1. HEALTHY WORK environments
It’s best for us all

2. 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

3. 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

4. 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.

5. 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)

7. 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.

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

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

11. 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

12. 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

13. 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

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

15. 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

16. 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

17. 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

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

19. 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

20. 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

21. 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

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

23. 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

24. 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

25. 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

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

27. 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

28. 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

29. 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

30. 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.

31. 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

32. 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

33. 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

34. What now?
Educate yourself
AACN
Shared Governance
LEAN
TEAM STEPPS

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

36. 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

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