ACCN Practice Standards Healthy Work Environments Ferris NURS 320 Practice Standards Assignment Jessica Behrenwald, Cheryl Howard, & Laura Zwagerman

Background In 2001, the American Association of Critical-Care Nurses (ACCN) made a commitment to promote & create healthy work environments. In 2005, six essential standards for establishing and sustaining healthy work environments were established by the ACCN as a part of a call to action. (Barden, 2005)

Healthy Work Environments Healthy work environments support and foster excellence in patient care. Unhealthy work environments contribute to medical errors, ineffective delivery of care & stress among health professionals. AACN standards for establishing and sustaining healthy work environment focus on 6 areas: communication, collaboration, decision- making, staffing, recognition & leadership. (Barden, 2005)

#1 Skilled Communication "A culture of safety and excellence requires that individual nurses and healthcare organizations make it a priority to develop among professionals communication skills - including written, spoken, and non-verbal - that are on par with expert clinical skills" (Barden, 2005, p. 16).

#1 Skilled Communication Application to practice: Where I work as an inpatient pediatric nurse, we are trained in using SBAR when communicating with physicians (Situation, Background, Assessment, Recommendation). Classes are also offered on Crucial Conversations and Crucial Confrontations. Any intimidating or inappropriate behavior is addressed immediately. Laura Zwagerman RN

#2 True Collaboration "True collaboration is a process, not an event. It must be ongoing and build over time, eventually resulting in a work culture where joint communication and decision making between nurses and other disciplines and among nurses themselves becomes the norm" (Barden, 2005, p. 20).

#2 True Collaboration Application to practice: On the inpatient pediatric oncology unit I work on, nurses are included in daily rounds with the attending physician, PA, resident, pharmacist, discharge planner, and social worker. Our input is valued. We collaborate among each other frequently when something does not seem quite right or we have something we aren't familiar with. We tell new staff there are no dumb questions, and our behavior backs that up. Laura Zwagerman RN

#3 Effective Decision Making Nurses are part of the interdisciplinary team that make important decisions about patient care. They are the "vital link" in the decision making in the health care team (Barden, 2005, p. 24). Healthcare organizations have successfully implemented professional care models in which nurses have the responsibility and related authority for patient care along with formal operational structures that support autonomous nursing practice (Barden, 2005, p.24). By creating systems where nurses are put in authority to make decisions, we create healthy work environments.

#3 Effective Decision Making Application to Practice: In my current nursing role as a pediatric home care nurse, the AACN practice standards of effective decision making influences my nursing practice by reminding me that I am truly the vital link in patient decisions. It is easy to become lackadaisical and forget that I am the patient advocate. I need to stay involved in nursing knowledge so I can make the proper decision in providing patient care. Jessica Behrenwald RN

#4 Appropriate Staffing "Staffing must ensure the effective match between patients needs and nurse competencies" (Barden, 2005, p. 28). Inappropriate staffing leads to nurse turn over which can harm quality of care. Staffing can not be based on a patient staff ratio, it needs to be complex and patient acuity must be put in prospective (Barden, 2005).

#4 Appropriate Staffing Application to Practice: In my current position, my Agency tries to hire nurses that have experience. They feel they can orientate a nurse to a client in two hours. This can not always be done. The AACN standard of appropriate staffing applies to my area of practice. If the skill level of the nurse does not match the needs of the child, errors can occur. The case worker should be reviewing the documentation and doing home visits to be sure the nurses are competent in caring for the childs needs. As a staff nurse, I need to take the time to train a nurse on a skill that she should know well. I need to tell my Agency if I feel a nurse is not providing competent care. Jessica Behrenwald RN

#5 Meaningful Recognition "Nurses must be recognized and must recognize others for the value each brings to the work of the organization." Recognition is a fundamental human need & a requisite to personal & professional development. Lack of recognition leads to discontent, reduced productivity & poor outcomes. Meaningful recognition is a process, not an event. Healthcare organizations need a comprehensive system recognition which validates meaningfulness to recipients. Team members understand that everyone is responsible for playing an active role in the process. (Barden, 2005, p. 32-33)

#5 Meaningful Recognition Application to practice: The AACN standard for meaningful recognition influences my practice as an RN in a long term care (LTC) because I always make sure to verbally encourage team members such as LPN's, CNA's, and fellow RN's for the diligent and good work that they do throughout the day. A twelve hour shift in LTC can be hectic, exhausting, and thankless work. Often, residents complain and are not very appreciative. Consistently recognizing contributions of team members can go a long way to feeling like your efforts are worth it and that what you do matters. Cheryl Howard RN

#6 Authentic Leadership "Nurse leaders must fully embrace the imperative of a healthy work environment, authentically live it and engage others in its achievement." All sectors of health care community strongly call for effective measures to strengthen nursing leadership. Properly trained & supported nurse managers are key to retention of satisfied staff. Nurse leaders must be positioned within an organization in order to influence decisions that affect nursing practice. Workers desire respect, high standard of management ethics & honest communication between employees & management. (Barden, 2005, p. 36-37)

#6 Authentic Leadership Application to practice: The AACN standard for authentic leadership influences my practice by causing me to desire leadership qualities within myself but also to look toward my supervisors and nurse managers for leadership. Leadership is a core component in the ANA's professional standards of nursing practice (Nursing, 2010). Currently in the LTC facility where I work there is not strong leadership which I believe does contribute to a less than optimal work environment. In the future, I plan to advocate and communicate the need for authentic leadership in my workplace. Cheryl Howard RN

Summary AACN Healthy Work Environment Standards: "reaffirm that safe and respectful environments are imperative" "provide a functional yardstick for performance and development of individuals, units, organizations and systems" "support the nine provisions of the American Nurses Association Code of Ethics for Nurses" "provide a framework to assist nurses in upholding their obligation to practice in ways consistent with appropriate ethical behavior" "assure that acute and critical care nurses have the skills, resources, accountability and authority to make decisions that ensure excellent professional nursing practice and optimal care for patients and their families" (Barden 2005, p.13). Interdependence of Healthy Work Environment, Clinical Excellence & Optimal Patient Outcomes (Barden, 2005, p.14).

References Ferris State University ~ NURS 320 ~ December 6, 2011 Barden, C. (2005). AACN standards for establishing and sustaining healthy work environments [PDF document]. Retrieved from the American Association of Critical-Care Nurses Web site: http://www.aacn.org/WD/HWE/Docs/HWEStandards.pdf Nursing: Scope and standards of practice (2nd ed.). (2010). Silver Spring, Maryland: American Nurses Association. Ferris State University ~ NURS 320 ~ December 6, 2011