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)
An environment that is
safe, healing, humane, and
respectful of the rights,
responsibilities, needs and
contributions of all peopleincluding patients, families,
nurses, and other health
care professionals.
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