Session: Helping leaders uphold accountability, cultivate a positive culture to boost nurse retention

Editor's Note

Hold everyone to the same standard, model the behavior you expect, and build trust through transparency—that is how OR leaders retain nurses and improve performance, according to this session’s panel that included Taneka Curtis, MHA, BSN, RN, CNOR, nurse manager-cardiac, transplant and vascular service lines, Hospital of the University of Pennsylvania; Simone Nicholson, DNP, MSN, RN, CNOR, nurse manager main operating room, Main Line Health Lankenau Hospital; and Nana Owusu-Afriyie, MSN, MBA, RN, CNOR, service team coordinator, trauma, assistant nurse manager, Main Line Health Lankenau Medical Center.

Per the panelists, leadership begins with how leaders show up. “If you show up with a great attitude, you make the whole room better,” they said, stressing that positive presence does not excuse poor performance. Leaders must “be fair” whether a favorite staff member or a frequent straggler slips. The group urged any managers in attendance to ask, “What would a reasonable employee do?” and to respond consistently through policy, documentation, and open conversation, not whispered exceptions.

The speakers distinguished leaders from managers. Leaders “motivate individuals on their team,” take appropriate risks, and act as change agents; managers coordinate tasks and often preserve the status quo. They encouraged nurse leaders to claim the leadership mantle even when their badge reads manager because “our ability to inspire is who we are and what we do,” especially in the OR’s high-stakes, interprofessional environment.

They outlined three anchors of accountable culture that supports retention: model desired behaviors, set clear expectations, and hold everyone equally accountable. “We are not our mistakes,” they said. Use errors as learning opportunities through huddles, debriefs, and just culture tools that separate human error from at-risk and reckless actions. That approach “promotes psychological safety” and increases reporting and learning, they stressed. Accountability improves trust, cohesion, quality, and operational efficiency, and 12 to 18 months is the critical window to make team members feel supported and part of a positive culture, they added. Engagement tactics should include regularly sharing survey results, co-creating action plans, and checking progress midyear.

The group contrasted leadership styles seen in the OR:

• overused authoritarian approaches may drive turnover
• laissez-faire risks inconsistency and slow feedback
• transformational leadership “sets a positive example” while offering support and clear expectations.

After polling the room, they found a strong preference for transformational leaders. Still, they emphasized that teams value situational flexibility. “Who do you need me to be today?” is one question they urged attendees to consistently ask so they can adapt between coach, counselor, and mentor as needs evolve.

Self-awareness was framed as a daily discipline. “Pause before reacting,” they said. Know your triggers, examine bias, and seek peer feedback so your team experiences steadiness rather than punitive swings. Leaders should learn, unlearn, and relearn as workforce expectations change. “What was normal before COVID is not normal after COVID,” they noted. Leaders need to embrace new communication habits and reinforcement methods that meet Gen Z and multigenerational teams where they are. In fact, developing new leaders is nonnegotiable, so identify emerging informal leaders such as preceptors and charge nurses and invest in mentorship, leadership workshops, shared governance roles, and shadowing, they said. Do it early, often during onboarding or after 6 to 12 months of performance, so a pipeline can be built and responsibility can be evenly distributed.

They closed with a reminder that culture is a practice, not a project. Keep expectations visible, communicate across multiple channels, and round with purpose. “Every consistent, fair action keeps the needle moving,” they concluded.