People become nurses to care for others, and yet they are often the least cared for employees within healthcare organizations.

They’re the ones caught between meeting a patient’s immediate needs while trying to keep things moving on the doctor’s schedule. Or trying to carve out time to answer patient questions while overwhelmed with the sheer volume of individuals in their care. Or wanting to share ideas or change the way things are done with senior leadership, only to be treated as a cog in the machine.

Olga Yakusheva, Ph.D., MSPE is a professor of nursing at the John Hopkins School of Nursing and also a healthcare economist. She acknowledges this challenge within the healthcare business model.

“It’s not that the organizations are mean or cold-hearted, not wanting to hear what the nurse has to say or how the nurse feels,” said Dr. Yakusheva. “Even if they identify a gap, and see [inclusion] as something they need to do, they just don’t have the resources.”

Healthcare providers and their leaders will soon pay the price if they continue to make their nurses feel excluded at work.

Dr. Yakusheva took this issue further by sharing, “I actually believe many organizations have the resources, it is a matter of prioritization. Because there isn’t much of a financial ROI on quality, nurses often fall to the bottom of the ‘investment’ list, receiving only the bare minimum needed to staff the beds. Nurse leaders end up between the rock and a hard place, not being adequately financially supported by their organizations while having to manage an under-resourced, undervalued, burned out nursing staff.”

Here are 4 steps to turn inclusion into a growth strategy for nursing:

1. Guide Nurses to Help Each Other

Nurses certainly know how to train each other in their particular expertise of caring for patients. But don’t neglect the other aspects of their specialized knowledge.

“A lot of new nurses have a lot of ideas, but they don’t always know how to implement them,” said Anthony Betz, business manager, nursing operations, Wellstar Health System. “They need seasoned nurse leaders to help guide them through that process.”

Seasoned nurses: help your newer peers find ways to share their ideas. Don’t judge them. Unleash them by knowing what matters to them about what they believe can be improved. Continue to encourage idea sharing by creating the conditions for them to share more. Because the moment they feel unsafe to share, continuous improvement opportunities are missed, and retention risks begin to elevate.

2. Non-Nursing Leaders: Learn From Your Nurses

Nurses are natural collaborators. The success and significance of their work has a deep dependency on collaborating with others. This skill allows them to broaden their observations and see beyond the obvious, especially during high-pressure situations. As such, they can instantaneously connect the dots and elevate their strategic focus on the right opportunities and know how to nurture them.

“When I walk out into my inpatient units, I see always nurses at the nurse’s station collaborating,” said Rebekah Marsh, BSN, RN, clinical nurse educator, Harborview Medical Center, UW Medicine. “The minute a nurse has a question, they immediately involve their team before they start formulating their own individual plan. Nurses are good at not making decisions until we’ve gotten second and third opinions.”

That’s a great leadership model for all of us, nurses or not. This is the core of inclusion: proactively involving others in decision-making, and seeking out new insights. Seek input from nurses on how to be more collaborative in the way you work. You will learn a great deal, and they will get to share their expertise in a way that benefits the entire organization—helping them see how valuable they are to the success of the enterprise.

3. Train Leaders to Disrupt their Comfort Zones

Inclusion is not just one person deciding to be more open-minded about who matters and who is able to share opinions and ideas freely. It’s that one person teaming up with more people to make their entire organization more open-minded about who matters—and making sure the organization is structured in a way that makes that level of inclusion routine.

When nurses feel their unique capabilities are being utilized beyond the bedside and points of view are welcome across this enterprise, this is when their individual contributions are most valued. Most leaders (nurses or not) are not trained how to disrupt their comfort zones and to deal with difference, because most of them value their comfort zones of sameness—doing more of the same, while practicing incrementalism, at best. Based on my firm’s research, leaders are more inclined to do what they know rather than break free from their comfort zone. As a result, they stifle their own growth and that of others.

Would you rather disrupt your comfort zone, or be forced to embrace discomfort? As you consider this question, remember this: Comfort zones might give you some comfort now, but they rob you of comfort later. It’s a false comfort, because it’s giving you the illusion of success now at the expense of being able to sustain it later.

4. Assess Your Own Ability to Tolerate Difference

Take a moment to reflect and be honest about how you would respond to the following five questions:

1. Who Do You Let In? Those who have contrary voices that seek to add value to the team, or those who think like you?

• Take this into account: Are you proactively looking to remove barriers that are keeping nurses out of the decision-making process?

2. How Do You See Them? As an individual who wants to be seen in their full humanity, or as a leader who has an important title?

• Consider this: How can you proactively plan for more conversations that expand your perspective about who your nurses are?

3. Who Do You Let Them Be? An expert in what they do and know, or someone who must conform to your ways of working and thinking?

• Consider this: Are there ways for nurses to share what they know with senior leadership whether or not they are directly asked?

4. What Do You Let Them Do? Can they be an individual who is empowered to chart a new path for the betterment of the team, or do they have to remain compliant with the ways we’ve always done things?

• Consider this: Do you hold nurses to rigid organizational standards that are no longer relevant?

5. How Do You Let Them Do It? Can they be an individual who is eager to explore what’s possible, or do they have to follow the predetermined paths to obtain the metric?

• Consider this: Is there a strict process for improvement or can nurses pursue growth in their own direction?

Healthcare Needs to Incentivize Inclusion

As much as organizations talk about inclusion, the financial and human capital model in healthcare doesn’t incentivize it. Healthcare is highly standardized, for many good reasons, but that standardization stifles individuality and doesn’t prioritize learning how to create workplaces in which people feel able to express opinions and ideas freely, and to be themselves without being judged.

If healthcare leaders don’t learn how to make nurses feel more included, they risk alienating a vital part of their workforce. Or as a group of nursing supervisors once shared with me, “what would happen if we decided not to come to work for 4 days?”