Results from 2018 HWE Study Show Progress

Feb 19, 2019

Added to Collection

Most recent national survey of critical care nurses identifies positive outcomes of implementing the AACN Healthy Work Environment standards

ALISO VIEJO, Calif. – Feb. 19, 2019 –The health of environments in which nurses care for acutely and critically ill patients has improved over the last few years, but areas of concern and opportunities for improvement remain, according to new research from the American Association of Critical-Care Nurses (AACN).

Results from AACN’s fourth national survey of critical care nurses are now available online prior to their publication in the April issue of Critical Care Nurse (CCN).Critical Care Nurse Work Environments 2018: Findings and Implications” reports key findings from the survey of over 8,000 nurses, compares the results with previous studies and recommends areas for continued improvement.

Among the findings:

  • For all items on the scale portion of the survey, there was improvement since the 2013 survey.
  • For every element, workplaces that have actively implemented the AACN Health Work Environment (HWE) standards had superior results to those that have not.
  • Appropriate staffing continues to be a major concern, with only 39 percent of nurses responding that they have the right number of nurses with the right knowledge and skills more than 75 percent of the time.
  • Nurses are highly satisfied with nursing as a career but less satisfied with their current jobs. Overall, 54 percent of respondents said they plan to leave their current position within three years.
  • More than 6,000 respondents (86 percent) reported experiencing at least one negative incident of verbal abuse, physical abuse, sexual harassment or discrimination in the past year. Patients and their families were the most frequently reported source of abuse. On average, abuse is less likely to happen when verbal and physical abuse policies are in place.

Principal investigator Beth Ulrich, EdD, RN, FACHE, FAAN, is a professor at Cizik School of Nursing, The University of Texas Health Science Center at Houston. She is also the editor of Nephrology Nursing Journal and an AACN consultant regarding HWEs.

“Healthy work environments are everyone’s responsibility – from the bedside to the boardroom,” Ulrich said. “Creating healthy working environments requires changing longstanding cultures, traditions and hierarchies. The benefits to doing so are increasingly clear, as are the consequences from inaction.”

A total of 8,080 critical care nurses participated in the 2018 study, which is twice as many participants as in the original 2006 study. The online survey has three parts: the 32-item Critical Elements of a Healthy Work Environment Scale, a series of additional questions to explore specific elements in greater detail and questions about the demographics of participants and their employing organization.

Almost 2,700 participants responded to a question asking them to describe a best practice in their unit or organization that others could use to improve their work environment. A related question asking respondents to describe an issue in their unit or organization that concerns them received 3,300 responses.

The survey is part of AACN’s unwavering commitment to improve the environments where nurses work. First published in 2005 and updated in 2016, “AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence” outlines six essential standards necessary for creating a healthy work environment: skilled communication, true collaboration, effective decision making, meaningful recognition, appropriate staffing and authentic leadership. The 44-page document or an executive summary can be downloaded from the AACN website at no charge.

The AACN Healthy Work Environment Team Assessment is also available 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.

AACN offers additional resources related to healthy work environments, including research published in its journals and continuing education materials.

As AACN’s bimonthly clinical practice journal for high-acuity and critical care nurses, CCN is a trusted source of information related to the bedside care of critically and acutely ill patients.

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 high-acuity, progressive and critical care settings. CCN enjoys a circulation of more than 120,000 and can be accessed at

About the American Association of Critical-Care Nurses: Founded in 1969 with 400 members, the American Association of Critical-Care Nurses (AACN) is now the world’s largest specialty nursing organization. In 2019, AACN celebrates 50 years of acute and critical care nursing excellence, serving more than 120,000 members and over 200 chapters in the United States. The organization remains committed to its vision of creating a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. During its 50th anniversary year, AACN continues to salute and celebrate all that nurses have accomplished over the last half century, while honoring their past, present and future impact on the evolution of high-acuity and critical care nursing.

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