Three Reasons Nurse Leaders Should Prioritize Healthy Work Environments

Insights from Stuart Downs, DNP, RN, NEA-BC, Chief Nurse Executive, Northeast Georgia Health System

In a healthcare environment that's constantly facing workforce shortages, nurse burnout and operational pressures, nurse leaders are searching for solutions that are both evidence-based and transformative. For Stuart Downs, Chief Nurse Executive at Northeast Georgia Health System (NGHS), the answer has been clear for nearly two decades: Use AACN's Healthy Work Environment (HWE) Standards as a tool to reveal challenges and opportunities.

Throughout his career, Downs has consistently implemented the HWE framework in every organization he has led. But at NGHS, his first system-wide implementation, he has watched the HWE Standards create measurable improvements in staff engagement, leadership effectiveness, patient outcomes and organizational culture.

His message to nurse leaders and CNOs is simple: "If you want your nursing workforce to thrive, HWE cannot be treated as a standalone initiative. Treat it as a defining element of your organization's nursing identity."

Hardwiring HWE Into the System's DNA

When Downs joined NGHS as Chief Nurse Executive, he saw an opportunity he'd never had before: applying the HWE framework not just at a single hospital, but across an entire health system.

Stuart Downs

"It started by integrating all six HWE Standards into our nursing strategic plan – what we call Nursing's Plan for Advancing Excellence," Downs said. "If you want to advance excellence, you have to live those standards."

That integration ensures HWE drives both short-term priorities and long-term strategy. Every initiative – from improvement projects and staffing redesigns to professional governance work – explicitly articulates how it begins and ends with HWE principles. This keeps the framework front and center in all matters of decision-making.

Why Nurse Leaders Should Prioritize Healthy Work Environments

Downs identifies three main reasons why nurse leaders and executives should make HWE a strategic priority.

• 1Strengthen Workforce Engagement, Retention and Recruitment

  Downs says hospitals do not succeed without people, and healthy work environments are essential for keeping them. He frames his nursing vision as straightforward as: “Get nurses. Keep nurses. Take care of nurses. Make it easy for them to practice.”

  HWE provides the roadmap. Downs has data-driven results that show units that implement the HWE Standards have:

  • More stable staffing
  • Lower turnover and callouts
  • Stronger teamwork
  • Higher RN engagement

  When the Standards shape culture, nurses choose to stay, and new nurses want to join.

• 2System-level Improvement in Quality Outcomes

  In every unit across its system, NGHS uses AACN's Healthy Work Environment Assessment Tool (HWEAT) to conduct an annual survey. The tool is free to use and measures the health of a unit's work environment against the six HWE Standards.

  Because NGHS's Human Resources department provides accurate headcount for each unit, participation can be measured against a true denominator, and results can be trended over time.

  This systemwide approach enables NGHS to:

  • Track baseline and year-over-year improvement
  • Identify which HWE Standards need targeted interventions
  • Tie HWEAT results to nurse satisfaction and patient experience

  And the correlation is clear. "Those units with high HWEAT scores also rate high on the NDNQI (National Database of Nursing Quality Indicators) survey and have excellent HCAHPS (Hospital Consumer Assessment of Healthy Providers and Systems) results," Downs said. "We are very committed to this."

• 3Elevate Patient Care and Frontline Pride

  Healthy environments aren't just tied to clinical outcomes – they create them. When nurses feel supported and psychologically safe, they can practice at their highest potential. Staff take pride in their work, and patients feel the difference. Downs calls this one of the most powerful effects of the HWE framework. "It elevates the practice environment in ways that staff can see, feel and measure."

  Two years ago, NGHS launched a Beacon Collaborative with the goal that every eligible unit apply for AACN's Beacon Awardrecognition.

  "The Beacon Award is more than a badge of honor," Downs explains. "It's external validation of a supportive work environment, high standards of practice and authentic leadership."

  Today, Beacon is embedded into the culture – from frontline teams to the CEO. It supports recruitment, strengthens retention and reinforces NGHS's mission of delivering safe, high-quality, compassionate care.

  "First and foremost, it's really aligned with our mission to deliver safe, high-quality, compassionate care. So anytime you can connect everything back to the mission, you can't go wrong," Downs said.

A Focus on Meaningful Recognition

The health system aligned all of its recognition programs with the HWE standard of Meaningful Recognition.

"There's a difference between recognition and meaningful recognition," Downs emphasizes. "Understanding the definition of that HWE Standard helps illuminate the difference."

Peer-to-peer recognition, unit celebrations, and system awards are now intentionally designed to honor behaviors and outcomes that advance healthy work environments, making recognition more impactful and more closely linked to shared values.

The Power of the HWE National Collaborative

Participation in AACN's HWE National Collaborative has accelerated NGHS's progress for improving and sustaining healthy work environments across its system.

Downs says the collaborative provided the structured framework needed to scale HWE across an entire system. It ensured leaders consistently applied the standards to staffing, communication planning, interdisciplinary leadership and shared decision-making.

Best Practice Sharing with Like-Minded Organizations

The collaborative allows leaders and frontline teams to learn from peer institutions facing similar challenges. Many of NGHS's most successful initiatives grew directly from insights shared at regional and national meetings for the collaboration.

"For example, our neuro service line used insights from the national collaborative to identify practice gaps and align new initiatives with the healthy work environment principles," Downs said. "The success of that work has since been scaled system-wide here, demonstrating the power of a structured shared learning approach. What we've learned across our neuro service line and the collaborative we've now scaled across the whole health system."

Transformational Leadership Development

For many NGHS leaders, participation has been "career defining," said Downs. The collaborative elevated internal expertise, visibility and capability – advancing an entire generation of leaders skilled in communication, collaboration and authentic leadership.

"The interactions our leaders have within the collaborative also pushed us to refine our initiatives and expand our thinking about what a healthy environment could really look like," he added. "We have preconceived ideas and preconceived notions of what it would look like, but when you get into a national collaborative like this and start partnering with others, it really expands your view of what the endless opportunities really could be."

How Should Leaders Get Started With HWE?

Downs offers one essential piece of advice: Begin by conducting an inventory of the work that's already happening across the organization.

• Start with what already exists. Quality initiatives, staffing workgroups, shared governance, communication plans, and leadership programs likely already touch HWE.
• Overlay the six standards on all current work. This process quickly reveals gaps and opportunities.
• Align intentionally – not unnecessarily. Avoid change fatigue from staff by keeping implementation realistic and sustainable.

"When you overlay HWE onto existing work, any deficiencies illuminate very quickly," Downs said. "This approach builds momentum early and preserves continuity."

The Bottom Line: HWE Is a Strategic Imperative

For nurse leaders seeking a sustainable path through workforce challenges, quality expectations and the demand for excellence, AACN's HWE Standards offer a proven, scalable evidence-based framework.

NGHS is living proof. Implementing HWE has reshaped the culture, strengthened leadership and elevated patient and workforce outcomes across the system.

"I always thought a healthy work environment was something you achieve with skilled communication – that it was all about my skill as a nurse leader," says Downs. "How do I really communicate to my staff? How do I involve them in decisions? How do I ensure appropriate staffing? How do I meaningfully recognize them instead?"

For Downs, HWE is a strategic imperative. His most important advice is to avoid approaching the HWE framework as separate.

"HWE has to become part of the fabric of your nursing culture," says Downs. "When you embed it into everything – how you lead, communicate, recognize, develop and decide – you create a place where nurses can truly thrive and practice at their highest potential."

What challenges could you solve by implementing HWE Standards at your facility? Tell us in the comments!