Creating Healthy Chapter Work Environments Rose Shaffer RN, MSN, CRNP-BC, CCRN President SePA Chapter AACN 2005-2006 Cardiology Nurse Practitioner Thomas Jefferson University Hospital Philadelphia, PA

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AACN’s Healthy Work Environment Standards In 2001, AACN made a commitment to actively promote the creation of healthy work environments that support and foster excellence in patient care wherever acute and critical care nurses practice In 2005 the healthy work environment standards were published

AACN Healthy Work Environment Standards The healthy work environment (HWE) standards uniquely identify behaviors that are often discounted, despite the evidence that they (contribute to creating unsafe conditions and) obstruct the ability of individuals and organizations (chapters) to achieve excellence

AACN Healthy Work Environment Standards Skilled Communication True Collaboration Effective Decision Making Appropriate Staffing Meaningful Recognition Authentic Leadership

The Evidence for HWE There is evidence that unhealthy work environments contribute to (medical errors, ineffective delivery of care and) conflict and stress among health professionals

Consider These Potential Hospital Examples: A night nurse chooses not to call a physician known to be verbally abusive. She uses her judgment to clarify a med order and administers a fatal dose of the wrong drug Isolated decision making in one department leads to tension and frustration Nurses are placed in leadership positions without preparation and support

Do each of these situations characterize poor and ineffective relationships or actions within hospitals?

Why Care About the Chapter Work Environment? Unhealthy chapter work environments can also lead to conflict and stress among board members, committee chairs and chapter members, as well as any one else involved in the organization and therefore the important work of the chapter may not be accomplished!

Consider These Potential Chapter Examples: A board member or committee member chooses not to address an individual on the committee who is verbally abusive or berating There is isolated decision making by certain individuals on a committee or the board Individuals are placed in leadership positions without adequate preparation and support for their role

Do each of these situations characterize poor and ineffective relationships or actions within the chapter?

Organizational Health “An organization is not its products, markets or technologies. Rather it is in the repetitious patterns of how people relate to each other, gather and interpret information, solve problems, make decisions, manage conflict and implement change while accomplishing the organization’s purpose.” Bushe, GR. Clear Leadership; 2001

Organizational Health It is important to create an organizational culture that develops self-awareness and consciousness of its people, including nourishing its people with a healthy culture, coherent policies, and effective procedures A healthy culture exists in an organization that listens to people and remains actively involved in how they feel about the services they provide Kilman, RH Quantum Organizations: A New Paradigm for Achieving Organizational Success and Personal Meaning; 2001

Healthy Work Environments: Four Key Points HWE do not sacrifice people at the expense of profit HWE do not reduce everything to cost vs. benefit or profit vs. loss HWE know that costs are multifaceted - they know that profit means to make progress, not just to make money HWE are about moving from trapped potential to tapped potential Heath, J, Johanson, W, Blake, N. Healthy Work Environments: A Validation of the Literature; Journal of Nursing Administration; 2004

“There is no power greater than a community discovering what it cares about.” Margaret Wheatley Organizational change and management author, International educator

AACN’s Commitment AACN is committed to creating work environments that are safe, (healing), humane and respectful of the rights, responsibilities, needs and contributions of all people, including patients, their families and nurses

Chapter Commitment Chapters are committed to creating a chapter work environment that is safe, humane and respectful of the rights, responsibilities, needs and contributions of all chapter members within the organization

Standard #1: Skilled Communication Chapter leaders must be (as) proficient in communication skills (as they are in clinical skills)

Paulo Freier International Educator Community Activist “We cannot be truly human apart from communication… to impede communication is to reduce people to the status of things” Paulo Freier International Educator Community Activist

Communication Techniques E-mail Instant Messaging Voice Mail Video Conferencing Telephone Face to face Verbal Non-verbal (including silence)

Skilled Communication It is more than a one-way delivery of information…..it is a two-way dialogue in which people think and decide together Chapters must make a priority to develop communication skills among it’s members - including written, spoken, electronic and non-verbal skills (that are on par with expert clinical skills)

Skilled Communication Intimidating behavior and deficient interpersonal relationships lead to mistrust, chronic stress and dissatisfaction among committee members…… which may lead to unhealthy situations that contribute to nurses leaving the chapter (their position and sometimes the profession).

Skilled Communicators…… Focus on finding solutions and achieving desirable outcomes Seek to protect and advance collaborative relationships among colleagues Invite and hear all relevant perspectives Call upon goodwill and mutual respect to build consensus and arrive at common understanding

Skilled Communicators…… Demonstrate congruence between words and actions, holding others accountable for doing the same Have access to appropriate communication technologies and are proficient in their use

The (Healthcare) Organization (Chapter) Establishes zero-tolerance policies and enforces them to address and eliminate abuse and disrespectful behavior in the chapter Establishes structures and processes that ensure effective information sharing among (patients, families and healthcare) committee members and the membership

The (Healthcare) Organization (Chapter) Establishes systems that require individuals and teams to evaluate the impact of communication on (clinical), financial and work environment outcomes Team members demonstrate skilled communication to qualify for professional advancement (leadership positions within the chapter)

David Thomas Ethicist Ethics of Choice Training Program “It is ethical to request, encourage and deliver feedback on all facets of individual and organizational performance. It is unethical to ignore, discourage or fail to give feedback.” David Thomas Ethicist Ethics of Choice Training Program

Standard #2: True Collaboration Chapter leaders must be relentless in pursuing true collaboration

David Thomas Ethicist Ethics of Choice Training Program “It is ethical to be open to the possibility that your view is incomplete and therefore capable of revision. It is unethical to ignore information that could allow you and/or your organization to grow.” David Thomas Ethicist Ethics of Choice Training Program

True Collaboration It is a process, not an event It must be ongoing and built over time, eventually resulting in a work culture where communication and decision making between nurses….. and among nurses themselves becomes the norm With true collaboration, the unique knowledge and abilities of each committee member are respected…….

True Collaboration Requires skilled communication, trust, knowledge, shared responsibility, mutual respect, optimism, and coordination, which are integral to successful collaboration Requires constant attention and nurturing……

Every Committee Member…. Embraces true collaboration as an ongoing process and invests in its development to ensure a sustained culture of collaboration Acts with a high level of personal integrity Demonstrates competence appropriate to his/her role and responsibilities

Every Committee Member…. Contributes to the achievement of common goals by giving power and respect to each person’s vote, integrating individual differences, resolving competing interests and safeguarding the essential contribution each must make in order to achieve optimal outcomes

The (Healthcare) Organization (Chapter) Creates, uses and evaluates processes that define each committee member’s accountability for collaboration and how unwillingness to collaborate will be addressed Makes available the time needed to resolve disputes

Archbishop Desmond Tutu Civil rights activist Nobel Laureate “We are different so that we can know our need of one another, for no one is ultimately self-sufficient. A completely self-sufficient person would be sub-human.” Archbishop Desmond Tutu Civil rights activist Nobel Laureate

Standard # 3: Effective Decision Making Chapter leaders must be valued and committed partners in making policy, (directing and evaluating clinical care) and leading organizational operations

David Thomas Ethicist Ethics of Choice Training Program “Individuals and organizations learn and evolve through conscious, deliberate action. Deliberate action is ethical. When the time to act has come, it is unethical not to do something.” David Thomas Ethicist Ethics of Choice Training Program

The (Healthcare) Organization (Chapter) Clearly articulates organizational values and committee members incorporate these values when making decisions Establishes systems………..to facilitate data-driven decisions Provides chapter members with support for and access to ongoing education focusing on strategies to assure collaborative decision making

The (Healthcare) Organization (Chapter) Establishes deliberate decision making processes that ensure respect for the rights of every individual, incorporate all key perspectives and designate clear accountability Has fair and effective processes in place at all levels to objectively evaluate the results of decisions, including delayed decisions and indecisions

Robert F. Allen Advocate for cultural change and wellness “People will not believe in an organizational change effort unless they have the opportunity to plan it, experience it, provide feedback, and own it. Involvement supports and sustains motivation, the essential ingredient for change.” Robert F. Allen Advocate for cultural change and wellness

Standard # 4: Appropriate Staffing Staffing must ensure the effective match between (patient) needs and (nurse) competencies

Appropriate Staffing of Committees Chapter leaders must ensure the effective match between the needs and desires of volunteers who want to join a committee There must be enough people on committees and those people should attend meetings regularly

The (Healthcare) Organization (Chapter) Has policies in place that are solidly grounded in ethical principles and support the professional obligation of nurses to do the work of the chapter

Standard # 5: Meaningful Recognition Chapter leaders must be recognized and must recognize others for the value each brings to the work of the organization

Johann Wolfgang von Goethe Philosopher, poet, playwright “Treat people as if they were what they ought to be, and help them to become what they are capable of being.” Johann Wolfgang von Goethe Philosopher, poet, playwright

Committee Members Understand that everyone is responsible to (play an active role in the organization’s recognition program and) meaningfully recognize contributions of others

The (Healthcare) Organization (Chapter) Has a system in place………that ensures a……… focus on recognizing all committee members for their contributions and the value they bring to the work of the organization Has a recognition system that reaches from the committee level (bedside) to the board room, ensuring individuals receive recognition……..

David Thomas Ethicist Ethics of Choice Training Program “It is ethical to offer feedback to those from whom you or your organization receive services. It is unethical to allow outstanding performance to go unacknowledged … just as it is unethical not to provide feedback to those whose performance or service threatens the optimal performance of your organization.” David Thomas Ethicist Ethics of Choice Training Program

Standard # 6 Authentic Leadership Chapter leaders must fully embrace the imperative of a healthy work environment, authentically live it and “ENGAGE” others in it’s achievement

Psychologist, Business Author, MacArthur Foundation Fellow “Managers assume that job security is of paramount importance to employees. Among workers, however, it ranks far below desire for respect, a higher standard of management ethics, increased recognition of employee contributions, and closer, more honest communication between employees and senior management.” Robert H. Rosen Psychologist, Business Author, MacArthur Foundation Fellow

Chapter Leaders….. ……successfully translate the vision of a healthy work environment Excel at generating …. enthusiasm for achieving the standards that create and sustain healthy chapter work environments Role model skilled communication, true collaboration, effective decision making, meaningful recognition and authentic leadership

The (Healthcare) Organization (Chapter) Provides support for and access to educational programs to ensure that chapter leaders develop…….skilled communication, effective decision making, true collaboration, meaningful recognition…….

The (Healthcare) Organization (Chapter) Ensures chapter leaders…… participate in key decision making…..have access to essential information and the authority to make necessary decisions Provides a (formal) co-mentoring program for all chapter leaders - chapter leaders actively engage in the co-mentoring program

Edgar Schein Organizational behavior and culture pioneer “One of the most decisive functions of leadership is the creation, management, and when necessary, the destruction and rebuilding of culture.” Edgar Schein Organizational behavior and culture pioneer

The Six Standards….. Represent evidence-based and relationship-centered principles of professional performance Are designed to be used as a foundation for thoughtful reflection and engaged dialogue about the current realities of each work environment, including chapter work environments

What are the Benefits of a Healthy Chapter Work Environment?

Some Benefits of Chapter HWE’s Better communication; less frustration among committee members/chairs Collaborative relationships, group cohesiveness, & authentic leadership resulting in a “can do” attitude to ensure the survival of the chapter Efficiency and productivity in decision making and the work of the chapter

Some Benefits of Chapter HWE’s Increased respect for others opinions More satisfied committee members who may “spread the word” of the chapter, thereby potentially increasing membership and future leadership in the chapter Other benefits???

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