Imagine stepping into a house for the first time. Before you notice the details, you can feel whether the place is cared for, lived in, and safe. Are the floors steady? Do the doors close? Does it feel welcoming? Walking onto a nursing unit is the same. New nurses sense immediately whether this is a place where they can learn, belong, and do good work or a place that takes more energy than it gives.
Last month, we talked broadly about engagement: what it is, why it matters, how to measure it, and how residency can jump‑start engagement. This month, we’re moving to what it takes to build engagement at the micro level, because as we’ve said before, if the day‑to‑day experience on the unit doesn’t reflect the tone we set in the classroom, your residency program will struggle to achieve the outcomes you’re hoping for.
To dig into this, I invited Dr. Dan Lose onto the podcast. He’s been leading teams for more than a decade and is the current Acute Adult Director at UnityPoint Health–St. Luke’s in Cedar Rapids, Iowa, where he focuses on building positive work environments and developing strong clinical teams. I asked him:
“What’s the number one thing that must be present for engagement to take root?”
His answer: a work environment that supports people.
From there, we unpacked what it actually takes to build that culture. One of the themes that came up quickly was infrastructure. We talk constantly about workforce shortages, burnout, and poor communication, but we don’t always call out the root of those issues: the infrastructure supporting the work. That is an important thing to do because you can’t fix what you don’t name. Infrastructure includes things like:
- Clear roles
- Defined processes
- Established systems
- Intentional development
This is the backbone. When these elements are missing, leaders end up fighting fires at every turn and nurses end up feeling unsupported.
Nurse residency is an important part of the infrastructure. Residency provides guided skill development, real‑time coaching, predictable support, and a consistent way to monitor progress and intervene early. And maybe most importantly, it reduces the hidden workload that falls on preceptors, unit leaders, and informal mentors when intentional development efforts don’t exist.
We also talked about the importance of having well-defined processes and systems that reduce friction and increase transparency—things like:
- Real-time rounding
- Real-time float feedback
- Follow-up plans that actually get executed
- Technology that helps close the loop quickly
Good processes and systems free leaders from constant triage and give them time back for the work that truly matters: developing people, solving problems, and building trust.
After exploring the structural foundation, our discussion shifted to what those structures are meant to support: the relational side of culture. As Katie Boston‑Leary said in an earlier episode, engagement is relational, not transactional. And strong relationships are only possible when the structure supports them.
Leaders need to:
- Know their people
- Understand motivations and strengths
- Support individual growth
- Connect intentionally
But leaders can’t do that if they’re drowning in administrative tasks or managing chronic instability. That’s why financial health is so important. Units must have the means to create roles, build processes, strengthen systems, and provide the professional development needed to allow leaders to actually lead.
As we talked this month, what stood out to me in my conversation with Dan is that culture isn’t created by just one thing. A positive, healthy work environment emerges from the interaction of several elements working together. Financial stability allows organizations to invest in the infrastructure, i.e., roles, processes, systems, and intentional development that make daily work smoother and support the growth of their people. Those investments give leaders the space to be present, accessible, and connected to their teams, which is what strengthens relationships. And when relationships are strong, the culture shifts. Nurses can feel it the moment they step onto the unit.
So culture is definitely a piece of the engagement puzzle, but it’s not the only piece. And even within culture, there are elements we didn’t touch on this month, like the skills and capabilities leaders need to actually build and sustain a healthy environment, as well as components outlined in AACN’s Healthy Work Environment (HWE) Standards. This month’s discussion helped clarify one important layer. In the months ahead, we’ll continue exploring the other drivers that shape engagement and influence nurse engagement.
Nicole Weathers, DNP, RN, NPD-BC
Iowa Online Nurse Residency Program Director
nicole-weathers@uiowa.edu
Wanting a Program Overview? Need to schedule a meeting? Book time with Nicole
Get all the latest IONRP news. Join our mailing list! Subscribe