Abstract
An incongruity between what is said and done can be harmful. Cultivating consonance is a place to bring organizations and nurses together.
With prescience it never could have imagined, the World Health Organization (2020) declared 2020 the “International Year of the Nurse and the Midwife.” For decades, nurses have endured physical exhaustion, burnout, depression, and even post-traumatic stress disorders (Dall’Ora et al., 2020), and these experiences are now heightened with the coronavirus pandemic (COVID-19). As nurses continue to care for communities of ill patients across the country, their health and well-being have taken a toll. More alarming is that some have begun to feel replaceable and even disposable (Foli et al., 2021), while organizations are eager to take credit for what nurses do.
This paradox—nurses feeling essential yet disposable—has been, in part, driven by organizational dissonance, a concept describing when an organization’s stated beliefs, purpose, and culture and action do not align (Bacharach et al., 1996). Organizational dissonance is derived from cognitive dissonance, which is an incongruity between what is said and what is done (Festinger, 1957) and can lead to conflict and discomfort for employees, leading them to cope by adapting or reshaping attitudes, perceptions, and behaviors in search of cohesion (Bacharach et al., 1996). Nurses encounter and manage such dissonance, but their comparatively limited control over their environment creates a sense of helplessness that sets the stage for burnout, job dissatisfaction, and turnover.
This dissonance has been especially pronounced over the last 18 months due to the prevailing “nurse as hero” discourse embraced by the organizations and the public. Signs hanging on hospitals praising health care workers, for example, are well-intentioned, but it deflects organizational responsibilities. At the onset of the pandemic, nurses were celebrated for going into battle without the protections owed to them by their organizations (Halberg et al., 2021). Their sacrifice and selflessness, in other words, made them “heroes,” and this hero narrative obliges nurses to model “neutral selflessness” by caring for patients without judgment and teases the notion that public endearment somehow offsets or even compensates for organizational inadequacy. In this vein, while neighbors ringing a bell at 7 o’clock was a thoughtful and appreciated gesture, it did little to propel organizations to address prevailing systemic issues such as chronic understaffing, high turnover rates, and a punitive organizational culture (Dall’Ora et al., 2020) that predated the pandemic and became more prominent during the crisis.
There are several ways that occupational health nurses can reduce this harmful dissonance at their organizations. By leveraging their positions between nurses and their employers, Occupational health nurses can engage nurses in employer-sponsored wellness programs individually and collectively as an organization while encouraging leaders to develop and demonstrate emotionally intelligent leadership and engage in clear, transparent, and honest dialogue with nurses. In August 2021, the Dr. Lorna Breen Health Care Provider Protection Act (S. 4349) was passed in the Senate (Congress, 117th, 2021). This bipartisan Act, meant to address the health and well-being of health care professionals and endorsed by over 70 professional organizations, was a groundbreaking first step toward addressing occupational stress at the system level. Although there are no staffing ratios or organizational programs that can entirely prevent workplace stress, especially during a global crisis, organizations with greater consonance between words and deeds—matching policies and culture with actions and practices—are a great place to start.
