H EALTHY W ORK E NVIRONMENTS Bethany Delong Amber Dykstra Shannon Jones Karin Mogren-Kuzma Toya Ozark

H OW IT STARTED Healthy Work Environments (HWE) began in 2001 with the American Association of Critical- Care Nurses (AACN). AACN found that unhealthy work environments contributed to medical errors, ineffective delivery of care, conflicts, and stress among coworkers.

H OW IT STARTED CONT. Along with AACN’s concern about quality patient care, they also recognized that the increasing nursing shortage was negatively influencing the work environment. AACN saw the need to improve work environments and standards to advance the quality of nursing practices and nursing retention.

W HAT IT MEANS

HWE is a standard of practice to ensure, establish, and sustain healthy work environments within an organization. Research literature affirms that environmental elements have a great effect on organizational performance, patient outcomes, and healthcare workers recruitment and retention. Therefore, healthy work environments are essential for patient safety and staff satisfaction. To develop and sustain healthy work environments, six different standards have been identified that support the professional practice of nursing.

S TANDARDS Skilled Communication Proficient communication skills include listening and providing feedback among colleagues and patients. True Collaboration True collaboration is an ongoing process between multidisciplinary professionals to ensure high quality care for patients.

S TANDARDS Effective Decision Making Enhanced decision making is necessary to increase nurse autonomy and improve patient advocacy. Appropriate Staffing Sufficient and appropriate staffing is necessary for patient safety and staff wellbeing.

S TANDARDS Meaningful Recognition Respect and recognition leads to high satisfaction and work morale among employees. Authentic Leadership A strong leadership is necessary to engage and maintain the standards for healthy work environment.

S TANDARDS U SED IN P RACTICE

Skilled communication Efficient communication with colleagues, patients, and families. Clarifying orders with providers. True Collaboration Collaborating with multidisciplinary team members. Utilizing resources such as pharmacists, case managers, social workers, and other nurses to meet specific needs of patients.

S TANDARDS USED IN PRACTICE Effective Decision Making Always keep the patient’s best interest in mind. Quick and critical thinking when an emergency arises. Appropriate Staffing Understanding patient acuity for appropriate nurse- to- patient ratio. Understanding that errors increases with fatigued employees.

S TANDARDS USED IN PRACTICE Meaningful Recognition Daily appraise coworkers for their work. Involvement of nurse managers to give nurses appropriate feedback. Authentic Leadership Following policies and standards to set good examples. Implementing new techniques that promotes safety.

R EASONS A ND E VIDENCE FOR S TANDARDS

Skillful Communication To promote proficiency in communication The Joint Commission identified “communication failure as the leading cause in medication errors, delays in treatment, and wrong site surgeries”. True Collaboration To foster collaboration of interdisciplinary team members. True team collaboration promotes quality outcomes by decreasing mortality rates, readmissions, pneumonia, and pressure ulcers.

R EASONS AND EVIDENCE FOR STANDARDS Effective Decision Making To hold nurses accountable for their actions. To empower nurses to develop skills and increase their knowledge to enhance decision making capabilities. Appropriate Staffing Maintain financial security for the institution. Provides enhanced patient safety and quality patient outcomes.

R EASONS AND EVIDENCE FOR STANDARDS Meaningful Recognition To promote a healthy work environment. Nurses feel valued which increases staff satisfaction and in turn decreases patients length of stay. Authentic Leadership Enhance team satisfaction, recruitment, and retention. Nursing environments with higher retention rates are attractive to new recruits.

P RESIDENT OF AACN “If you dare to be powerful, if you are ready to make a promise that will make a difference, I challenge you to join me in making your promise public.” - Connie Barden, president of AACN

I NDIVIDUAL P RACTICES

B ETHANY D ELONG In my current practice area of the operating room, Healthy Work Environment Standards influence me by: Communicating with my fellow co-workers on a regular basis. Providing guidance and leadership to new staff members. Recognizing team members when expectations are exceeded. Using my knowledge base and experience to make educated decisions. Realizing my ethical and moral responsibilities for my patients.

A MBER D YKSTRA Healthy Work Environments is used in my everyday practice. I use all of the standards of the AACN on a daily basis. I clarify new orders with the physician. I collaborate with my MDS manager on care plans. Daily I will tell my nursing assistants know they are doing a good job. Demonstrate healthy work procedures for not only myself but for my patients as well.

S HANNON J ONES Healthy Work Environment Standards are important to me in my daily work as an RN on a Med/Surg floor in that: I am always trying to advocate for my patients, since I work nights and the only communication the patient and I have with physicians is via the telephone, so that the patients treatment plan can be carried out effectively. I believe in treating my co-workers (nurses and PCTs) fairly and make sure if I find and error or something that needs to be addressed that I do it tactfully, however I do believe in accountability. I also work cohesively with many of the hospital staff to get appropriate treatments ordered and completed on nights that are not has readily available as they are on days. Lastly, I utilize healthy working standards for myself and patients but using aseptic or sterile technique, use lift team, and wash in and wash out. These are just a few things within the HWE that influence me as a nurse.

K ARIN M OGREN -K UZMA In my professional practice, I am influenced by the healthy work environment standards in many ways. I communicate and collaborate with co-workers as well as patients to make sure that the team meet patient goals and resources are utilized appropriately. Making effective decisions allows me to practice autonomously and delegate tasks to appropriate staff, as needed, to safely care for and advocate for my patients. I am always respectful of my co-workers and I praise their work on a regular basis. I always try to lead by setting a good example, by following polices, helping co-workers, and having a positive attitude.

T OYA O ZARK In my hoped for practice area, as an emergency department nurse, HWE practice standards will influence my nursing practice by providing a work environment where: I promote team building by communicating with all team members respectfully. I actively participate in decisions making responsibilities by being involved in my patients care. I recognize and acknowledge the accomplishments of all team members by giving them praise. I seek out and pursue education and experience that enhances my knowledge and skills. I am an advocate for my patient and their family.

R EFERENCES AACN Standards for establishing and sustaining healthy work environments. (2005). Retrieved from Blake, N. (2012). Practical steps for implementing healthy work environments. AACN Advanced Critical Care 23(1), DOI: /NCI0b013e318240a44e Goran, S. & Mullen-Fortino, M. (2012). Partnership for a healthy work environment. AACN Advanced Critical Care, 23(3), DOI: /NCI.0B013e31825c1cc2 Kruse, Kevin. (2012). 100 Best quotes on leadership. Retrieved from Rogers, A.E., Hwang, W.T., Scott, L.D., Aiken, L.H., & Dinger, D.F. (2004). The working hours of hospital staff nurses and patient safety. Health Affairs, (23) 4, Retrieved from Stichler, J. (2009). Healthy, healthful, and healing environments: a nursing imperative. Critical Care Nursing Quarterly, 32 (3), doi: /CNQ.0b013e3181ab9149 Vollers, D., Hill, E., Roberts, C., Dambaugh, L. & Brenner, Z. (2009). AACN’s Healthy work environment standards and an empowering nurse advancement system. Critical Care Nurse, 29(6), DOI: /ccn