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Management Training for a Positive Work Environment

AOTA Classification Code: CAT 3: Professional Issues: Administration and Management.
Content Level: Intermediate.
AOTA does not endorse specific course content, products, or clinical procedures. AOTA provider number 9757.

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Author:    Sandi Winston (MSN, RN)


In any work environment, there are goals to be met. A goal, vision or mission statement explains your team’s dream for the future growth and success of the work environment. We are all faced with challenges at work as well.  All people respond to challenges and change differently. Some people react positively to change whereas others respond in a negative way. Negative energy gets in the way of implementing your vision and goals. The important lesson is we have a choice of how we respond. You can help bring out the best in your team, achieve your goals, and have fun getting there!

The Vision

First, you need to create a vision. In healthcare, it is called a mission statement. By developing a vision statement, your organization clarifies the beliefs and governing principles of the organization.1 There are certain characteristics that most vision/mission statements have in common:

  • Understood and shared by members of the community
  • Broad enough to include a diverse variety of local perspectives
  • Inspiring and uplifting to everyone involved
  • Easy to communicate1

Writing down your vision statement helps you and your team stay focused and on track. It helps keep the goals clear, builds positive expectancy, and then the team begins to see that it is doable. The best way to get your team on board to help meet your goals is to have them participate in making the vision/mission statement.

Using a team approach to setting and reaching common goals is an example of Shared Governance; a model for nursing practice designed to improve nurses’ work environment and to achieve quality care.  A Shared Governance system is designed to reflect the professional character of the participants in the nursing organization and to promote certain positive behaviors and practices. The purpose of shared governance is the establishment of a system in which staff participates fully in all activities that have an impact on their work and their ultimate goal of meaningful patient care. Although Shared governance was created to improve nurses’ work environment, it can be utilized in other healthcare professions to achieve a positive workplace.

The vision statement should be simple and short and include all staff (clerical staff, nursing, etc.). Everyone would want to be on the bus going to a positive productive future.

Productivity Express

For example, our vision statement is to maintain a maximum number of patients scheduled daily for all procedures rooms while maintaining excellent nursing care and excellent patient outcomes. This vision includes scheduling staff, nurses and techs as well as receptionist and financial representatives. We need the entire team to maximize our procedure schedule daily as well as have excellent care and outcomes!2

When creating your vision statement, here are a few important things to remember:

  • What do you want to achieve?
  • Write your goal in complete detail.
  • Write your goal in the positive. The more positive instructions you give it, the more positive results you will have.
  • What do you hope to accomplish?
  • Write your vision down and share it, then rewrite it.
  • Keep it simple yet specific and measurable.
  • Continue to reinforce the vision.
  • Keep fine-tuning your vision as your team continues to grow or move forward.
  • Once the vision is met, make a new one to keep the team motivated and focused.

Positive Energy

Positive energy is essential to help you achieve your vision. Energy is contagious whether it is positive or negative. Negativity is not productive in the work environment and does not serve a purpose. Many of you have heard the phrase, what you think about, you bring about. It is so true! What we put our energy into and focus on will show up more in our life. Unfortunately, some people complain and are continuously negative, and therefore it brings about a negative outcome. In Jon Gordon’s book The Energy Bus, on which this course is based, he calls those negative people Energy Vampires. That is a perfect name for the negative people because at times they really suck the life out of you!

We spend so much of our life at work, and with today’s stressors, especially in healthcare, there are more challenges than ever before. The attitude we bring to work plays an important role. Always try to give positive reinforcement, show gratitude, and most importantly, spread happiness!4

After twenty years of working as a nurse, Susan noticed that a twelve-hour shift in the ICU working with several negative staff members was more mentally and physically exhausting than working the shift and taking care of the sickest patient on the unit, short-staffed and going without a break!

Research shows that negative energy can cause medical problems with our immune system, blood pressure, sleep cycle, and energy levels causing a huge obstacle to being positive. It is vitally important to encourage the positive energy. If you encourage the positive, then the negative will not spread. So, as Jon Gordon says, Feed the Positive Dog…2

A man goes to the village to visit the wise man and he says to the wise man, “I feel like there are two dogs inside of me. One dog is this positive, loving, kind and gentle dog and then I have this angry mean-spirited and negative dog and they fight all of the time. I don’t know    which one is going to win.” The wise man thinks for a moment and he says, “I know which one is going to win, the one you feed the most, so feed the positive dog” 2

God dog, bad dog

As Jon Gordon proposes, the fuel for your bus is the positive energy….so; here are a few notes on how to fuel up!

  • Positive Energy + Positive People = Positive Outcomes
  • Positive energy helps keep your bus moving toward your vision
  • Positive doesn’t just change you; it changes everything around you
  • When you are positive, you not only make yourself better, you make everyone around you better
  • The more positive dogs, the better!

To help the nurse leader, whether this is a Nurse Manager, Nursing Supervisor, Charge Nurse, Assistant Director or any one in authority, there are steps to take to make the work environment a positive one. Positive work environments help to create more positive dogs.

This type of positive work environment facilitates a feeling of cooperation, teamwork and joy among healthcare providers at all levels which results in better care to their patients and customers.

  1. To be successful it is vital that the Chief Executive Officer (CEO) be involved because this individual helps to set the tone and creates an incentive for employees to excel. This person can give out special awards and certificates of recognition to deserving employees. At times the CEO can connect with the staff at town meetings or visit the different areas that help to make patients/customers feel valued as they receive the care to improve their health in a timely and safe manner.
  2. Eliminate the cliques that are endemic in any large organization in order to develop trust so that all are working toward implementing the organization’s Vision Statement. Everyone would then have the same objective and feel part of the master plan of the organization. People from different departments would then work together cohesively for their common goal.
  3. Everyone in the organization must always remember that patients are customers.
  4. Physicians need to be a part of creating a positive work environment since they bring in the customers. Keeping an open line of communication between all departments can help to develop a great place to work and create clinical excellence. All departments working together end up giving the patients/customers excellent care.
  5. Employees need to feel empowered and valued. Using the concept of Shared Governance allows the employees to verbalize what has been done, what could be done to improve patient care and changes that might be implemented to provide safe quality patient care.
  6. Employees need training and constant education to improve their scope of practice. Training sessions should include how they are working to implement the mission and vision, as they all work together to give the best patient care possible. Training keeps employees up to date with changes being made to improve care, processes, new policies and procedures they are accountable for implementing.
  7. Leadership as a whole needs to be visible on all shifts and should listen to what staff has to say. Communicating how they are doing in implementing the organization's mission and vision is one way to help employees feel important and valued. Asking staff what they need to improve patient care and what they are presently doing is important. Listening to the staff in all departments and their suggestions can improve the work environment hospital wide.
  8. Organizations to survive need to take risks and be willing to explore new systems which could improve and provide the best safe quality patient care. This might entail being open to new viewpoints and developing new relationships with people who are involved with preparing for the future. (i.e.: technological innovations, computer systems, communication systems, training tools & seminars).
  9. Developing respect for nurses and everyone in the organization. This entails preventing sexual harassment and having and implementing the consequences if this occurs. This helps to create a healthy and positive work environment for all.
  10. Staff from all departments should be active within their community. Customers respect those who are active members of the community they live in and will refer others to come to their hospital.

These ten factors are beneficial in helping to build a positive work environment, but as leaders, there is more to learn in building cooperation, teamwork, a positive attitude and pride in their accomplishments.2

The factors that leaders need to learn and practice include the following:

  1. Building a Trustful Environment by doing what you say you are going to do in a timely manner. Leaders need to be reliable, responsible, accountable, dependable, and consistent in their actions. Leaders’ words and behaviors affect how employees develop a trustful relationship. Once trust is broken it takes a long time to repair this relationship.
    In challenging situations, it is important a leader is up front, honest, tactful, and compassionate, even if the staff does not appreciate what is being done and said. Employees need to know when they say something in confidence it is kept that way. An effective manager never talks about his staff in a negative, destructive way. The manager should strive to emphasize the positive and be willing to provide the necessary education which will enhance the team.
  2. Leaders need to learn to communicate positively and openly creating a work environment where employees feel proud of their accomplishments and valued.
    Leaders should have regular staff meetings for all shifts. During these meetings reinforcement of the organization’s philosophy, mission, values, and goals should be stressed. Using the Shared Government Model employees are asked for their ideas and thoughts on how they individually and as a team can help the supervisors unit accomplish the organization’s purpose. Once again, the leader needs to share his or her own vision on how the healthcare team can accomplish what the organization requires to fulfill its philosophy, mission, values, and goals. The weekly meetings are an excellent venue for rewards and recognition. After the initial business is attended to, make the rest of the meeting fun.4
    Everyone should feel they are all on the same level and everyone’s job is equally important.
    Employees need to realize that they are accountable to their job and showing up with a positive attitude, and on time which is expected. Focusing on work and leaving at home the challenges that are occurring is vital to the success of each person. Therefore, personal issues should be left at home. Work should be a place for professional growth and lifetime learning. Everyone needs to feel valued and respected.
  3. Leaders/supervisors set the stage and should expect the best from their staff. Employees generally perform in the way they are expected to perform. If they are treated as being capable, competent, and trustworthy, they will strive to do their best. However, if micromanaged and seen to be mediocre, the leader will receive behavior that the leader expected. A good, productive supervisor should always have high expectations for his/her staff and treats them accordingly and with pride.
  4. A constant action a supervisor/leader needs to do is Create a Positive Team Spirit. A team approach helps people feel part of something bigger than themselves, part of a supportive work group and builds a unified team. Having pride in what they do decreases tardiness and absenteeism while accomplishing the organization’s mission, vision, and goals.
    ?Creating this team spirit and identity can be accomplished by the following
    • Convey to the staff that everyone plays an important role.
    • Encourage an attitude of cooperation rather than competition.
    • Help each team member know they are valued and create an atmosphere of respect for each other and their special contributions.
    • Be open to communication from everyone, including patients, residents, family members, peers, and staff.
    • Be responsive to the needs of all who share their concerns.
    • Be attentive when listening by establishing eye contact and your full attention.
    • During staff meetings set time to recognize accomplishments, and have staff write down words of appreciation on a card of the co-worker, including positive personal characteristics, attitudes and special skills they bring to the team.
    • Ensure that constructive humor is part of the daily work environment while treating all with respect.
    • As a leader, be human and learn to laugh at one-self and model this for your staff.
    • Practice problem solving and awareness exercises at staff meetings and have each write down how they can create a positive team spirit.
    • Respect each other’s culture.
  5. It is vital for the leader/supervisor to give recognition and appreciation whenever possible. Stress your appreciation for those who stretch by doing overtime, willingness to float with a positive attitude, doing something special for a customer and or family member, helping another staff member with a challenging chore, consistently doing an excellent job. Have awards ceremonies and give out certificates of recognition for an outstanding accomplishment.
    When possible make sure on your staff’s evaluations their accomplishments are recognized and rewarded. Rewards could be a financial bonus, a step level, or however the organization shows appreciation for an outstanding job.
  6. As a supervisor give credit and take responsibility. Praise staffs who are successful in their accomplishments and if things do not go as planned take responsibility. This means that staff may need to be trained, re-educated, and given constructive direction so that they can perform up to the required standards.
  7. Leaders/Supervisors in all departments need to Be Available and Approachable to staff and all customers. Listen attentively to what is being said and convey your concern and respect their suggestions to solving the challenges that have occurred. Do the necessary follow-up and inform those of the progress being made into solving their problems. Thank customers, staff for their concerns and input, show respect. Be positive, smile and use body language to show that you are attentive to what is being said.
  8. Provide a Positive physical environment on your own as well as on the employee’s unit. Environments should be clean, well-organized, and cheerful, with proper lighting and give each staff member room for their personal space.
  9. When a leader/supervisor does evaluations with staff, make evaluations a positive experience to help them grow and give praise for their team-work and cooperative spirit. Utilize this time to thank them for bringing their special talents to the team. When discussing where improvement is needed focus on the good and all they are doing right
  10. Leaders need to help make work fun and enjoyable. This can be accomplished by celebrating special events like birthdays, the birth of a baby, upcoming marriages. Employees should be asked how they would develop a happier atmosphere. 

    Listen to what the employee has to say and help them establish goals. Prior to completing staff’s evaluations ask for their input with examples of what they have done as individuals and as part of the healthcare team. Use this information in their evaluations.
    When meeting with the employee ask them to share what they have written, and discuss it with them. Obtain further input on how to prepare for the future by covering.

    • What new education do they need to gain within the next six months to improve their work, team participation, and care of their patients?
    • What skills do they want to develop to reach their objectives?
    • What would they like to do differently when working with their peers?
    • What can you as a leader do to assist them in reaching their goals?
    • Revisit the evaluation in six months and ask how they are accomplishing their goals and how they have been dealing with any challenges/conflicts.
    • Ask staff what else needs to be done to resolve any conflicts and how you as a supervisor may assist.

 As a manager and supervisor challenges are met when having to counsel an employee who is not performing up to the established, required, standards. Prior to the evaluation counseling should have occurred and resolutions discussed. Progress or lack of should be noted on the evaluation. This is an opportunity for the supervisor to demonstrate how the employee has improved his performance, behavior, and quality of their work. The employee should feel that their manager has been supportive. The employee may decide to choose to leave or choose to stay on.

An effective manager helps the staff member at the end of the evaluation feel appreciated, in control with personal power over their work life and future. Most of all they need to feel valued. This is accomplished as leaders focus on their staff’s strengths rather than their weaknesses. People need to work in a positive environment where they can excel, feel comfortable and have fun doing their job. Managers often have to be creative in accomplishing their goals to improve the work environment.

Dealing with Change

A leader and their staff on a constant basis have to deal with change and how this is done is reflected in their job performance, team work, and patient care delivered.

Most people do not like change. Change causes uncertainty and fear. In healthcare, there is constant change. The important lesson in change is not to resist it but grow from it. Think of change as a roadblock and how your vision can still be obtained by taking the detour.

Here are a few points to discuss with staff as you take a detour:

  • Reinforce the vision with any change
  • Encourage the team to leave the past behind and look to the future
  • Show the team what they can learn from change
  • What actions does the team need to make to keep on course for the vision?
  • What opportunity does this change present to the team?


Susan, as a manager, noticed that an employee’s first response to change is to complain. She realized that this is the fear talking. It was important to listen to her employee’s concerns and to reassure them that she is still on the right course to implement the organizations’ vision. If the employee continued to complain, she would talk to them further. What is their complaint? Then she would ask them to be a part of the solution instead of being a complainer. Complaining feeds the negative dog, so as in The Positive Dog by Jon Gordon2, think of the solution and feed the positive dog instead!

Once Susan had an employee, named Daisy, and all she wanted to do was complain. Daisy did not handle change well. As her unit was moving forward, toward their vision, Daisy was only able to dwell on the past, say how things used to be and the negative energy was affecting the entire staff. Susan explained to Daisy that she needed to let the past go and move forward with the team’s vision. Susan explained that they could not change the past, but they could change their future…. for the positive! So, Susan asked Daisy that when she had a complaint to write it down and before bringing the complaint forward, to write down a solution as well. At their next meeting, Daisy brought forward a list of complaints, some with solutions, and the group went through them one by one. Each issue was addressed individually and each complaint was resolved immediately. Daisy, finally realized that if issues arose with change that they would be addressed and that change didn’t have to be negative. Finally, Daisy was able to let go of the past and join the team on our bus.

Negativity in the Workplace

Negativity is like a virus that spreads causing problems with productivity and morale, and may ultimately prevent a department from achieving success, so you are wise to seek ways to remove it before it increases. Although everyone has moments of negativity about his or her work, when it becomes a habit, it becomes a problem.6 Negativity can be very infectious in the workplace. At first, you begin with one negative team member, and before too long you have several. You have to stop the spread of the negative behavior. Empower the positive people to stand up to the negative ones and say to them, “We do not allow negativity here” …or as Jon Gordon (2007, pg. 47) would say, “We don’t allow any Energy Vampires on our bus!”

Negative people will stop you from obtaining your vision. Negative team members are usually the lower performers. The low performers will have to eventually step up to the plate or get off the bus.  You have to identify the negative team members who are affecting your team’s success. Once you identify those vampires, you need to do the following:    

Vampire bat

  • Open up the lines of communication and let them know they are being negative.
  • Explain to them that the negative behavior is unacceptable and it needs to change.
  • Explain that negative behavior does not serve a purpose.
  • Be a mentor to them, praise them, and lead with optimism and positivity.
  • See negative people as teachers who help us become more positive.
  • If they fail to change their negative behavior and then explain that it will not be accepted and you will have no choice but to let them off the bus.

When Susan spoke to her employees and rolled out the bus concept, there were many staff members that were a relieved.  They felt relief in the fact that the negative behavior was not was going to be a part of their work environment anymore. Many agreed that the negative behavior was more exhausting than the busiest work day. They felt empowered to be able to say to negative teammates that they did not want to hear it, or that was not allowed on our bus. In fact, immediately after their meeting, and several times since, Susan overheard staff members make a comment to a negative one or one complaining. They actually called them out on the negative behavior….and those people immediately stopped!

Another situation Susan encountered was with Amy. Amy was the newest employee in the unit. She just wanted to fit in with the other staff. So, when other staff was being negative around Amy, she would agree and join in with the negative behavior. One day Susan spoke with Amy and pointed out the negative behavior. Amy was devastated. She didn’t realize how she was behaving and the negative impact on other staff members. Amy apologized and stated that she would strive to be positive and not to let the negative behavior spread. Since her discussion, Susan has seen a whole new side of positive Amy, but she has stepped up to the plate and been a great team-player and asset to their team.

Join the Team

To get your team members on board with the vision and positive energy, invite them to join the team and invite them on the bus. Make them feel that they are a valued part of the team and that you would love them to be a part of your vision. There are always going to be a few staff members that don’t want to be a part of the team or get on the bus. Those are usually your Energy Vampires. Do not waste your time on those who say they don’t want to be a part of it. I am not saying to let those negative people continue their destructive behavior, but if they realize that they don’t want to be a part of the team, then maybe they will realize that this is not the job for them.

First, present the team with the vision. Second, explain the rules of your team or bus. These rules are just another way of expressing their Best Behaviors in healthcare. Their Best Behaviors are a list of customer-focused expectations for all employees. Employees are evaluated on these behaviors on their evaluations annually. Third, explain to the staff that you expect them to follow the rules and that if they cannot follow the rules then maybe they need to think about if this is the right place for them. Finally, present each staff member with a ticket to join the team. Have each staff member sign the back of the ticket and place in their employee file to show they agreed to the rules of the team. 

Join the Team

Our Best Behaviors:

  1. Customer Focus
  2. Teamwork
  3. Adapting to Change
  4. Developing Self and Others
  5. Problem Solving

Once the team agreed on their vision, and they discussed the rules of the bus, Susan offered every employee a bus ticket and invited them on the bus. Everyone, so she thought, had turned in their ticket. Many employees felt revived from the meeting after discussing goals and where they could go with all of the positive energy to fuel their bus. Several staff members came to Susan after the meeting and thanked her; they stated that was the best staff meeting they had ever had. In addition, several staff members that occasionally would exert negative behavior and not be team-players, have really turned around and made a difference. Susan thought that possibly they were ones that didn’t realize their behavior and once pointed out, they changed. Susan called them converted vampires.

At first, Susan had thought everyone turned in their ticket. Susan found out later that she was missing one, Lucy. Evidentially, Lucy went into the bathroom after meeting and threw her ticket in the garbage. Another staff actually saw Lucy throw it away and said, “Why did you throw your ticket away? That is not the behavior we want on our bus.” So, the next day, Susan spoke with Lucy. She asked her why she didn’t turn her ticket in and threw it in the garbage. She stated, “Well, I want to be on the team, but I don’t want to be on the bus!” Susan stated, “It’s really the same thing.” Susan explained that the rules of the bus are basically an extension of their Best Behaviors and those are expectations of all employees already. Lucy had previously had issues with not being a team-player, negative behavior and not adapting to change well. Susan had hoped that this would help convert Lucy as well, but Lucy is currently looking for another job. Down the road, Lucy will find the right bus to get on, but in the meantime, our bus will continue to move forward toward our vision with the other positive passengers.

Reward the Positive Dog

We want to starve the negative dog as Jon Gordon (2012) expresses in his books. In doing that you have to encourage and reward the positive. It is very easy once the positivity starts, it is contagious! There are many ways to reward the positive; you just have to find ways that help encourage your staff. ?
Angel Dog

Here are a few examples:

  • Recognition
  • Mentoring
  • Appreciation
  • Encouragement

On Susan’s unit, she asked the staff what they would like to do to recognize the positive people. They came up with several great ideas! First, they made a bulletin board called The Positive Dog. On that board, they have a large section called Top Dogs where the staff can write up recognition for their teammates and nominate them as Top Dog. The staff has been very receptive to this, and when one of their teammates goes over-and-above to help out the team or a patient, they recognize them. They also put any patient/customer appreciation notes on the board as well to recognize the staff. Next, they have a smaller section on the board called Barking up the Wrong Tree. That is a reminder of the negative behaviors that we discourage. For example:  

  • Not treating your peers with kindness and respect
  • Not assisting your teammates
  • Talking negatively about your teammates
  • Not communicating in a respectful manor, verbal or non-verbal
  • Not supporting the vision of their bus
  • Not displaying openness to new ideas or change
  • Not being supportive and welcoming of new colleagues

Then at the end of the month, Susan announces the Top Dogs in the staff meeting to help give further encouragement and recognition as well as give them a little reward. The reward may be a $5 gift card or such. Then out of the Top Dogs for the month, we draw a name out of those nominated to see who gets the Employee of the Month parking space…. although Susan has changed the sign to say Positive Dog of the Month! The staff has been so receptive they are fighting (not really) over the parking place!

The staff also created a bus and hung on the wall. All the staff brought in pictures, the ones who signed their tickets, so everyone could see the staff that was on the bus. This also helps reinforce the positive behavior…. the staff is very proud to show others that they are on the bus….and it helps encourage others to get on the bus as well.


Hopefully, this has given you, as a manager in the healthcare profession, additional tools and principles to encourage positive attitude and teamwork in the work place. By making a team bus, rules of the bus and inviting your team along for the ride, you might find that the vampires get on another bus, your bus is more positive than ever and the team is then actually more productive……and the team actually will have fun coming to work! The role of the nursing manager plays a major factor in nurses’ intention to remain or leave their current workplace.5

By following the above rules, and by making the work place a fun environment, managers are more able to retain their nurses.

Implicit Bias Statement

CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.


  1. "What Is a Vision Statement?". Community Tool Box. N.p., 2017. Web. 17 Apr. 2017.
  2. Gordon, Jon. "Feed the Positive Dog". N.p., 2014. Web. 17 Apr. 2017.
  3. Gordon, Jon. "The Energy Bus". N.p., 2013. Web. 17 Apr. 2017
  4. Hollis, Tina. "12 Ways to Create a More Positive Work Environment". Good & Co./career insights. N.p., 2017. Web. 19 Mar. 2017.
  5. Roche, M et al. "Leadership Skills for Nursing Unit Managers to Decrease Intention to Leave". Dove Press:2015:5 (2017): 57-64.
  6. Frandson, B. "Negativity in Nurses: Help Staff Reverse Bad Habits". AANAC. N.p., 2015. Web. 17 Apr. 2017.