1. Group 4 Michelle Robinson, Jody Van Halsema, Colleen Houle, and Marlene Marlatt

2. The creation of the Healthy Work Environment Standards (HWEs) The American Association of Critical-Care Nurses identified in 2001 that the many of the current acute and critical care work environments were unhealthy and contributing to patient errors, tension between care team members and the nursing shortage.

3. Creation continued -  The AACN created the HWE standards based on the research that showed how unhealthy work environments contributed to:  Increased rates of medical errors  ineffective delivery of patient care  conflict and stress among health professionals

4. Reasons defined -  Unhealthy work environment examples  Understaffed hospital floors – too many patients assigned to one nurse increasing the potential for  Patient injury  Upset nursing staff  Abusive providers – results in nurses being reluctant to contact them for orders and potentially making judgment calls that put the patient at risk  Placement of nurses in leadership roles without proper training and backup creating high stress environments

5. Standard Development The AACN called upon professional nurses to develop six standards of clinical excellence for optimal patient outcomes. Expert nurses from around the country with various degrees, knowledge and certifications in specialty areas contributed their skills in creating the Healthy Work Environments for nursing practice (AACN, 2013).  The president of AACN, Connie Barden RN, MSN, challenged association members to  Identify the most pressing challenge in their immediate work environment.  Initiate discussions with their colleagues to find solutions to this challenge.  Remain actively involved in the solutions until they are working.

6. The standards for establishing and sustaining a healthy work environment were identified as  Skilled communication  True collaboration  Effective decision making  Appropriate staffing  Meaningful recognition  Authentic Leadership

7.  SKILLED COMMUNICATION  Nurses must be as proficient in communication skills as they are in clinical skills.

8.  TRUE COLLABORATION  Nurses must me relentless in pursuing and fostering true collaboration.

9.  EFFECTIVE DECISION MAKING  Nurses must be valued and committed partners in making policy, directing and evaluating clinical care, and leading organizational operations

10.  APPROPRIATE STAFFING  Staffing must insure the effective match between patient needs and nurse competencies.

11.  MEANINGFUL RECOGNITION  Nurses must be recognized and recognize others for the value each brings to the work of the organization.

12.  AUTHENTIC LEADERSHIP  Nurse leaders must fully embrace the imperative of a healthy work environment, authentically live it and engage others in its achievement.

13. Benefits  Implementation of HWEs has been proven to contribute towards  Decreased medical errors  Improved patient safety  Effective delivery of patient care  Improved team work between care team members

14. How can employers and nurses assess their work environment  Employers and nurses can assess their work environment to see where they are at in meeting the HWE standards through the use of a free online assessment tool located at http://www.aacn.org/WD/HWE/Content/hwehome.content?me nu=hwe

15. The assessment tool provides -  A way to assess staff perceptions  A report showing where your organization is at in terms to meeting the HWEs with all sources de- identified  Provides baseline results with comparisons to new data as you progress  Understanding of how nurses see the current work environment

16. My Experience At Spectrum Health there are many ways that we work to achieve a healthy work environment.  We use bedside report, SBAR, and and ask clarifying questions to promote skilled communication.  We make daily rounds with various disciplines and pass yearly competencies to achieve true collaboration  We participate in Shared Leadership to foster effective decision making.  We use an acuity based staffing tool to make appropriate staffing decisions.  We use WOW’s to recognize staff.  We always have a manager and supervisor on call to achieve authentic leadership. Jody Van Halsema, RN

17. My Experience In my current practice area of cardiothoracic surgery, HWE practice standards influence my nursing practice by appropriate staffing. A critical patient after surgery it is always 1:1, a step-up assignment is 3:1. We have pool nurses and an on-call sheet to sign up for any nursing shortages. There is true collaboration between the nursing staff, physician assistants and surgeons. We have effective decision making by contributing to the development of protocols that affect the outcomes of our patients. Skilled communication is ongoing with education in the form of a monthly conference by our surgeons who discuss issues that face our patient population. Authentic leadership can be found with management, coordinators and the unit action committee (UAC). The UAC combines staff and leadership together in making crucial rules and regulations for the safety of our patients. We also use meaningful recognition to increase staff satisfaction. The value of our staff is respected and ongoing with employee of the month winners, birthday events and unit activities. Colleen Houle, RN

18. My Experience Having appropriate staffing. We are a level 1 trauma center in a very busy metropolitan area and we must be ready at any time for a trauma. Therefore we always keep a stand by OR team. -We have amazing collaboration with the many different disciplines that have to come together to make a surgery successful. For example: if we have an emergency orthopedics case we have to collaborate with the emergency room, the trauma doctors, the orthopedic surgeons, anesthesiologist, surgical residents, SPD (our sterilization department), radiology, OR nursing and surgical technologist and in the end ICU. -We use a passport system to pre-op the patients to ensure that all consents are signed, the right procedure will be performed on the correct side and that it is the right patient. This is one of our many forms of communication. -We have an employee of the month within our department that is voted on by the staff. Our hospital also has a recognition system call a high 5. Anyone within the organization (staff or patients) can send one to an employee. -Authentic leadership can be found in our management system. We have an OR director, manager, charge nurse, specialty team leaders (neurology, urology, cardiac, general surgery etc.). There is someone from the group present and on call at all times. Michelle Robinson, RN, OR Charge Nurse at George Washington University Hospital

19. My Experience  Where I work – the use of the HWEs would be extremely beneficial  Not having worked in acute or critical care hospital settings for the past 18 years I can truly see the benefit of these standards I truly am dealing with many of the issues these standards are aimed at preventing – we have providers that are abusive of staff, have in the past failed to provide proper orientation to positions putting patients at risk and most of all we have failed to follow through with reviewing staff to see where they are at with their competencies on a regular basis. This is something I have been working to change since taking over the Clinical Operations Director position by setting up a formal orientation program and instituting a no penalty process for reporting of verbally abusive providers. Marlene Marlatt, RN, Clinical Operations Director, Thunder Bay Community Health Service, Inc.

20. The American Association of Critical-Care Nurses’ Vision works hand in hand with the HWEs. “A healthcare system where acute and critical care nurses can make their optimal contribution.”

21. Nursing Organizations Alliance A coalition of nursing organizations, the Nursing Organizations Alliance, are supporting and contributing to the AACN’s call for a healthy work environment:  American Association of Nurse Executives  Sigma Theta Tau International, The Honor Society of Nursing  American Academy of Nursing  American Association of Colleges of Nursing The principles of healthy work environment is identified in each organization. They continue to support, research and collaborate on the standards of nursing practice that reflect an outstanding environment for the health of patients, families and co-workers (Shirley, 2006).

22. References American Association of Critical-Care Nurses (2013). Healthy work environments initiative. Retrieved from www.aacn.org/hwe Ives Erickson, J., (2010). Overview and summary: Promoting healthy work environments: a shared responsibility. The Online Journal of Issues in Nursing 15(1). DOI: 10.3912/OJIN.Vol15No01ManOS Shirley, M. R., (2006). Authentic leaders creating healthy work environments for nursing practice. American Journal of Critical Care, 15(3), 256-267. Retrieved from http://ajcc.aacnjournals.org/content/15/3/256.long Vollers, D., Hill, E., Roberts, C., Dambaugh, L., & Brenner, Z. R., (2009). AACN’s healthy work environment standards and an empowering nurse advancement system. Critical Care Nurse, 29(6), 20-27. Retrieved from http://ccn.aacnjournals.org/content/29/6/20.long