AACN News—April 2005—Opinions

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Vol. 22, No. 4, APRIL 2005


President's Note
Live Your Contribution
Two Past Leaders Speak Out on Healthy Work Environments


By Kathy McCauley, RN, PhD, BC, FAAN, FAHA
AACN President

In January, AACN released a landmark document that will radically transform the healthcare workplace. The “AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence” is a bold and provocative prescription for treating what is perhaps the most destructive force in healthcare today. Patient safety isn’t optional and, without nurses, hospitals will cease to exist. Indisputable evidence shows that toxic work environments harm patients and drive nurses away from hospitals. The new standards put forward an unambiguous framework to reverse the tide. Healthy work environments are healing environments.

During a recent think tank meeting of past AACN leaders, I talked with the two past presidents who most influenced development of the new standards—Dorrie Fontaine (DF), during whose presidency the standards project was initiated, and Connie Barden (CB), project leader and executive editor.

KM: Why standards? Why AACN? Why now?
DF: The drumbeat of fear for patient safety from federal organizations like the Institute of Medicine, regulatory bodies like the Joint Commission on Accreditation of Healthcare Organizations and consumers themselves is deafening. Nurses are seeking the right way to care for patients, and that’s the safe way based on evidence. Anything less than a national prescription that boldly sets the direction for individuals, units and organizations would have missed the mark. Why us? Because AACN is consistently ahead of the curve when it comes to helping acute and critical care nurses make their optimal contribution to meet the needs of patients and families. It was only natural that we would emerge as a leader once again.

CB: Frankly, AACN felt time was running out. Nearly 100,000 nurse members and constituents help AACN keep its finger on the pulse of practice. They made it clear that working conditions are a major dissatisfier. They tell us that disrespectful and outright abusive interactions between healthcare providers are allowed and often overlooked. What could be more important than addressing an issue that jeopardizes patient safety and drives nurses out of the workplace? The standards are a blueprint that I consider a critical step in turning the tide.

KM: How were the specific standard topics selected?
CB: The standards focus on six areas that were staring us in the face: communication, collaboration, decision making, staffing, recognition and leadership. Thorough environmental scanning, case reports, expert advice and member feedback confirmed all six as flash points.

DF: The topics were confirmed for me over a year ago, when I joined our campus mediator, an attorney, to meet with new nurse orientees. We listened to their concerns about adjusting to a new work environment. The hot spots were communication, collaboration and decision making. I tested language from the draft standards about creating a healthy work environment. I described the part each person must play to make this happen. It hit a nerve. Everyone wanted a copy of the standards.

KM: The standards speak to nurses, but clearly everyone on the healthcare team needs to buy in. How can nurses alone be expected to make this happen?
CB: AACN knows most about nursing, so we address nurses. However, both the standards and the supporting critical elements apply to everyone, from the board of trustees to the CEO to the most revered physician and expert nurse to every team member. This universality has been confirmed by consistent feedback from our members and constituents, expert reviewers and organizations like the American College of Chest Physicians and the Joint Commission.

DF: The emergency department invited a colleague and me to a retreat about redesigning its work. In the room were physicians, nurses, unit clerks … the entire team. Again, I tested language from the draft standards. By the end, each group wanted to meet with us about their part in making the standards work. “Look,” they said, “we’re moving into new space, and we don’t want to bring along our old ways. We need new thinking and attitudes about how we work together.”

KM: Are some of the standards more critical than others?
CB: I believe every standard is essential. Highlighting one implies the others are less critical when, in fact, all are necessary because they are interdependent. For example, you won’t have effective decision making without skilled communication and true collaboration. You could never have an environment that works well without authentic leaders and meaningful recognition of the folks who work there.

DF: I’m partial to the need for skilled communication because I think it’s the foundation for the other five. But I have a personal favorite—true collaboration. Collaboration is such a misused buzzword. It is so hard to make happen unless we’re relentless in pursuing and fostering it, just like the standards require us to do. The courage to be relentless and to speak up will hopefully snowball as the study Silence Kills, done by VitalSmarts with AACN, suggests.

KM: Some people believe these problems are already being addressed. One administrator said, “It’s easy to say the hospital needs to do more. The individuals need to be able to step up.” Is he making a valid point?
CB: Not one hospital in the country would say it is ignoring work environment issues. But most places act as if just talking about a problem will solve it. Nothing could be further from the truth. You can’t just tell people to communicate better when they don’t know how. Creating the kind of healthy work environments our standards envision requires systemwide goal setting, planning, education and evaluation of progress. It means creating an entirely new culture that will look nothing like what we’ve seen before. Traditional systems of power and authority will be dismantled and replaced with ones where professionals work together to create safe environments that produce extraordinary outcomes because it’s the right thing to do.

KM: When all is said and done, it sounds like creating healthy work environments depends entirely on having authentic leaders. Where will they come from?
DF: Authentic leaders are out there right now giving excellent care to patients and families or sitting in classrooms learning how to be skilled and compassionate nurses. Recently, nurse attorney Deb Gerardi and I hosted a program for nurse managers titled “Why
doesn’t anyone want my job?” When it sold out, we knew we’d struck another nerve. Nurses are ready to find creative ways of nudging solid nurse citizens into leadership positions where they can truly shine. Sure they’ll need new skills, encouragement and support, but first they need to be tapped and coached to step up to the plate.

CB: First, the standards are a blueprint for individuals to improve their unit and their hospital. No one needs to wonder anymore how to do that. Anyone, regardless of title or position, can use the standards to change how they interact with others. At least how they communicate, collaborate, participate in decision making and give recognition.
Second, just like Dorrie, I’ve seen that the leaders are already there. What we sorely need is a serious commitment to make these standards a reality. By acting on the critical elements for each standard, leaders can start to create the systems that create healthy work cultures. Leaders inspire others and authentically work to create what will in turn inspire the world of healthcare.

There you have it. Now go forward and make it so.

You can obtain the AACN Standards for Establishing and Sustaining Healthy Work Environments at www.aacn.org/hwe.

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