional, physical and spiritual exhaustion.”15

The scenario presented at the beginning of this paper, describes a situation where nurses find themselves in circumstances that cause moral distress. The actions taken to replace ill staff often create snowballing circumstances that impair a worker’s sense of community, thereby diminishing the individual’s sense of values, purpose, achievement and satisfaction, thus reducing the sense of individual and workplace SAW. This in turn, has an enormous impact on service delivery.

SAW is a measurement of how an individual experiences work; in essence, it is the sum of how an individual can live out and act upon their personal and professional moral values within the work place. When there is consistency between the individual and work place values, individuals experience a high sense of SAW. When there is an inconsistency, SAW wanes, and employees begin to experience high levels of moral distress. As the levels of moral distress increase, employees begin to withdraw. They do this in various ways, including work termination, absenteeism, and by withdrawing services, commitment and involvement.16

Charles Taylor identified three values of the modern age: individualism, freedom and instrumentalism as common sources of anxiety to health care workers.17 Instrumentalism (getting the job done) and the economic efficiency commonly associated with it are great barriers to SAW, because when the driving force is economic efficiency, getting the job done and achieving predetermined business goals become more important than how the job is done. Staffing health care organizations with the minimum staff required to keep them in operation and without a contingency plan for adequate sick-call coverage is an example of instrumentalism. Managers frequently describe instrumentalism and economic efficiency as the rationale behind the methods they use to meet their goals and objectives in the achievement of business success, regardless of the impact these methods may have upon individual employees.

Solution Focused: Enhancing Spirit at Work

The integration of spirituality into the workplace increases employee wellness and organizational performance.18, 19, 20Many have recognized the direct relationship between spirituality and creativity and between creative individuals and successful organizations.21, 22, 23, 24, 25 Management theorists suggest that excellent organizations produce employees who ask for what they need and find creative solutions to meet their needs. Cuilla26 encouraged the empowerment of workers, claiming that giving employees a voice in how their work is performed and how their jobs are designed, culminates in increased high quality output, or improved patient care. Encouraging employees to participate in finding creative solutions to the problems that affect them fosters SAW and ultimately leads to the development of a successful organization.27

How then, can SAW be kindled in situations similar to those described in the introductory scenario? Several management models including transformative leadership,28 participative leadership29 and resonant leadership,30 could be applied to this scenario since they all recommend the involvement of followers in decision- making. In our situation, management encouraged staff to develop creative solutions to the staffing difficulties, and in so doing, to defeat “instrumentalism.” Freedom to contribute and the opportunity to have one’s ideas heard almost immediately enhanced the sense of community. Many staff said they felt an increased sense of recognition and of being valued.

Following a review of recommended options, a “care coordinator” was hired for the day and evening shifts. The care coordinator assists during “crises” and can be the replacement for an ill staff when other attempts at replacement fail.

At present approximately 75% of all shifts are covered by a care coordinator. As a part of her role, she provides physical and emotional support when a resident experiences a crisis, and when the workload increases unpredictably. Knowing that a care coordinator is on “duty,” helps the staff to focus on completing their tasks and going home on time thus considerably reducing job stress. Gratitude for this tangible evidence of senior management support, has fostered respect for management and strengthened team morale. This joint solution-focused approach encourages freer and richer communication among staff and between staff and management. Finding creative solutions in the provision of quality care has promoted staff empowerment and has nurtured SAW at our LTC.

The literature suggests a relationship between staff empowerment and increased organizational commitment and the consequential decreased absenteeism.31, 32, 33, 34, 35We hope this will be a natural off-shoot, but to date we have seen no evidence of reduced sick time. However, there appears to be a reduced turnover of staff, which is also an indicator of staff’s commitment to the organization.36 As well, and despite the closure of beds in other facilities in Alberta, due to staff shortages, our LTC center continues to maintain its established staffing allotment.

Conclusion

While our organization is a private “For-Profit” industry,” the director of nursing services asserts that “a more satisfied staff will provide more quality. This can only result in positive outcomes for all.” Freedom to contribute and the opportunity to have one’s ideas heard, almost immediately enhances a sense of community.

In her definition, Kinjerski37 stated, “SAW reflects a distinct state that involves… a belief that one’s work makes a contribution, a sense of connection to others and common purpose, an awareness of a connection to something larger than self.” As a member of the front-line nursing staff with a dual management role of ensuring staff coverage on evenings, nights and weekends, I view the request for a creative solution to our staffing shortages as a signal that senior management values staff contributions and that their concern about other staff and clients care are important. In turn, this initiative has contributed greatly to staff feelings of belonging and connectedness to others, to the organization and to the residents. Spirit at Work is beginning to bloom in our organization.

References

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