ALISO VIEJO, Calif. - Oct. 1, 2025 - A concerted effort to improve the workplace culture at a California hospital produced a variety of significant improvements, with an impact far beyond the initial goals, according to an article in Critical Care Nurse (CCN).
“A Multimodal Approach to Transform Culture by Implementing AACN’s Healthy Work Environment Standards” details how Los Angeles General Medical Center initiated a multipronged project to increase nurse retention and improve other nurse-sensitive indicators.
The L.A. County Department of Health Services (DHS) manages the 650-bed public hospital, as well as four other hospitals and multiple outpatient clinics and facilities. Los Angeles General Medical Center is affiliated with the University of California Los Angeles (UCLA) academic medical center as a clinical teaching site.
As the COVID-19 pandemic began to wane, a national shortage of nurses was impacting hospitals around the country. The hospital’s nursing executive team responded with a nurse-specific strategic plan focused on reducing turnover and increasing retention.
Author Nancy Blake, PhD, RN, CCRN, NEA-BC, is chief nursing officer at the hospital and an associate adjunct professor at UCLA School of Nursing.
“When we developed our initial plan, we could not have anticipated all the positive changes that would happen,” she said. “Transforming our organization’s culture required hard work by everyone involved, but the results are well worth the extra effort.”
The initiative was based on implementing the Healthy Work Environment (HWE) Standards established by the American Association of Critical-Care Nurses (AACN). “AACN Standards for Establishing and Sustaining Healthy Work Environments” was first published in 2005 and updated in 2016. The six HWE standards are skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition and authentic leadership.
Key elements of the project:
- Implementation of professional shared governance, including unit practice councils
- Development of a transition-to-practice residency program for new graduates
- Participation in AACN Clinical Scene Investigator (CSI) Academy, a nurse leadership development program, and AACN’s inaugural HWE National Collaborative with an interprofessional group of medical, nursing and administrative staff
- Enhanced communication and collaboration between nursing staff and leaders, aided by a mobile application
- Grant-funded support to enhance efforts to reduce burnout and improve meaningful recognition
- Establishment of an in-house nurse leadership development program
- Launch of an interactive system for staffing and scheduling
The turnover rate for nurses fell from 20.62% in 2022 – an all-time high for the institution and on par with rates being reported nationwide – to 10.44% in 2024. Other nurse-specific outcomes included an increased rate of nurses with specialty certification (10.96% in 2022 to 19.76% in 2024) and a higher proportion of nurses educated at the Bachelor of Science in Nursing level or higher (49.30% in 2022 to 57.36% in 2024).
The residency program led to more than 500 new graduates being hired, with a retention rate of 93% in the first 24 months. Before the program, the retention rate was approximately 50%.
Patient outcomes improved from 2022 to 2024, with decreases in all nurse-sensitive indicators. Notably, the incidence of both catheter-associated urinary tract infections and central catheter-associated bloodstream infections decreased by more than 50%. Falls and hospital-acquired pressure injuries also decreased significantly.
More than 10 units have received AACN’s Beacon Award for Excellence, and the hospital is awaiting word on potential Magnet® recognition.
As AACN’s bimonthly clinical practice journal for acute and critical care nurses, CCN is a trusted source of information related to the bedside care of critically and acutely ill patients. Access the article abstract and full-text PDF by visiting the CCN website at http://ccn.aacnjournals.org.
About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The award-winning journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in acute, progressive and critical care settings. CCN enjoys a circulation of about 130,000 and can be accessed at http://ccn.aacnjournals.org.
About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with about 130,000 members and nearly 200 chapters in the United States.
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