Journal of Radiology Nursing xxx (2020) 1e3

Contents lists available at ScienceDirect

Journal of Radiology Nursing

journal homepage: www.sciencedirect.com/journal/
journal-of-radiology-nursing

New Nurse Leaders: Creating a Work-Life Balance and Finding Joy

in Work
Kristy S. Chunta, PhD, RN, ACNS, BC *
Department of Nursing and Allied Health Professions, Indiana University of Pennsylvania, Indiana, PA

a b s t r a c t

Keywords: New nurse leaders assume complex and demanding roles. These time-consuming positions can prevent
New nurse leaders work-life balance and eventually lead to burnout. Joy in work has been described as a concept in health
Work-life balance care opposite of burnout. The Institute for Healthcare Improvement developed a four-step model for
Joy in work
addressing barriers to joy in the workplace. This article will describe how new nurse leaders can use the
four-step model to evaluate barriers to joy in the workplace. Strategies for change to address common
challenges that prevent joy and work-life balance will also be provided.
© 2019 Association for Radiologic & Imaging Nursing. Published by Elsevier Inc. All rights reserved.

Introduction leaders. Furthermore, with advancing technology, the use of cell

phones and computers often makes nurse leaders always accessible.
Nurse leaders assume complex roles that encompass a variety of Not being able to completely disconnect from work can lead to a
responsibilities on a daily basis. In these positions, nurse leaders vicious cycle that further contributes to dissatisfaction and burnout.
manage staff needs and problems, address patient and family issues, In 2017, the Institute for Healthcare Improvement (IHI) pub-
and meet organizational expectations related to productivity and lished a white paper addressing joy in the workplace (Perlo et al.,
clinical outcomes. Consequently, new nurse leaders are often pro- 2017). On a continuum, the concept of joy exists on the opposite
moted into leadership positions but may lack the advanced knowl- end of burnout and is linked with engagement and satisfaction
edge and skills needed for these complex roles (Kelly, Lefton, & (Kelly & Adams, 2018). The IHI's Framework for Improving Joy in
Fischer, 2019). This can add increased stress to an already Work depicts a healthy workforce in the center and consists of nine
demanding position, and eventually result in burnout. Defined as a components in a circular format that impact joy: physical and
state of physical and emotional exhaustion (Simmons, 2012), psychological safety, meaning and purpose, choice and autonomy,
burnout has been associated with job turnover and has recently been camaraderie and teamwork, wellness and resilience, participative
described as an epidemic in health care (Perlo, Balik, Swensen, management, real-time measurement, recognition and rewards,
Kabcenell, Landsman, & Feeley, 2017). Although the concept of and daily improvement. The IHI's white paper provides examples of
burnout has traditionally been associated with nurses in a direct how organizations can use the framework to evaluate their current
caregiver role, this response to chronic stressors can also occur in workforce, identify potential problems or concerns, and make
nurse leaders (Kelly et al., 2019; Kelly & Adams, 2018). For example, a systematic changes for organizational improvement. The white
nurse leader may experience emotional exhaustion when dealing paper also provides four steps that leaders can use to move forward
with patient and family complaints or after addressing a staff with finding joy in work. These include (1) Asking staff “What
member's performance issues. In addition to daily stressors, burnout matters to you?”, (2) identifying what impedes joy in work, (3)
can result from being unable to decline work projects, improper implementing change to correct what impedes joy, and (4) using
work-life balance, not setting work boundaries, and technology evidence-based strategies to measure outcomes. The University of
overload (Kelly & Adams, 2018). Identified as one factor contributing Virginia's School of Nursing used the four-step model to address a
to burnout, work-life balance can be challenging for new nurse concern with wanting time off without the expectation of
responding to email. This was identified as the first step, “what
matters to you.” Employees felt a constant expectation to respond
No grant funding or financial support was provided. to email even during off hours. The School of Nursing piloted a
* Corresponding author: Kristy S. Chunta, Department of Nursing and Allied
Health Professions, 1010 Oakland Avenue, Room 223 Johnson Hall, Indiana,
program change to not send email during time off. This resulted in
PA 15705. positive feedback, and all School of Nursing employees eventually
E-mail address: [email protected]. implemented the change. Follow-up measurements noted that 80%

https://doi.org/10.1016/j.jradnu.2019.12.007
1546-0843/$36.00/© 2019 Association for Radiologic & Imaging Nursing. Published by Elsevier Inc. All rights reserved.

Please cite this article in press as: Chunta KS, New Nurse Leaders: Creating a Work-Life Balance and Finding Joy in Work, Journal of Radiology
Nursing, https://doi.org/10.1016/j.jradnu.2019.12.007
2 K.S. Chunta / Journal of Radiology Nursing xxx (2020) 1e3

of employees reported feeling more respect for their personal time habit when possible (Chunta & Boothby, 2017). In addition,
(Perlo et al., 2017). This article will describe how new nurse leaders boundaries should be communicated with staff to ensure that
can use the IHI's four-step model to evaluate barriers to joy in the others are respectful of the leader's time away from work.
workplace. Strategies for change to address common challenges Communicating clear expectations helps establish boundaries and
that prevent joy and work-life balance will also be provided. ensure specific work hours (Schooley, 2019).

What matters to you? Time Management Strategies

New nurse leaders should begin by reflecting on the following In addition to scheduling downtime, nurse leaders should also
two questions: (1) What matters to you? and (2) What is your assess their time management. Poor time management can lead to
purpose in your work role? This reflection involves time and may inefficient work flow and quality, unmet deadlines, and decreased
include questions that address short- and long-term goals. Addi- work satisfaction (Chunta & Boothby, 2017). New nurse leaders can
tional questions that leaders should ask themselves include the struggle with the challenges of juggling multiple tasks, prioritizing
following: What do I want to be doing in one, five, and 10 years? work, and addressing interruptions and distractions on a regular
and What makes me happy in my work role? These reflection basis. Evaluation of one's time typically begins by keeping a time log.
questions will begin the first step of identifying meaning and pur- For example, a nurse leader may complete a time log and find that
pose. For example, a nurse leader may identify what matters to significant time during the work day was spent on work projects, but
him/her is leading staff to provide good patient care. A nurse also on surfing the internet and reading social media posts. The time
leader's goals may include developing as a leader over the next one log should document all activities for 24 hr a day over several days.
and 5 years and then obtaining a director-level position to impact This helps identify patterns of how time is being spent, where small
patient care on a larger scale by year 10. increments of time may be available, and opportunities for time
management improvement. After patterns are identified, changes
What impedes joy in work? can be made to improve productivity and balance home and work
responsibilities. Time management logs may reveal that nurse
Step two includes identifying barriers to joy in the workplace. leaders spend significant time repeatedly checking email throughout
The IHI white paper described these as “pebbles in a shoe” that the day. Consequently, this practice leads to distractions and ineffi-
impede one's needs and joy. These issues can relate to professional, cient time management. Instead, a change could be committing to
social, or psychological needs (Perlo et al., 2017). For example, new check email during scheduled times, preferably not first thing in the
nurse leaders may identify barriers such as difficulty with sched- morning, and turning off email notifications to avoid repeated dis-
uling downtime, not achieving a work-life balance, and the tractions. Distractions can prevent effective time management. In
expectation of always being available in the work setting. Nurse addition to email, distractors often include the internet, social media,
leaders should identify and prioritize what things prevent them workplace conversations/gossip, and other miscellaneous items.
from finding joy in their work roles. List specific items that can be New nurse leaders should identify distractors that can be avoided for
addressed by making changes. Although every issue may not be better time management. For example, placing cell phones on a ‘do
immediately corrected, the process of finding joy includes identi- not disturb’ mode and not opening internet sites can be helpful
fying things that impede it so changes can be made. strategies to stay focused on work.
If struggling to stay on task, a new nurse leader could use the
Committing to change Pomodoro technique. This approach uses a timer set for 25 min to
focus only on work during that timeframe. The 25 min of work
Although the IHI's step three involves making system level should be followed by a 5-min break. This can be carried out
changes, the same framework can be used by the nurse leader on an repeatedly with several increments of work time followed by a
individual basis (Perlo et al., 2017). After identifying what impedes larger break. The Pomodoro technique helps avoid distractions and
joy, new nurse leaders can identify where change is necessary. It is can be especially useful for completing large tasks that feel over-
not feasible to tackle multiple changes at once but committing to whelming. Another time management strategy includes developing
make minor changes can lead to significant results. The examples a to-do list and learning to prioritize tasks. Projects and work items
below relate to common challenges that new nurse leaders typi- that are more difficult should typically be performed during the
cally face in their daily routines. Making changes in these areas can most productive time of day (Vanderkam, 2013). For example, if the
help leaders achieve work-life balance and joy in the work setting. nurse leader works best during early morning hours, then avoid
checking email during this time or scheduling meetings if possible.
Scheduling Downtime and Work Boundaries Instead, plan the most important or challenging projects during
peak work time to get them accomplished. Finally, learning to plan
Work-life balance issues often relate to not establishing work the week ahead can help new nurse leaders to improve their or-
boundaries and feeling that downtime does not exist. Downtime ganization and time management. Focus on prioritizing a to-do list
should be scheduled into a nurse leader's calendar to provide op- before the week begins to avoid delays in getting started on
portunities for nonework-related activities with family and friends. Monday morning. All of these strategies provide opportunities for
The act of scheduling downtime activities in a calendar helps to change to more effectively manage time and increase productivity
ensure that work activities do not replace personal time (Mattock, (see Table 1 for additional time management tips). Getting work
2015). Scheduling downtime also prioritizes activities or hobbies done efficiently can help prevent frustration, additional stress, and
that are important to the nurse leader. This step helps the new lead to improved work-life balance.
nurse leader to obtain control of his/her time, which is necessary for
achieving work-life balance (Schooley, 2019). Prioritizing Self-Care
Another step in scheduling downtime is to create work bound-
aries that separate home and work. New nurse leaders may be Change to improve work-life balance and find joy in work in-
tempted to use the weekend to complete work projects. During cludes focusing on personal self-care. Although self-care practices
busy periods, work may need to be finished at home, but avoid this should be a priority, nurses have been identified as being less

Please cite this article in press as: Chunta KS, New Nurse Leaders: Creating a Work-Life Balance and Finding Joy in Work, Journal of Radiology
Nursing, https://doi.org/10.1016/j.jradnu.2019.12.007
 K.S. Chunta / Journal of Radiology Nursing xxx (2020) 1e3 3

Table 1 systems level, the nurse leader can still assess personal and pro-
Time management tips fessional outcomes after making changes that lead to a work-life
 Prepare the night beforedget your coffee and clothes ready along with your balance. For example, nurse leaders who focused on strategies to
to-do list more effectively manage time may find that after a 30-day period,
 Identify small increments of time (5e20 min) where small tasks can be work is being completed on a timely basis and less work is being
completed
 Go to lunch at 11 am or 1 pm instead of during the busy lunch hour
taken home. This would be one way to evaluate the benefits of time
 Keep your email inbox organized to avoid clutter; use folders to organize management in relation to work productivity. In addition, nurse
messages leaders who initiated a regular walking program to improve self-
 Separate personal and professional email accounts to avoid added messages care may find that this change resulted in measurable outcomes
and distractions (eg, shopping coupons or personal messages) in your work
such as weight loss, improved blood pressure, better sleep, and a
account
 Check email 3-4 times per day or consider automated email batching to send more positive mood. Changes that are made to help incorporate
email at preset times more joy in the workplace should be evaluated for their effective-
 Manage interruptions such as social visits from coworkers; use a “do not ness. If positive outcomes have not been achieved after a designated
disturb” sign or close your door if needed to avoid unnecessary distractions time period, nurse leaders should determine if more time is needed
 Complete similar activities at the same time
 Balance your personal time and be prepared to say “no” if needed (Chunta &
to reassess the outcomes or if additional changes are necessary.
Boothby, 2017) Once changes have been effective on a personal level, new nurse
leaders could seek to implement the IHI's four-step model on an
organizational level to help promote joy within the workplace.
healthy than most Americans (ANA, 2019; Waddill-Goad, 2019).
Achieving work-life balance is a continual process that requires
Specifically, nurses tend to sleep less, be overweight, and have high
reassessment of goals and priorities (Schooley, 2019). Although
levels of stress (ANA, 2019). Nurse leaders often sacrifice their own
change has the potential to produce positive benefits, nurse leaders
self-care because of busy schedules, but part of a work-life balance
need to remember that the process of change takes time and
includes self-care. Furthermore, nurse leaders serve as role models
practice. Leaders should strive toward excellence, not perfection
and should demonstrate appropriate self-care practices (Mattock,
(Mattock, 2015). Begin by focusing on small change in one or two
2015). Common self-care strategies include focusing on health
areas. Identifying realistic and achievable goals can lead to success.
and wellness concepts such as incorporating physical activity, good
dietary habits, sleep, and relaxation into daily routines. The
Conclusion
American Heart Association (2017a) recommends that individuals
obtain 150 min of moderate physical activity/week or 30 min/day
New nurse leaders face challenges from demanding role ex-
five times a week. Physical activity does not need to be completed
pectations that make it difficult to separate work and home life.
entirely at one time but can be broken into increments. For
Continual work stressors can lead to burnout. Using the IHI's four-
example, if a nurse leader struggles to find time for a 30-min
step framework opportunities for change can be identified, imple-
workout, it may be easier to walk for 10 min in the early morn-
mented, and evaluated, leading to positive outcomes that allow for
ing, 10 min during the day, and 10 min in the evening. Physical
improved work-life balance and joy in the work setting.
activity has multiple benefits including lowered blood pressure,
improved blood glucose and sleep, and reduced stress, depression,
References
and risk of dementia (AHA, 2018). In addition, physical activity in-
creases alertness and productivity, which is beneficial for work American Heart Association. (2017a) The American Heart Association diet and
(Simmons, 2012). Walking remains one of the safest and simplest lifestyle recommendations. Retrieved from https://www.heart.org/en/healthy-
ways to incorporate physical activity (AHA, 2017b). Getting steps living/healthy-eating/eat-smart/nutrition-basics/aha-diet-and-lifestyle-recom
mendations. Accessed November 12, 2019.
can also be completed by taking the stairs, walking during lunch, American Heart Association. (2017b) Why is walking the most popular form of exercise?.
parking a distance from the workplace, and walking with a Retrieved from https://www.heart.org/en/healthy-living/fitness/walking/why-is-
colleague or even having walking meetings. Self-care practices walking-the-most-popular-form-of-exercise. Accessed November 12, 2019.
American Heart Association. (2018) How much physical activity do you need?.
should also focus on dietary practices. The AHA recommends eating
Retrieved from https://www.heart.org/en/healthy-living/fitness/fitness-basics/
at least 4e5 servings of fruits and vegetables per day. Other dietary aha-recs-for-physical activity-infographic. Accessed November 12, 2019.
lifestyle recommendations include limiting fats, sweets, and sugar- American Nurses Association. (2019) Healthy Nurse Healthy Nation Grand Chal-
sweetened beverages, avoiding foods high in sodium, and limiting lenge: leading the nation’s journey to better health. Retrieved from www.
healthynursehalthynation.org/. Accessed November 12, 2019.
alcohol (AHA, 2017a). Adequate rest should also be a self-care pri- Chunta, K., & Boothby, J. (2017). Time management strategies for nurse leaders.
ority for new nurse leaders. Sleep is often sacrificed to manage busy American Nurse Today, 12(11), 10-11.
schedules, but guidelines recommend adults receive seven or more Kelly, L.A., & Adams, J.M. (2018). Nurse leader burnout: how to find your joy. Nurse
Leader, 16(1), 24-28.
hours of sleep per night. Sleep has been identified as an essential Kelly, L.A., Lefton, C., & Fischer, S.A. (2019). Nurse leader burnout, satisfaction, and
component to health (National Sleep Foundation, 2019), and like work- life balance. Journal of Nursing Administration, 49(9), 404-410.
physical activity and dietary habits should be a priority. Relaxation Mattock, S.L. (2015). Leadership and work-life balance. Society of Trauma Nurses,
22(6), 306-307.
may be another area where the new nurse leader can incorporate National Sleep Foundation. (2019) How much sleep do we really need?. Retrieved
change to improve joy in work. Relaxation practices may include from https://www.sleepfoundation.org/articles/how-much-sleep-do-we-really-
activities such as prayer and meditation, reading, art or music need. Accessed November 12, 2019.
Perlo, J., Balik, B., Swensen, S., Kabcenell, A., Landsman, J., & Feeley, D. (2017). IHI
therapy, Yoga, mindfulness activities, essential oils, massage, va- Framework for Improving Joy in Work: IHI white paper. Cambridge, MA: Institute
cations, and even simply unplugging from electronics. Incorpo- for Healthcare Improvement.
rating changes to prioritize self-care strategies can prevent burnout Schooley, S. (2019) 8 ways to improve your work-life balance today. Retrieved from
https://www.businessnewsdaily.com/5244-improve-work-life-balance-today.html.
and improve work-life balance for new nurse leaders.
Accessed November 12, 2019.
Simmons, S. (2012). Striving for work-life balance. American Journal of Nursing,
Measuring outcomes 112(1), 25-26.
Vanderkam, L. (2013). What the most successful people do before breakfast. New York:
NY: Penguin Group.
The final step in the IHI's model focuses on outcomes (Perlo Waddill-Goad, S.M. (2019). Stress, fatigue, and burnout in nursing. Journal of Radi-
et al., 2017). Although this would traditionally be measured on a ology Nursing, 38, 44-46.

Please cite this article in press as: Chunta KS, New Nurse Leaders: Creating a Work-Life Balance and Finding Joy in Work, Journal of Radiology
Nursing, https://doi.org/10.1016/j.jradnu.2019.12.007