My Work Environment Is Unhealthy, Now What?

If you read my previous blog, "A Healthy Work Environment Begins With You," you know the health of our national nurse work environment is in trouble. Luckily, at our core, nurses are problem solvers. We possess highly refined assessment skills that we use each day when caring for patients and families. We take pride in systematic work and we are good at it. It makes sense then, that we could leverage this skill set and the well-established nursing process to improve the health of our work environment.

HWE Standards and Me

I learned about AACN's Standards for Establishing and Sustaining Healthy Work Environments (HWEs) during a low point in my career when I was grappling with the effects of low morale and stifled professional growth, feeling powerless to effect change, and generally questioning my decision to become a nurse. The HWE standards presented an evidence-based solution to my problem and gave me great hope. Still, I was a direct care nurse with a small sphere of influence learning to navigate a complex hospital system. I wasn't sure exactly where to begin or how to operationalize the standards.

Going back to basics with the nursing process allowed me to approach the HWE framework by breaking it into manageable pieces. But, before diving into a work environment assessment, I realized the importance of gaining support at each level of my organization.

How to Gain Support

You can't transform your work environment all alone. You need the help of committed direct care nurses, engaged nursing leaders, and hospital administrators who not only understand the value of the work but can appreciate the future return on investment (ROI). Begin by introducing HWEs to your team, then create a business case or project proposal, followed by an ROI calculation to prove the value of HWEs.

Introducing HWEs to Your Team

By beginning with your peers and working your way up to senior leadership, you not only have the opportunity to perfect your presentation, but you'll generate widespread excitement along the way. I found success in introducing the HWE standards through a simple PowerPoint presentation. Your presentation should "set the scene." It can summarize how the HWE standards were developed, explain how they can transform unit culture, and convey the value of working together toward a common goal.

AACN offers a similar presentation, Healthy Work Environments: Getting Started, as a free resource on their website. The slide deck is not copyrighted, so you are free to adapt the presentation to meet the needs of your facility. It includes the following information:

• An introduction to HWEs
• Information about how the standards were developed
• Evidence to support how HWEs improve patient, nurse and hospital outcomes
• Definitions of each standard
• Evidence to support how implementing HWE standards improves the health of the work environment
• Resources on the HWE Assessment Tool
• Links to the latest HWE publications and "AACN Standards for Establishing and Sustaining Healthy Work Environments"

Making a Case for Implementing Healthy Work Environment Standards

Creating an HWE provides unmistakable benefits for all of us (nurses, patients, families and the hospital organization), which makes our healthcare system more viable. Providing evidence to support this claim is critical to the success of your proposal. As you brainstorm, ask yourself the following questions:

What do I get?

• Higher job satisfaction
• Lower levels of burnout and compassion fatigue
• Less moral distress related to missed or delayed patient care
• Higher levels of engagement

What do my patients get?

• Better survival rates
• Fewer hospital-acquired conditions and other adverse events
• Decreased length of stay
• Fewer readmissions
• Better quality of care

What does my hospital get?

• Ability to report better quality outcomes
• Higher reimbursement rates
• Better patient satisfaction rates
• Improved nurse satisfaction rates
• Lower nurse/employee turnover
• Fewer sick calls
• Improved business - more patients, higher profits

The decades of important evidence should have hospital organizations clamoring for the opportunity to take part in this work, especially during a time when nursing staff and hospital systems are suffering so greatly. However, disseminating these results and gaining support for this work has been challenging. AACN's National Nurse Work Environment Survey indicates that only about 50% of critical care nurses have heard of the HWE standards, and only 29% of nurses report that their unit has started or fully implemented them. This is where you come in. It's time to make a case for HWE implementation!

Create a Proposal

A solid project proposal will include a comprehensive description of what you hope to accomplish by implementing the HWE standards. In your proposal, look for ways to tailor your objectives to your hospital indicators and strategic plan. This strategy will ensure your vision aligns with your CNO's goals for the organization. Clear proposals provide viability for a project, so be sure to include the following:

• Description of the problem
• Solution to the problem (your HWE vision)
• Benefits and risks
• Costs (see ROI discussion in next paragraph)
• Final recommendation

Perform a Return on Investment Calculation

Establishing value in measurable terms can make all the difference in gaining support for HWE implementation. When a hospital or department invests in a new program or quality-improvement project, hospital leaders typically want to know what kind of ROI it will yield. An ROI analysis calculates net financial gains (or losses) while considering all the resources invested. Check out this ROI tool from the Agency for Healthcare Research and Quality for more information about how to estimate your ROI.

Lead or Follow, but It's Time to Dance

I'd like to tell you about a three-minute video that I stumbled upon around the same time I introduced the HWE standards to my team. "Leadership Lessons from a Dancing Guy," a Ted Talk by Derek Sivers, shows how an entire movement can be generated by just one person. Be that person. Don't be afraid to get out there and look a little bit crazy. If you do it long enough, you will find that first follower who will help you build enough momentum to reach the tipping point.

The video is fun but, make no mistake, it is time to get serious about improving our work environments. The national nursing shortage is projected to be between 200,000 to 450,000 nurses by 2025, and declines in nurse satisfaction are reflected in National Nurse Work Environment Study. Establishing HWEs now can help prevent a larger nursing shortage, safeguard our nursing profession and improve our healthcare system. Using familiar tools, such as the nursing process, is one of many ways nurses can take the lead in making changes now. Our healthcare system depends on nurses, and nurses deserve work environments that are healthy. Will you introduce the HWE standards to your team?

What effective approaches have you found to introduce your team to the HWE standards?