Nurse Leaders Key to HWE, Professional Quality of Life

Mar 03, 2020

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Research published in American Journal of Critical Care finds authentic leadership is strongest predictor of compassion fatigue, burnout among critical care nurses

ALISO VIEJO, Calif. – March 3, 2020 – New research reinforces the importance of nurse leaders to the overall health of the work environment and to individual nurses’ professional quality of life.

A survey of nurses in four critical care units at the University of Tennessee (UT) Medical Center assessed the relationship between nurses’ professional quality of life (ProQOL) and the Healthy Work Environment (HWE) standards developed by the American Association of Critical-Care Nurses (AACN). The six HWE standards are authentic leadership, true collaboration, effective decision-making, meaningful recognition, appropriate staffing, and skilled communication.

The researchers found that authentic leadership is the HWE standard that most significantly correlated with burnout and was the strongest predictor of compassion fatigue and secondary traumatic stress.

The survey results, “The Relationship Between Critical Care Work Environment and Professional Quality of Life,” are published in the March issue of American Journal of Critical Care (AJCC).

The survey included questions from two validated instruments – the 30-item ProQOL questionnaire to measure compassion fatigue, compassion fatigue and burnout and the 18-item AACN HWE Assessment Tool to measure the state of the work environment. Nurse managers emailed the survey link to their nurses, and participation was voluntary. Of the 219 nurses in the projected sample size, 45% completed the survey.

Marissa Monroe, DNP, FNP-BC, RN-BC, CCRN, is a nurse practitioner with Cardiology and Cardiothoracic Surgery at UT Medical Center. As part of her doctoral studies, she worked with faculty at Belmont University’s Gordon E. Inman College of Health Sciences and Nursing to conduct the survey.

“Our findings suggest that strong leaders are key to retention and satisfaction,” she said. “Developing nursing leaders who are skilled communicators, team builders and collaborators can have a positive impact throughout the organization.”

The composite average of all six HWE standards was good at 3.5 on the 5.0 scale, suggesting that the four critical care units have an overall healthy work environment, with room for improvement. None of the standards was rated as excellent.

Participants reported compassion satisfaction and burnout levels as average and secondary traumatic stress levels as high. The high levels of secondary traumatic stress correlated with the HWE standards of leadership, appropriate staffing and meaningful recognition. The findings suggest that improved staffing may create a more balanced worklife at this facility and that nurse recognition may help counterbalance the effects of secondary traumatic stress.

The HWE Assessment Tool is part of a collection of AACN resources to help organizations align quality and safety improvement efforts with the HWE standards. Healthcare professionals can use the free online tool to survey staff, compare their results with industry standards and develop step-by-step strategies to improve performance, patient safety, staff recruitment and retention, and their workplace environment.

To access the article and full-text PDF, visit the AJCC website at

About the American Journal of Critical Care: The American Journal of Critical Care (AJCC), a bimonthly scientific journal published by the American Association of Critical-Care Nurses, provides leading-edge clinical research that focuses on evidence-based-practice applications. Established in 1992, the award-winning journal includes clinical and research studies, case reports, editorials and commentaries. AJCC enjoys a circulation of more than 120,000 acute and critical care nurses and can be accessed at

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 more than 120,000 members and over 200 chapters in the United States.

American Association of Critical-Care Nurses, 101 Columbia, Aliso Viejo, CA 92656-4109; 949-362-2000;;;