Does your work environment support and foster excellence in patient care? Use this Assessment Tool to
measure the health of your work environment and to answer this crucial question.
The American Association of Critical-Care Nurses has identified the systemic behaviors that maintain
patient safety, ensure optimal outcomes, and support excellence in nursing practice. AACN has organized
these behaviors into six standards that are essential for establishing and maintaining a healthy work
These six standards include:
Nurses [and their care-giving partners] must be as proficient in communication skills as they are in
Nurses [and their care-giving partners] must be relentless in pursuing and fostering true collaboration.
Effective Decision Making:
Nurses [and their care-giving partners] must be valued and committed partners in making policy, directing
and evaluating clinical care and leading organizational operations.
Staffing must ensure the effective match between patient needs and nurse competencies.
Nurses must be recognized and must recognize others for the value each brings to the work of the
Nurse leaders must fully embrace the imperative of a healthy work environment, authentically live it and
engage others in its achievement.
What the Tool Is and What It Is Not?
This Assessment Tool is a screening test for organizations, departments, and units to measure progress on
achieving these essential standards. It provides an overall healthy work environment score and scores for
each of the six essential standards.
This is a screening tool, not a diagnostic test. It evaluates a work environment based on each of the
standards, but does not diagnose specific challenges within a standard. We recommend using the tool to
identify problems and evaluate progress, not to diagnose specific causes.
For example, most standards require support and collaboration among administrators, nurse managers,
physicians, nurses, and other staff. Creating a healthy work environment is more than a thing to do. It is
a way of being that relies on the strength of the entire team. The culture becomes compromised when any part
of the team fails to support a standard.
This tool evaluates your environment based on the standards and not individual groups within a team. It
isn't designed to place blame or to isolate specific factors. The score report recommends steps and
resources to help you diagnose the root cause of problems and start the journey to resolve them.
Test Development and Psychometrics
The psychometric characteristics of this tool are evolving. Each standard is assessed in a scale composed
of three unique questions. The questions and scales have been reviewed for face validity and administered to
two groups of 250 subjects each. Both samples were tested for reliability and showed internal
consistency with identical factor structures and Cronbach's Alpha scores of 0.80 or better.
The tool was re-administered and revised to create the current version. Reliability studies will be
replicated with the current version and tests added to establish convergent and discriminant validity
using well-known surveys as benchmarks against which to test the subscales.