Overcoming walls and voids: Responsive practices that enable frontline workers to feel heard

Abstract

Background There is increasing recognition that beyond frontline workers’ ability to speak up, their feeling heard is also vital, both for improving work processes and reducing burnout. However, little is known about the conditions under which frontline workers feel heard. Purpose This inductive qualitative study identifies barriers and facilitators to feeling heard among nurses in hospitals. Methodology We conducted in-depth semistructured interviews with registered nurses, nurse managers, and nurse practitioners across four hospitals (N = 24) in a U.S. health system between July 2021 and March 2022. We coded with the aim of developing new theory, generating initial codes by studying fragments of data (lines and segments), examining and refining codes across transcripts, and finally engaging in focused coding across all data collected. Findings Frontline nurses who spoke up confronted two types of challenges that prevented feeling heard: (a) walls, which describe organizational barriers that lead ideas to be rejected outright (e.g., empty solicitation), and (b) voids, which describe organizational gaps that lead ideas to be lost in the system (e.g., structural mazes). We identified categories of responsive practices that promoted feeling heard over walls (boundary framing, unscripting, priority enhancing) and voids (procedural transparency, identifying a navigator). These practices appeared more effective when conducted collectively over time. Conclusion Both walls and voids can prevent frontline workers from feeling heard, and these barriers may call for distinct managerial practices to address them. Future efforts to measure responsive practices and explore them in broader samples are needed. Practice Implications Encouraging responsive practices may help ensure that frontline health care workers feel heard.