Nancy Anderson, RN, MA, Senior Vice President of Engagement Solutions


When one year closes and another begins, I tend to get reflective about my life. I think about things for which I feel enormously grateful, ponder accomplishments for which I feel very proud, and consider what I want to achieve in the upcoming year. Sometimes my thoughts turn to things that I wish I would have done differently or could have done better in the past. You know… those disquieting thoughts that make you think, “I wish I knew then what I know now!”

Recently, I overheard something that triggered this latter type of recollection. It’s estimated that 90% of Americans leave their job at the end of the day feeling unfulfilled by their work. Now I don’t know how accurate that is, but upon hearing this startling statement, I began to wonder… over the course of my career, how might I have contributed to this situation? In the various leadership roles that I’ve held, did I create an environment that left employees feeling disconnected and unsatisfied?  

My mind drifted back to many years ago when I was a first-time director of nursing in a skilled nursing facility. Being new to the role, my focus was on compliance, staffing and clinical quality. My time was spent ensuring our processes met regulatory requirements, confirming that all the slots were filled on the staffing schedule, monitoring my budget, conducting audits and updating our policies and procedures. All this left very little time with the people I was leading. Looking back, I wish I knew then what I know so deeply now. People matter. Relationships matter.  And one of the most important roles as a leader is to create the conditions in which employees can flourish.

Now I get it!

As we navigate our increasingly busy work days with all of the varying demands on our time, it’s easy to become somewhat mechanical, perfunctory and non-relational in our actions. Yet it’s the people, and their level of engagement in their work, that makes or breaks all the rest of the stuff! A high level of employee engagement is highly correlated with increased productivity, improved safety, higher levels of patient experience and better clinical outcomes. If I knew then what I know now, I would have started by focusing on employees and aligning their interests with the organizations. So much of what I was trying to control with audits and staffing schedules and procedures would have been so much easier. Alignment of purpose provides a very powerful force for building a meaningful and fulfilling work environment.

Simon Sinek, author of the book “Start with Why,” notes that every organization and every individual functions on three levels: What we do, how we do it and why we do it. 

Most of us know what we do and how we do it, but very few of us can articulate why we do what we do. The “why” he refers to is not about earning money. It’s about understanding our driving purpose, our cause, our belief about what we contribute to the world. 

Sinek says that a leader’s job is to “preach the cause” so that employees understand the deep purpose of why the organization exists. Then help people connect their personal “why”, i.e., their passion and cause, with the “why” of the company. In the senior care world, this means helping employees see how what they do on a daily basis contributes and impacts the quality of people’s lives.

Coulda, woulda, shoulda…

Yes, I could have done a much better job at working with employees to make our facility and the nursing department a fulfilling place to work. I could have provided a clear line of sight to facility and nursing goals and engaged staff in determining how best to meet these goals. I could have established better listening forums in which employees could safely share their ideas, opinions and concerns. I could have shown more appreciation for the great work my employees did every day.

But wait!

All that being said, a few years ago I attended a long-term care conference. As I walked down the hallway of the conference center, intent on finding my next breakout session, a young woman walked over to me and said, “You don’t remember me do you?” I felt a bit embarrassed because it was true, I didn’t recognize her. She went on to say, “When you were the director of nursing at “XYZ” facility, you interviewed me for a nursing position. Although I was a new grad, you took a chance on me and helped me be successful as I launched my nursing career. And now, I’m a director of nursing! Thank you for your support and mentoring!”

Wow! Maybe I wasn’t so clueless after all!

Nancy Anderson, RN, MA, is the SVP of Engagement Solutions for Align. In her role, she provides strategic leadership and supports development of solutions to help providers successfully build and sustain a culture of engagement.