Designing for Belonging: Building Connection, Confidence, and Retention in Nursing

What helps nurses stay? Dr. Jihane Frangieh of the Johns Hopkins School of Nursing joins us to explore how belonging and social connectedness influence engagement, confidence, psychological safety, and retention. From nurse residency programs and mentorship to shared governance and leadership strategies, this conversation offers practical ideas for creating workplaces where nurses feel valued, supported, and connected.

Guest: Dr. Jihane Frangieh
Assistant Professor and Director of the MSN Healthcare Organizational Programs at Johns Hopkins

Dr. Jihane Frangieh brings more than 20 years of nursing experience, including a clinical background in neonatal nursing, to her work as an educator, scholar, and nurse leader. Her scholarship focuses on nursing leadership, healthy work environments, workforce well-being, quality and safety, and the conditions that help nurses feel seen, supported, and connected. Dr. Frangieh is the lead author of a 2024 Nursing Outlook article on belonging and social connectedness in nursing, and her writing has also addressed self-care, connection, and belonging as essential to nurse well-being and patient care. She currently serves as President of Sigma’s Nu Beta at-Large Chapter and is passionate about mentoring nurses and cultivating leadership practices that foster belonging across education and practice settings.

LinkedIn Profile

Frangieh, J., Hughes, V., Edwards-Capello, A., Humphrey, K. G., Lammey, C., & Lucas, L. (2024). Fostering belonging and social connectedness in nursing: Evidence-based strategies: A discussion paper for nurse students, faculty, leaders, and clinical nurses. Nursing outlook, 72(4), 102174. https://doi.org/10.1016/j.outlook.2024.102174

Frangieh, J., Sarver, L. C., & Hughes, V. (2024). Caring: The heart of online nursing education- An integrative review. Journal of professional nursing: official journal of the American Association of Colleges of Nursing, 52, 40–49. https://doi.org/10.1016/j.profnurs.2024.03.008

Frangieh, J., Chow, S., Rodney, T., Monk, J. J., Lucas, L. S., & Hughes, R. V. (2025). Kindness beyond care: an integrative review of kindness in the nursing profession. Contemporary Nurse, 61(1), 77–95. https://doi.org/10.1080/10376178.2024.2426693

Supporting nurses is our priority. Visit https://nursing.uiowa.edu/ionrp  to explore our resources for new graduate nurses and beyond. 

Transcript

Why Belonging Drives Engagement

Host Nicole Weathers 0:00

You're listening to the Beyond Nurse Residency Podcast, an educational series where we interview experts on all topics related to the transition of new graduate nurses into practice and beyond. I'm your host, Nicole Weathers, Director of the Iowa Online Nurse Residency Program. Thanks for joining us. Let's jump in. This year I've been on a bit of a quest having conversations with people who are experts in different components of engagement. We've explored infrastructure, culture, competency, and safety. And I've increasingly come to believe that belonging and connectedness are the next essential piece of the puzzle. Nursing is known for many things, but I think some of the most powerful are caring, compassion, connection. Most nurses are instinctively wired to show these things to our patients, yet we don't often talk about how caring, compassionate relationships with our teams actually shape how we feel at work, how engaged we are, and ultimately whether we choose to stay in this profession. So that's what we're exploring in this month's episode: belonging, social connectedness, what it is, why they matter, how they impact transition to practice, and the practical strategies nurse leaders and nursing professional development practitioners can use to intentionally build greater belonging at work. And to do this, I have with me a very special guest, Dr. Frangieh. Welcome, Dr. Frangieh. Thank you so much for being here with us today. It's my pleasure to be here with you, Nicole. Thank you for having me.

Dr. Jihane Frangieh 1:33

Why don't we start off by having you tell our listeners a little bit more about yourself? Sure. So, and I'll be very brief, so I'll save the time for our conversation. My name is Jihane Frangieh, assistant professor and the director of the MSN Healthcare Organization leadership programs at Johns Hopkins School of Nursing. I have over 20 years of nursing experience with a clinical background in NICU. And my work really focuses on nursing leadership, healthy work environment, workforce development, and also like strengthening academic practice partnerships, online nursing education.

Guest Background And Paper Origin

Dr. Jihane Frangieh 2:20

I'm really passionate about building meaningful collaborations and mentoring future nurse leaders. So, yeah, this is me briefly.

Host Nicole Weathers 2:31

Excellent. Well, it sounds like we have a lot in common as far as some of our interest areas. So it makes sense that as I was digging into this topic, I came across the paper that you had written on fostering belonging and social connectedness in nursing. And I think what really stood out to me in this article is that you didn't just focus on one group like students or new graduates, but instead you really looked at belonging sort of across that nursing career continuum. So I think maybe to start us off, I'd love to hear a little bit more about kind of the story behind the paper. What was really the impetus of this work? What made you want to explore belonging and social connectedness in nursing?

Dr. Jihane Frangieh 3:12

Yeah, that's a great question. And um, so this is not only my work. I have amazing colleagues who worked with me on this paper, and we were able to uh bring the perspective of every aspect of nursing from students to like clinical nurses to faculty nurses, and um, it really started by one simple question, right? So we wanted to look at what makes nurses feel they belong. So, and we had this conversation and we wanted to move beyond the um statistics of burnout. Uh, you know, we do have lots of evidence supporting um uh like the uh impact of burnout uh on the nursing profession, on the workplace environment, on the patient. But we started the conversation to talk about an inverse, right, of like a loneliness and like uh what can be a solution for burnout, and we came um across like a connection and not as the soft skill, but really as a structural and leadership uh priority, and we did like some um a review of the literature, and the data really um honestly it stunned us. Uh, we saw that uh loneliness rates among healthcare workers is really high, and it's not only in the US, this is from international uh also uh literature. Um, it ranges from 10% in Italy to 90% in Bangladesh, and um it's it's not just an emotional issue. So, loneliness, it's really a predictor of burnout, of turnover, of uh poorer mental health. Uh, and um in nursing it impacts and erodes teamwork, trust, motivation. It also increases burnout. But what really pushed us to write this paper is some observations we found around us, right? So colleagues, when colleagues um at the bedside in academia or in leadership, they started naming uh loneliness and uh the feeling of they don't belong. It was almost always came before their decision to leave the organization. We also came across uh the work that the US Surgeon General and his team did in 2023 when they declared loneliness as a public health academic. And if you go to their website and if you read this um report, you will be really stunned by the evidence we have. And even AACN um nailed belonging as a priority for nurses. So um this is why we thought, okay, let's get together, let's see the other side, right? Like not only focusing on burnout, but on the solution which is we propose social connectedness and belonging. And because this is something we also observe, and I'm sure you have observed at work that when you belong, like people will stay, right? Like when that people will be motivated uh to stay and to work with you. So this is why we wanted to look at those concepts and how it is embodied in nursing.

Host Nicole Weathers 7:00

I really like that you took what I'm gonna call a strengths-based approach. So looking at turnover, looking at burnout, a lot of a lot of research out there on that, but kind of flipping that script and instead of just talking more about that, talking about okay, and what are the positive things that we can do to kind of help solve this? So I've definitely noticed and and have read about loneliness being this um epidemic in the US. And um, I think it makes sense that if this is happening at like a public health level, this is most definitely happening inside of our organization. So again, just found um this article to be uh very piqued my interest uh and wanted to have, you know, just a little bit more conversation here. So

Loneliness Versus Connectedness Defined

Host Nicole Weathers 7:45

I always like to start kind of our podcast and making sure we're all on the same level as far as what it is that we're talking about. So maybe you could next kind of distinguish the difference between loneliness, show social connectedness, and belonging. How would you explain um those concepts in sort of basic terms for us?

Dr. Jihane Frangieh 8:06

Yeah, in the paper, we describe this based on the science, right? And we go and look at some deep definition of those concepts because we built our framework and work on these three interrelated concepts. So uh, in plain language, loneliness is the subjective perception of being disconnected, even if you are surrounded by people, right? You can be on a busy unit and you can still feel completely alone, right? It's okay to feel sometimes lonely, but when it becomes a habit and a pattern, then this is loneliness and it can have an impact on your health.

Host Nicole Weathers 8:48

And I think with loneliness, I mean, I think that's something that can be a little bit confusing sometimes because, you know, we think, you know, you're on a busy unit, you have all these colleagues, these coworkers, um, people from different departments that you're interacting with each and every day. How can you possibly be lonely?

Dr. Jihane Frangieh 9:05

Right. But you are lonely, like you feel like you don't have this, which is next step, the social connectedness with the people around you, right? And um, we propose that social connectedness is an the inverse of um uh loneliness as a concept. And um the the nice thing about social connectedness, it's a complex concept, right? But it has and it has many dimensions, such as the structure, which is the size and type of your network, like how many people you have around you, who do you have around you, like the function, which is the reliability of the people around you, and then the quality of the interactions, right? Is it like positive or negative? And you can think about it as um, it's about who we can go to, how often we can interact with them, and how safe we feel doing that. So I feel like those are the three elements of uh social connectedness, and belonging is uh the deepest layer there, it's that sense of affiliation and inclusion where we feel valued and integrated into a larger purpose, and this is like belonging at work, right? One of the uh lines in this paper that I really um uh favor is as social beings, humans inherently thrive on connection and interaction, so it's like something um it reframes belonging as a biological and professional need, right? It's not only a luxury. Um, as a human, really, we do thrive by being together, by connecting and interacting with other people.

Host Nicole Weathers 11:04

I think those definitions are are really important to understand. I like, again, sort of loneliness, and then on the other side of that, that social connectedness, which the imverse of loneliness. And then I think really talking to about belonging as that biological need. Um, you know, I think a lot of times when we talk about different strategies and things in the workplace, a lot of it can feel like, you know, these extra things that we're having to do, or you know, kind of going kind of out of our way to do different things. And I think kind of bringing this back to it really is the biological need of the human to have these types of relationships and this type of connection.

Dr. Jihane Frangieh 11:48

Yeah, and we all saw during COVID how the isolation um had a huge impact on all of us, right? This uh deprivation of social connectedness um had a huge impact on uh everyone's mental health, physical health, um, and uh how you show up to others. So it is real.

Host Nicole Weathers 12:14

Well, and I think, you know, sometimes I always think about COVID as, you know, one of those terrible things that happened, but it did come and shine a light on a lot of challenges and issues that existed before. We just weren't paying as much of attention, I think, to it. Yeah, I definitely think it came and kind of shined a light on how important this is, you know, like I said, within our public health and our communities, but also in our organizations.

Dr. Jihane Frangieh 12:41

Yeah, I agree. Like it magnified what was already there. It magnified it. And like it gave us opportunity to think right about

What Belonging Looks Like At Work

Dr. Jihane Frangieh 12:50

it and to value those um concepts.

Host Nicole Weathers 12:54

So, in your view, what does belonging at work actually feel like for a nurse?

Dr. Jihane Frangieh 13:00

One uh important uh condition is when nurses feel safe to ask a question. So when they are in a room with other people, with leaders, uh, they are not worried uh to ask like dumb questions, right? And that matters because belonging is what creates this psychological safety. Um, a nurse will uh who belongs will ask questions that can prevent errors. Uh and um a nurse who feels alone uh will hide, uh, will hide the question. Uh when you truly belong at work, you are included in opportunities where you can really grow, right? You are not overlooked, you are not passed over, you are invited to be part of uh committees, part of the solution, part of the mentorship. Um your contributions are known and your name is known. Um, this really sounds basic, but um in my previous work, I interviewed a nurse about uh her nurse manager. And what she said, she told me, my nurse manager doesn't even know my name. And that's why I'm planning to leave. Being known really matters, uh, specific recognition matters, um, so not a generic phrase. And um, also in my work when I was looking at social support, like nurses and nurse leaders told me they want like individualized recognition, individualized, um, sincere thank you. Yes, like nurses um should see that their contributions are known. This is a type of belonging. Another thing is when you feel you are entered within your team. Uh, even on um hard days, right? You know that if things go sideways, someone has your back. Uh, we as nurses we never work alone, we always work uh within a group. So um this is a very important uh um condition to feel belonging at work. Um the other thing is feeling that you are integrated. And by this I mean that you are not just tolerated, you are integrated. You are not just in the room, you feel that the room is yours too, right? Uh it feels like you are part of something bigger than yourself, part of the organization mission, of the purpose, part of a bigger purpose. This is when people uh feel they belong, and when we as nurses we feel we belong.

Host Nicole Weathers 16:03

Do you think there's anything too about kind of the sense of belonging within a team when people know and show interest in you outside of what you're doing professionally?

Dr. Jihane Frangieh 16:13

Yeah, absolutely, right? Like this is how you build those quality connections with people. It's not just like there's superficial knowing, it's trying to know people, who they really are, what matters to them. Um, and we all come from uh somewhere, we all have our own uh luggage with a different context. And this is important to share with others, to be able to find this, like the common things between people. So, yeah, I agree. This is very important.

Host Nicole Weathers 16:48

Because I do, I, I do personally sort of see that within our teams as well, kind of knowing a little bit more about that individual. So, yes, knowing their name, like you gave in that example, but also knowing, you know, who they really are. You know, do they have, you know, kids or a significant other? What do they like to do on their time off? You know, just kind of showing a little bit of interest in somebody outside of the immediate need that you have with them in the professional workplace, I think really goes a long way for developing that social connectedness and eventually then that sense of belonging.

Dr. Jihane Frangieh 17:27

Yeah, yeah. Totally agree. This is

Transition Points Where Nurses Feel Alone

Dr. Jihane Frangieh 17:30

very important and to make time for this to happen.

Host Nicole Weathers 17:33

So you looked at sort of this continuum from student to clinical nurse, nurse leader, academic, faculty member. From your perspective, were there particular times in a nurse's career where they felt especially vulnerable to loneliness or feeling disconnected?

Dr. Jihane Frangieh 17:52

In every transition, right? Like in every transition, like you feel like this disconnection, right? Transition, let's say, transition from being a nurse's student to being like a grad nurse. This transition, it's like a very vulnerable time in the nurse life. And this is when belonging is hard to implement, right? You have to be more intentional about this. This is where uh also retention is won or lost during this uh transition. Also, like let's say moving from being uh a clinical faculty, a clinical nurse to a faculty, this is um also a time where you can suddenly feel um lonely. Uh because, like in clinical practice, you work more in a group, in academia, it's more individual work. So uh some people they really lose this uh belonging and they can be prone to feeling uh lonely. Also, like a shift from like being a staff nurse or a faculty to a leadership position, right? Because leadership can also uh feel uh lonely. Leaders like they have staff concerns, they have organizational demands, they worry about patient outcomes, student outcomes. It depends on the uh context, but they don't always have peers to process this uh with. And um, we know that even like evidence uh shows that like nurses are uh being promoted just based on their clinical uh expertise and not leadership skills, and suddenly they find themselves in this position where they are leaders and they feel um lonely. Another thing that I noticed is like maybe during online and hybrid programs like hybrid or online nurses, they are more prone to feel lonely because you need this being you need to be intentional in reaching out to people. Usually when you are on site, like you meet them in the hallway, going to the restroom, in the kitchen, and you have this connection and conversation, and you share like a picture of your kids or something, but online program it's like hard. But there are ways to do it, but you have to put uh more uh effort into this. So I feel like in those, like the transition usually and like some contextual uh places, it's hard or more, like more hard to build like be long game.

Host Nicole Weathers 20:44

I think that makes a lot of sense. And I think you know, big obviously reason why nurse residency programs exist for new graduate nurses, while we're seeing a lot more sort of fellowship for different specialties and some of those transitions. Um, we're seeing a lot of those sort of fellowships pop up as well. Um, yes, there's a competency component to it, but I think also sort of this um social connection and belonging piece that's really important with these types of programs.

Dr. Jihane Frangieh 21:14

Because, like, really, like in those programs, this is where you help students to ask questions, to get feedback, to feel confident, right? To feel confident to ask those questions, seek mentorship, be part of a group, and uh have those connections.

Host Nicole Weathers 21:30

So, I mean, that kind of goes to my what my next question was going to be about how does the sense of belonging really shape confidence or that willingness to ask for help.

Dr. Jihane Frangieh 21:40

Yeah, it can impact the confidence, right? The lack of belonging, it can impact the confidence of a new grad. Because remember, we said it's it creates this psychological safety, right? And if it's not there, then students will hesitate to ask questions. And when they do this, Then they will make more errors or they will hide their errors. So it will have an impact on patient outcome as well. Because as I said, like students, they grew in this safe environment. And we all know that the data shows that up to 30% of new graduate nurses they leave within their first year and more than half within two years. So this transition year matters, especially for like those in new grad people. And I feel like a new grad with strong technical skills and no belonging is a flight risk, right? But a new grad with developing skills, but strong belonging will grow into excellence because they will reach out, they will ask those questions. And they will be also at ease to debrief after like a stressful event as well.

Host Nicole Weathers 23:05

Yeah, I almost think, and it sounds like you are kind of agree with this, that belonging is almost more important than hiring a nurse that has the excellent skills sort of coming out of nursing. Those are things I think that we can work on, we can develop them. But without that connection to the organization, without that sense of belonging, um, like you said,

Inclusive Leadership That Builds Belonging

Host Nicole Weathers 23:30

they're a flight risk. Uh we need to give them a reason to stay.

Dr. Jihane Frangieh 23:35

Okay. Yes, absolutely.

Host Nicole Weathers 23:38

So you talked a little bit about inclusive leadership in your paper, in your article. Uh, what is inclusive leadership? What's it look like? What's sort of the goal of it all?

Dr. Jihane Frangieh 23:48

Yeah, and and this is like I have to attribute this section to my colleague, uh Dr. Hughes. She's a big fan of uh inclusive leadership, which is an amazing theory, and um it's fundamentally like human-to-human uh leadership, right? It's uh it's leadership that sees the person before uh the role. Um and um in North House uh leadership theory and practice book, there is a whole chapter uh about inclusive leadership, but uh I will outline like three fundamental qualities for inclusive leaders that are very important and how this is linked to belonging. So, first, uh inclusive leaders they develop a shared identity among individuals, right? So it's not just you work here, it is you are part of something with us, you are part of the mission, vision of this institution. Second, they decrease the status differences, allowing individuals to be treated with respect. So this means whether you are a new grad, a floater, a pool nurse, or a seasoned charge nurse, you are treated as someone who really matters. Third, they facilitate the participation of everyone to allow for equal voice. So it's not just having an open door policy, it's really actively inviting people in and making sure that every voice is uh heard. So those are really important qualities of uh inclusive leaders and how they can uh build belonging and like foster the social connectedness uh as well. And and we do have lots also of evidence supporting and literature to tell us that those qualities create a sense of security at work, develop a safe uh place for individuals, build a culture uh where everyone can show up uh and thrive and flourish as well. And and this framework it really embraces divergent opinions and contributions. Uh so um this means there is a place for everyone, a place for the new grads, a place for the quieter personalities, a place for um agency nurses, let's say, a place for uh anyone who could fall through the cracks of belonging. Um so inclusive leaders they don't wait for people to find their way in. They actively create the conditions where people can belong and where belonging can really happen. So um like it puts it also on the organization, not only uh the individual.

Host Nicole Weathers 26:54

So I I definitely see kind of you're a part of this, you matter, you have a voice. I think those all sound really great. What tangible or practical strategies can nurse leaders and educators use to make those things happen?

Dr. Jihane Frangieh 27:14

Yeah, and that's a great question. And this is what we try to look at in the paper, like from different perspectives. So for clinical nurses and the new grad, mentorship and peer connection is important, committee work and shared governance, right? This is where people can uh make their voices heard, uh, the psychological support, debriefing after stressful events. So I know, like for example, at Hopkins they have health systems, they have this rise event where they uh bring uh people together and to debrief after like a stressful event and specific individual recognition. For faculty, um, it's like the transparent communication from leadership, it's like having their voice in decision making, it's being included in team projects. Uh

Practical Strategies For Teams

Dr. Jihane Frangieh 28:10

this is how they belong. They belong through formal mentorship programs, it's through a sense of community, not uh through a sense of competition. Uh, for nurse leaders, um, it's a little different. It's like um uh encouraging an open conversation culture, it's uh through building common values around um honesty, respect. It's through creating nurse-driven traditions and social events. And for students, it's through uh peer-to-peer mentorship, through faculty student mentorship, they want this. Uh they want to participate in conferences. This is how they felt they belong to the school, um, and they want their assignments uh that make them talk to each other, like the create those opportunities in courses where they can meet and work with their uh peers. And um this came up especially in online programs. Um, this is how students like they feel they belong when they have those opportunities to meet with the faculty and to meet with their uh peers. And uh, you know, this was very interesting to us, and also we wrote another paper to talk about caring in online uh nursing education because students who are uh and learning online, and we know we do have many now programs, uh nursing programs, uh, they want to belong, they want to have those connections, but it looks different from the in-person program.

Host Nicole Weathers 29:59

So I just about a year ago finished up uh online DMP program, and I can totally relate to that. You know, we don't always look forward to you know the um scheduling and all of that that come with assignments where we have to work with others, you know, in an online program. But I do think it definitely makes a huge difference when it comes to kind of that sense of belonging or even having friends that I'm going to school with that, you know, I can now have somebody that I can call up and say, hey, what are you thinking on this assignment? Or how did you interpret what they said about this? Building in opportunities, I think, within an academic program to develop that, those relationships really do help with that belonging piece. But I want to go back to something you said about the sort of clinical nurse and how we can begin to help them develop the shared identity, feel like they matter, you know, facilitate kind of their voice. Um and you talked about peer support and mentorship, which I think again are big parts of residency and fellowship programs for that transition period. But also you talked about committee work, getting them involved and shared governance, that type of thing. You know, that's that's something that I get a lot of questions about. So in our residency program, we require that they are they complete what we call a professional experience. And this professional experience gets them engaged in some form of change, whether that's by um getting involved in a committee, whether that's, you know, thinking up things that we think need to happen and proposing it to a committee, or, you know, just tackling a change or an improvement process that they have recognized and think that the unit, you know, needs to look at. Um, and we get a lot of questions about that because it's a lot of work, right? I mean, it requires both the participant, the leaders of the organization, the facilitators of the program to kind of take it to that next level. But we feel very confident that this is something that needs to remain in a transition to practice program. Um, and so could you just expound a little bit on kind of that piece of it and how that helps with the social connectedness, with the belonging, with some of these um inclusive leadership principles?

Dr. Jihane Frangieh 32:20

Yeah, it's it's it's really funny how you brought this point after saying that like a group work is always hard as a student, but it helps you build those relationships. And I often hear like the same uh comment, uh, but you know, I feel this is essential. Like um uh it's essential to stay in this residency program because it's something expected from us as nurses, whether you work in clinical practice or in academia, to serve on committees and uh to serve on different task forces. It's something, it's an expectation. And they should be very like um grateful that they are having this experience under uh a safe environment because they are still under this program, they have a formal mentorship to do this, right? They have like they can um receive feedback from you and the team. They have this like formal, uh, safe, uh psychological safe environment uh to do um this activity that will prepare them in the future um uh to better lead, better serve in um in committees because they will be doing this at some point in their career. And it's sooner than later they will be uh doing this. Um what I tell my students, um, it's an opportunity for you. I know that um thing like group work is not always easy, but we as nurses we never work alone, we always work in a group, and this is how you are building your leadership skills. Like if you cannot manage uh like um group assignment, how can you manage like a group or like 100 nurses if you are a nurse manager? Because like mainly I teach um nurse leaders. Uh so um I feel and I tell them this is the right time to do this. This is when you can make mistakes and you can get like feedback to grow. Growth doesn't come without um pain, right? Or without discomfort, let's say, discomfort. And um, this is the right time to do it because they

Committee Work Builds Confidence

Dr. Jihane Frangieh 34:50

have to do it later and they will be on their own. And we all know that often we don't have those formal mentorship, right? Uh relationship. Uh, we wish we have, but we don't. So this is the right time for them to do it, even if it's extra work. They should see it as an opportunity, not like a challenge and opportunity, but not a problem.

Host Nicole Weathers 35:15

And I I agree with that. You know, that's really my sort of soapbox that I get on from time to time is this is a learning experience. It's an opportunity to have exposure to this type of work, like you said, in a safe environment. Um, I think what sometimes holds people up is they think it has to be like this earth-shattering improvement that we totally like make huge strides in the workplace. And, you know, I always go back to it's actually better if it's small. We want them to be successful. We want them to feel like this is something they can do and that they want to continue to do. And when we bite off something too large for a new grad in this sort of situation, it can kind of do a little bit more harm than good. And that's it's really hard, um, I think, concept to kind of wrap our heads around sometimes because we always want to take it to, you know, the 110% a lot of times. We might grumble about it in the beginning, but then as we get into it, we want to solve all the world's problems. And so scaling it back sometimes is the hardest part. But I do strongly believe that not only is it important to teach the skills of change and how we bring about change within our organizations, but also develop those relationships because every single professional experience, like you said, requires that you're interacting and engaging with new people. And a lot of times for a new nurse, they've never met some of these people before. Like they don't know what these people in the quality department do, or they don't know where to who to talk to to get the data that they need for this professional experience. And so it's about so much more than just engaging in a in a in a change, right? Or engaging in a project or experience. It's about everything that they do along kind of the way. And and just like your example with, you know, students and student projects, we gotta we learn to work together, we form those relationships.

Dr. Jihane Frangieh 37:16

Yeah, scaling it uh down to something manageable is also important. So you can set them up to success, as you said, also enhance their confidence and uh their self-efficacy that they can do this. So this is on us as faculty or as like director of the program, but then on them is um to build those relationships, to reach out to people, to know who to ask and when to ask, and to do it in a safe environment, to think about it like a role play, because this is what you will be doing later on. And like for me, I feel like the important part is this reflection on it. This is when I see students really growing, because uh in practice you rarely have the time to pause and reflect on your performance, but when you are like in those environments, like whether in school or like in uh the residency program, so if they get the moment to reflect on their own performance, on their own areas for improvement, their own growth. This is where I feel like, and I received feedback from students, this was how this is important uh for their own uh growth and the lessons they learned and how they were able to apply it in real-world um scenarios.

Host Nicole Weathers 38:43

So we've talked about things that can

What Undermines Belonging

Host Nicole Weathers 38:45

help foster the sense of belonging. Let's talk about the flip side for a minute. Are there any is there anything that as leaders or educators we do maybe unintentionally, that can undermine the sense of belonging?

Dr. Jihane Frangieh 39:00

I want to say, like, not only as a faculty, right, but mainly maybe at an organization or program, like uh the structural conditions, right, that can lead to diminishing belonging or not creating a favor in a favorite environment for social connectedness. So for instance, like heavy workloads, staffing patterns, all this can make conversation sometimes a luxury, right? Like you don't intentionally create time for those connections to happen. Or like if you are busy, and I notice this even in my emails, if I'm very busy, like I just write one or two sentences, just like uh on point, and I don't take the time, one or two minutes, to build the connection with the person on the other end. We work also under a stressful environment, and stress can cause um incivility, right? I was just listening the other day to Christine Porat. Uh, she worked a lot on uh incivility, and uh, she was saying that her research consistently shows that uh stress is the number one drive of incivility. And we all know that as nurses we work under stressful um environments, and uh sometimes when we are overwhelmed, we don't take the time to connect with people, right? Uh we are more like uh we'll be performance uh-driven, uh outcome-driven. We want to finish tasks and check boxes, so it's not like I don't want to say like one faculty doing something wrong or one person, it's more like the organization. Uh, but I feel like this is something we can tackle, like we can um intentionally build those, build time for those connections. Uh, when uh for one of my studies, I uh interviewed nurse managers to look at social support and the impact on their uh leadership uh behaviors. Um, a common thing that they all shared is that they want those social events to be a priority in the organization because they felt this is how they grow in knowledge, not only like the connection, because this is when they can talk to the other nurse manager and know more about what they're doing. This is how they can impact their own nurses. So I feel like the organization has a huge role in creating those opportunities where nurses can connect and nurses can feel the belonging as well.

Host Nicole Weathers 42:12

I really like that you point out that you know, sometimes undermining belonging isn't an individual thing, right? It's not something that one person does, but it's really sometimes how our system is built. Uh, and as you're kind of talking about, you know, heavy staffing, um, stress, some of these things, you know, one of the things that came to mind for me was kind of the difference between how we look at productive and non-productive time, right? So productive time, we pay, we support, we're constantly asking nurses to give us productive time. But this idea of non-productive time, so education, unit councils, that is really where belonging comes from. Yeah, we're very hesitant. Our system is set up to not always support that at the same level, but it's just as important, if not more important, than the productive time. Or if we want better productive time, we need to invest in the non-productive

Measure Belonging Like A Metric

Host Nicole Weathers 43:10

time.

Dr. Jihane Frangieh 43:10

Right. That's a great point. How can we together like maybe change the language, right? Because uh the language matters and it makes a difference, right? Imagine saying social connectedness is non-productive time, but we all know and see like the the evidence showing that uh let's say loneliness impact on um high blood pressure, on mental health, on even like death, even death, like uh right. So um we need to bring the science in, we need to, and I had a point here uh that I wanted to uh talk about what if we make belonging uh as a measured outcome, same as um research. Detention rates or uh safety metrics, right? What if we do this? Because uh why when I was doing this work, I saw that there are many tools out there, so the science is there, there are many tools to measure uh belonging at work. Like I saw belonging a scale for clinical placement, the sense of belonging instrument, and believe it like or not, it has been used in nursing research since 1990s, so it's not like very new, right? Uh so what if we make a belonging as a metric and we measure it and we see the science behind it and it's impact, right? So I feel like this is what's missing. Um, it's the will to take or make belonging as an outcome we hold ourselves accountable to, like we do for retention, or like for falls, or for patient satisfaction. So, in other words, like we design for belonging, not just hope for it.

Host Nicole Weathers 45:11

And I that just reminds me of something that I was writing yesterday about retention. When when we start designing for the metric, like our focus, I don't know what the saying is. Something like when when a metric becomes our target, it becomes a bad sort of metric. So I think sometimes we're designing everything for retention. We're so focused on retention and that we lose sight of some of these important things that actually make the conditions for retention possible. And I do think one of those key things is belonging. So I would love, I'm with you. I would love to see more of us measuring sort of that belongingness at work. And I think it's so great that, as you said, this has been around for a while. These tools have been around for a while. They're there. We just need to get organizations using them. Well, I have had a great conversation with you about this idea of social connectedness, of belonging, the importance of this in, you know, nurse engagement and retention. Looking ahead, what gives you hope about nursing and how we might do this better in the future?

Hopeful Future And Final Takeaway

Dr. Jihane Frangieh 46:15

So, what gives me hope is um the nursing profession itself, right? We've been named for years and years as the number one trusted profession in the US. Uh, we are doing amazing things in every corner of healthcare, of education. Uh, I feel like what's missing is to bring this caring to uh the peer-to-peer interaction and to um really to the not only to the life of the patients, but to the people around us. If we extend the kindness and the trust we give to patients to our colleagues, uh belonging stops being aspiration and it starts being embedded in the organization, embedded in our uh everyday practice. And as I said before, we need to keep studying this, keep studying the impact of belonging to make it part of the organization.

Host Nicole Weathers 47:18

I have a last question. If there's one strategy that you've seen really work well in organizations that you think makes a huge difference when it comes to social connectedness, belonging, and something that you wish more organizations would adopt, what would that be?

Dr. Jihane Frangieh 47:36

I think the intention of creating those opportunities where like people can't connect, like they should, it should be within the institution. Um, I feel like at the organization level, this is the most uh important strategy. First, to understand the importance of uh social connectedness and belonging and not to treat it as like non-productive uh strategy, but also to intentionally create the opportunities for people to thrive and to connect and to feel um that they belong, because this is how people can make great things, innovate, and move forward with the mission of the organization.

Host Nicole Weathers 48:24

That is so good. I think that is a great place to wrap up this episode of the Beyond Nurse Residency podcast. Again, I am so grateful for you being here today and sharing all your expertise and wisdom on this topic. And I look forward to you know continuing this conversation and seeing what uh more you know research and information is out there around belonging and social connectedness and the importance in our nursing profession.

Dr. Jihane Frangieh 48:52

Thank you for having me.

Host Nicole Weathers 49:01

Wait, before you go, I want to make sure you know all about our suite of resources you can use to support your new graduate nurses. This

Resources To Support New Grads

Host Nicole Weathers 49:10

includes our Academy, a coaching program designed for organizations as they prepare for the implementation and ongoing sustainability of a nurse residency program. Work one-on-one with residency program experts to make sure your organization is residency ready. Our Clinician Well-being course is an asynchronous online course that aims to enhance the well-being and resiliency of healthcare professionals, equipping them with the necessary psychological capital to navigate challenges inside and outside of work. Supporting nurses is another asynchronous online course for preceptors, mentors, and coaches to learn the skills they need to support any new hire. Both of these offerings can be used as a standalone professional development opportunity or to augment any nurse residency program. And we can't forget about the program that started it all, the online nurse residency program. This includes a comprehensive curriculum designed to support new graduate nurses applying all the knowledge they learned in school to their practice. We focus on professional skills, personal well-being competencies, and new graduate nurses even get the opportunity to create real change in their own organization. Offered completely online and in a blended format, this program is highly adaptable to all clinical practice settings. You can learn more about all of these programs and more of what we offer using the links in the show notes below.