Now more than ever, nurse leaders are facing complex challenges in healthcare systems that demand highly developed skills to adapt to physical, psychological, or social adversity and to influence change at the macro- and microlevels of an organization. Nurse leaders are expected to positively influence the workplace environment and to build thriving teams.1 Evidence focuses on the leader's role in creating experiences in which employees feel motivated and supported. For example, Mortier and colleagues found nurse managers' authentic leadership enhances nurses' thriving at work.2
However, nurse leaders aren't really thriving at work, and they're struggling to enhance their functioning and effectively perform their job.3 The American Organization for Nursing Leadership reported in their longitudinal study that 45% of nurse leaders who left their positions in the past 6 months did so because of challenges they faced with their leaders, colleagues, or organization.4 Thriving at work is essential for nurse leaders to positively impact their staff members, the quality of patient care, and the organization. In nursing, the concept of thriving at work is mainly borrowed from psychological and organizational research. The purpose of this article is to define thriving, discuss the antecedents and outcomes of thriving, and propose practical solutions nurse leaders can use to create a thriving environment.
Definition of thriving at work
Thriving can be defined as a positive psychological state characterized by two essential dimensions: a sense of vitality and a sense of learning.5 Vitality is a positive feeling of being alive and energetic, and learning is acquiring and applying knowledge and skills.5 The experience of these two dimensions should be joint and simultaneous because an employee can't thrive if they experience burnout or have no energy. Vitality without opportunity for learning stunts the growth innate in thriving. Likewise, learning without vitality impairs the desire to apply new knowledge and skills.
According to Paterson and colleagues, "the two components of thriving interact to create an overall sense of forward momentum and progress at work that isn't captured by either vitality or learning alone."6 When nurse leaders acquire new skills (learning) without the desire and energy (vitality) to apply them, they're not thriving. Likewise, when leaders feel alive in their work with no growth or potential, they can't thrive.
Conceptual model of thriving in nursing
Su and colleagues describe thriving as the fullest range of mental, physical, and social positive functioning and well-being.7 Both Spreitzer's and Su's definitions emphasize that the outcomes of thriving often relate to personal psychological well-being.5,7 We expand the definition of thriving and propose that thriving in the workplace exists on a growing continuum and includes social, psychological, emotional, and cognitive well-being. Figure 1 depicts a conceptual model of personal and organizational antecedents of thriving (see Figure 1A). These antecedents develop the continuum of thriving (see Figure 1B). Only when an individual is thriving in the workplace can positive personal and organizational outcomes occur (see Figure 1C).
However, reciprocal relationships exist among the antecedents, thriving, and outcomes. For example, when nurses have meaningful work and a supportive organizational work culture (antecedents), they can thrive, leading to improved job satisfaction, reduced staff turnover, and cohesion. Consequently, these outcomes can improve work engagement, trust, and personal characteristics (such as positivity), feeding back into the thriving continuum.
Domains and concepts of thriving
The concepts of vitality, learning, autonomy, purpose, and growth directly influence the psychological, cognitive, emotional, and social well-being domains of an individual. The antecedents previously described filter into the concepts of thriving, which feed the individual well-being domains. These four well-being domains are essential for thriving (see Figure 1).
Psychological well-being broadly includes a positive outlook and satisfaction with one's life and mental health. Related, yet distinct, emotional well-being constitutes healthy regulation of emotions and attitudes. For example, a person's mental health may affect the emotions they experience, but mental health doesn't dictate emotions. Likewise, emotional distress doesn't dictate mental health. Many individuals experience painful emotions without developing a mental health condition.
An individual's attitude and cognitive perception of the distressing situation can lead to the development of resilience. Gratitude practices and emotional regulation can improve cognitive and emotional well-being and promote better communication. Cognitive well-being includes aspects of learning, growing, and challenging yourself. A positive mindset sets the tone for solution-focused cognitive processes and may lead to an optimistic attitude. Healthy relationships and conflict resolution demonstrate social well-being. Separating the well-being domains into distinct, interrelated categories appreciates and aligns with nursing's holistic lens of health.
Antecedents of thriving at work
Liu and colleagues' meta-analysis revealed four themes of antecedents of thriving: 1) unit contextual features, 2) resources produced at work, 3) individual agentic work behaviors, and 4) personality traits.8
Some of the unit contextual antecedents identified for thriving include stress, autonomy, work control, trust, supportive climate, organizational justice, and useful feedback.8 Moderate stress levels can positively induce personal learning, growth, and accomplishment, supporting the notion that adversity spurs thriving.8,9 Autonomy leads to employees being more invested, feeling necessary, and having positive work experiences.10
Under resources produced at work are the categories of leadership style, purposeful and meaningful work, and work experience.8 Transformational, authentic, empowering, and servant organizational leadership promote thriving.8,10 Work climates in which leadership values employee well-being, promotes learning, and provides support during adversity foster individual thriving.6 In line with learning, workplaces that offer training and advancement also facilitate thriving.11 There's no doubt that the foundation of nursing is purposeful, meaningful work; however, leadership style and workplace culture can create obstacles and often thwart thriving.
Individual agentic work behaviors include exploration, task focus, and heedful relating.8 Exploration demonstrates discovery, innovation, and risk-taking, which increases self-directed, creative problem-solving.6,8 Although process and protocols are important to patient safety and care, nurses' critical thinking and creativity to practice the nursing model can be stifled. This leads to task-oriented rather than patient-oriented care, which diminishes thriving. Heedful relating involves cooperative and mutually supportive interactions among workers, which increase vitality, learning, and cohesion.8 In line with this theme, Kleine and colleagues suggest individual work engagement fosters thriving. Engagement increases connections with coworkers and their work, vitality, and the desire to learn new skills.10
The final category of antecedents to thriving is employee personality traits, such as self-efficacy, optimism, openness, proactiveness, and conscientiousness.8,10 Kleine and colleagues describe these terms as psychological capital.10 Self-efficacy occurs when individuals have the confidence to master tasks.10 Optimism exists when individuals feel they can succeed.10 Conscientiousness involves self-discipline, a sense of responsibility, and continued motivation to achieve goals.8
In nursing literature, few studies have highlighted the personal and organizational antecedents of thriving at work. Some personal factors such as being open, present, and nonjudgmental were identified as essential to thriving. For example, Sahin and colleagues found that nurses who practice mindfulness by focusing their attention on the present moment without judgment and fully accepting the experience have reported higher levels of thriving.12 Some organizational factors contributing to nurse thriving are empowerment, the mood of the organization, an enabling environment, organizational justice (perception of fairness and equality), togetherness with colleagues, and leaders' connectivity.13 Congruent to the psychology-derived literature, supportive work environments that provide training, recognition, guidance, and mentoring promote thriving in nursing.14
In addition, some workplace constraints can inhibit nurses' ability to thrive. For example, Zhao and colleagues found that workplace violence had a significant negative impact on nurses' thriving.15 Additionally, healthcare systems with excessive administrative burden, a lack of autonomy, inadequate support and resources, and poor communication promote moral distress and moral injury in nurses, the antithesis of thriving.16
Outcomes of thriving
Spreitzer and Sutcliffe proposed thriving as an essential foundation to the health and well-being of employees that can positively affect organizational outcomes.17 Positive personal outcomes include increased job satisfaction, fulfillment, and social engagement. Reducing employee moral distress, moral injury, and the resulting burnout are also outcomes of thriving. Adversity and stress loom throughout the nursing profession, but employee thriving improves skills for coping with adversity, which leads to personal and professional growth. Additionally, Kleine and colleagues found a positive correlation between thriving at work and individual subjective health.10
Mutually beneficial outcomes of thriving exist for the employee and organization. These benefits include cohesion, which means the organization and the employee work synchronously and even synergistically. Other benefits are increased productivity and better job performance.
Organizational outcomes of employee thriving include lower staff turnover, better organizational citizenship, and increased financial savings.10 Organizational citizenship occurs when employees take ownership in the organization; demonstrate commitment, knowledge, and skills; and proactively help others within the organization.10 These benefits ultimately save the organization money with decreased turnover and onboarding, and fewer temporary or agency nurses. Therefore, it's incumbent on organizations and leadership to provide cultures and resources with a focus on promoting employee thriving.
Much of the literature on thriving derives from psychology; however, thriving's relevance to nursing is clear and paramount for the future and health of the profession. Zhao and colleagues found job satisfaction to be an important predictor for thriving and nurse turnover.18 Additionally, work engagement affects thriving and ultimately nurses' affective commitment.15 These findings highlight the relationship among the antecedents, thriving, and outcomes.
Practical suggestions and actions
Personal strategies
Thriving at work is an opportunity for nurse leaders to be involved in making choices that create a positive work environment and influence how individuals respond to adversity. To achieve optimal psychological, emotional, cognitive, and social well-being, nurse leaders must embrace and enhance their personal characteristics while operating within an environment that fosters thriving. By cultivating their own traits and skills and creating a conducive workplace, nurse leaders can contribute to a state of thriving for themselves and their team members, ultimately improving overall outcomes and well-being in the healthcare setting. Table 1 describes actionable personal strategies that nurse leaders can adopt and implement to help them thrive at work.
Organizational strategies
Nurse leaders can't thrive in isolation, and their personal characteristics and vitality alone aren't enough. Creating an environment that supports and nurtures thriving is equally essential. Nurse leaders require a workplace culture that values well-being, growth, and innovation. When organizations prioritize the cultivation of a thriving culture, nurse leaders are empowered to reach their full potential and positively impact their teams. Table 2 highlights key strategies and initiatives organizations can adopt and implement to support nurse leaders in their pursuit of excellence and well-being.
A synergistic relationship
The best practice for nurse leader thriving includes combining personal strategies with organizational strategies. Nurse leaders can influence the organizational environment by sharing information and knowledge that promotes learning and by maintaining their own energy, vitality, and passion for the contributions that nurses can make to meaningful healthcare delivery. Positivity and solution-focused thinking can be infectious when modeled by a nurse leader who lives according to their values. Similar to the conceptual model in which reciprocal relationships exist between thriving, antecedents, and outcomes, nurse leaders and organizations can influence each other in a way that produces synergy.
Thriving senior leaders serve as role models and a source of inspiration for their teams. When leaders demonstrate vitality, enthusiasm, and a passion for learning, it can inspire team members to adopt a similar adaptive and positive mindset. Nurse leaders are often positioned between upper management and staff, putting them in a pivotal place to positively influence the organization at multiple layers.
Senior nurse leaders can meet regularly with the nurse leaders who report to them to individualize the strategies proposed in Table 1 and to create an action plan to fit their needs, preferences, passions, and aspirations. By enabling them to choose learning opportunities and pursue their areas of passion, senior nurse leaders can identify knowledge gaps within the leadership team and address those gaps through targeted training programs, workshops, and seminars. Senior nurse leaders should create opportunities for nurse leaders to develop new skills and encourage them to take on new challenges and expand their knowledge, which benefits the individual's growth and the team's collective capabilities.
The mark of truly successful nursing leadership is fostering the success of staff, patients, and the organization. How nurse leaders deal with failure, disappointment, and adversity influences the work climate for others. A nurse leader can choose to create the context for thriving environments or contribute to a culture of blame and shame. Many of the antecedents or contributing factors for thriving stem from organization- or system-level processes.
A two-dimensional approach
This narrative review defined thriving at work, focusing on the two vital dimensions: vitality and a sense of learning. Without vitality, the desire to learn and grow diminishes, and without opportunities for learning, vitality alone can't sustain thriving. However, the interaction between vitality and learning creates a sense of forward momentum and progress that goes beyond either dimension alone. Nurse leaders who acquire new skills without the energy and motivation to apply them hinder their ability to thrive. Likewise, feeling alive and engaged in their work without opportunities for growth and development limits their potential for thriving.
The expanded definition of workplace thriving presented here includes social, psychological, emotional, and cognitive well-being. Vitality, learning, autonomy, purpose, and growth directly impact an individual's well-being in these domains. Recognizing and fostering these distinct yet interconnected dimensions of well-being aligns with nursing's holistic perspective on health and acknowledges the multifaceted nature of thriving in the workplace.
Nurse leaders can advance their own capacity to thrive by engaging in mentorship, pursuing leadership opportunities, and embodying a positive mindset. At the system level, healthcare organizations should tangibly value nurses by recognizing achievements, assisting work-life balance, and promoting autonomy and clear communication to contribute to the overall prosperity of nurse leaders. By creating the right environment to promote both vitality and learning, and nurturing the broader well-being domains, nurse leaders can establish a solid foundation for thriving, ultimately enhancing their effectiveness and the overall well-being of their teams.
INSTRUCTIONS Nurse leaders thriving: A conceptual model and strategies for application
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