HEALTHY WORK environments It’s best for us all

Teresa M. Jones, MSN CCRN-K Director of ICU/CVICU, Cookeville Regional Medical Center President Upper Cumberland AACN Adjunct Faculty TTU Whitson-Hester School of Nursing No disclosures

Objectives To Define Healthy Work Environments (HWE) To Review the Supporting Evidence for Promoting HWE To Examine the 6 Essential AACN Standards for Establishing/Maintaining HWE To Discuss Implementation In Our Own Practice/Facility

History of the healthy work environment concept 2001: American Association of Critical-Care Nurses (AACN) makes a commitment in philosophy to actively promote the creation of healthy work environments. They want these environments to support and foster excellence in patient care wherever acute and critical care nurses practice. 2005: AACN releases the Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence. There were 6 essential standards providing an evidence based framework. 2016: AACN releases the 2nd edition of the Standards with no additions or subtractions. Evidence continues to support these 6 essential standards as key to developing healthy work environments.

Good news travels fast American Association of Critical-Care Nurses (AACN) Joint Commission Institute of Medicine now National Academy of Medicine (NAM) American Organization of nurse Executives (AONE) American Association of Colleges of Nursing American Nurses Credentialing Center (ANCC) Society of Critical Care Medicine (SCCM) American Nurses Association (ANA)

What is a Healthy Work Environment? An environment that is safe, healing, humane, and respectful of the rights, responsibilities, needs and contributions of all people- including patients, families, nurses, and other health care professionals.

Skilled Communication Meaningful Recognition 6 Standards for HWE Skilled Communication True collaboration Effective Decision Making Appropriate Staffing Meaningful Recognition Authentic Leadership

Standard 1 Skilled Communication Nurses must be as proficient in communication skills as they are in clinical skills.

Standard 1:Skilled Communication More than a one-way delivery of information Requires mutual respect exist Each party involved in communication believes the other has something to offer Both parties involved are seeking a resolution to a problem

Standard 1:Skilled Communication Critical Elements: The Organization Provides team members with support and education regarding communication, conflict management, negotiation and listening. Establishes zero-tolerance policies and enforces them to eliminate disrespectful behavior Includes communication in performance appraisals of all team members

Standard 1:Skilled Communication Critical Elements: Nurses Accountable for identifying learning needs r/t communication Seek to protect and advance collaborative relationships among colleagues Invite and hear all relevant perspectives Seek input and strive to improve on their communication skills

Standard 2: True Collaboration Nurses must be relentless in pursuing and fostering true collaboration.

Standard 2: true collaboration Built over time and requires nurturing Requires that skilled communication be in place Essential in today’s critical care world Respect is the foundation

Standard 2:true collaboration Critical Elements: Organization Provides education on collaboration skills Defines accountability for collaboration Creates, uses, and evaluates operational structures that ensure the decision-making authority of nurses is acknowledged

Standard 2:true collaboration Critical Elements: Nurses Master skilled communication Acts with a high level of integrity and holds others accountable for doing the same Gives power and respect to every person’s voice

Standard 3:Effective decision making Nurses must be valued and committed partners in making policy, directing and evaluating clinical care, and leading organizational operations.

Standard 3:Effective decision making The original patient advocate Nurses need a voice in their practice Nurses have to have a presence in directing clinical care from the bedside to the boardroom

Standard 3:Effective decision making Critical Elements: Organization Ensures that nurses are in positions to participate in all levels of decision making & allows time/resources for them to participate Provides support for education to equip nurses to participate in decision making Has operational structures in place to ensure the perspectives of patients and families are incorporated into decision affecting patient care

Standard 3:Effective decision making Critical Elements: Nurses Identifies the need to possess decision making skills and seeks education Communicates opinions clearly based on fact based information Holds team members accountable for effective decision making

Standard 4: Appropriate staffing Nurses must ensure the effective match between patient needs and nurse competencies

Standard 4: appropriate staffing RNs at the bedside in HWE produce better outcomes Educational preparation, specialty certification and clinical nursing expertise also give better outcomes. Inappropriate staffing quickly increases burnout and turnover Patient acuity MUST be considered

Standard 4: Appropriate staffing Critical Elements: Organization Has staffing policies that are solidly grounded in ethical principles Is committed to nurses providing high quality care Adopts technology that increases effectiveness of nursing care delivery Evaluates how staffing decisions affect outcomes

Standard 4: Appropriate staffing Critical Elements: Nurses Participates in organization phases of the staffing process Seek opportunities to obtain knowledge and skills requires to bed competent in matching needs to skill

Standard 5:Meaningful recognition Nurses must be recognized and must recognize others for the value each brings to the work of the organization.

Standard 5:Meaningful recognition Recognition is a fundamental human need Doesn’t need to be an event Only meaningful when it is relevant to the person Personal needs

Standard 5:Meaningful recognition Critical Elements: Organization Implements a formal process to ensure recognition within the facility and reaches out regionally and nationally Reaches all levels (bedside to boardroom) Regularly evaluates if the recognition is meaningful to its intended recipient

Standard 5:Meaningful recognition Critical Elements: Nurses Understands that everyone is responsible for playing an active role in the organizations recognition program Utilizes opportunities to recognize others

Standard 6: Authentic Leadership Nurse leaders must fully embrace the imperative of a healthy work environment, authentically live it, and engage others in its achievement.

Standard 6: Authentic Leadership Plays major role in HWE development and maintenance Must commit to the concept and educate themselves High bar for the leader of a HWE

Standard 6: Authentic Leadership Critical Elements: Organization Provides education to nurse leaders to develop skills in all the 6 standards Ensures leaders are appropriately positioned in their role to make change Commits the financial and human resources to the nurse leader for a HWE Evaluates at regular intervals HWE

Standard 6: Authentic Leadership Critical Elements: Nurse Leader Generate visible enthusiasm for achieving a HWE Design of systems necessary to effectively implement and sustain standards Role model skilled communication, true collaboration, effective decision making, meaningful recognition and authentic leadership

What now? Educate yourself AACN Shared Governance LEAN TEAM STEPPS

What now? Rally the Team Show them the benefit Expect commitment Communication is key

What now? Survey the Staff No unit is like another Focus has to be on what staff see The Healthy Work Environment Assessment Tool ww.hweteamtool.org Survey Monkey

What now? Work Groups Staff driven, leadership supported Groups work on standards individually Good place to initiate a shared governance model