Assessing Barriers to Drive Positive Change

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Constant change is a certainty in today’s healthcare environment. Workload, regulations, technology and leadership all play a role in work environments that create barriers to exceptional patient- and family-centered care. In an effort to help high-acuity and critical care nurses work through these longstanding issues, AACN has sought many opportunities to listen and learn from our community.

AACN recently completed a focused assessment to identify and validate the barriers that are impeding the optimal delivery of nursing care to inform our educational and advocacy strategies for the future. The assessment included conversations with members at various forums across the country, a survey, soliciting feedback through social media channels and a comprehensive literature review.

Assessment Results

It’s no surprise that we found that systemic problems continue to get in the way of nurses doing their important work at the bedside. Besides having a detrimental effect on patient- and family-centered care, these barriers have an adverse impact on nurses’ well-being. As expected, the barriers often do not occur independently but tend to interact with one another, magnifying negative consequences.

The top barriers identified in the assessment:

  1. Staff shortages and the attendant workload increases were the most-often-mentioned barrier. This included nurse and ancillary staff turnover, insufficient numbers and skill mix of staff for the patient volume and complexity, work shifts being too long and overflow admissions.
  2. Government regulations and hospital requirements, often associated with electronic documentation, were noted because of the unique challenges these systems have introduced to the workplace as well as the increased time requirements associated with them.
  3. Behaviors of our patients and families often impede nurses’ ability to deliver optimal care sometimes unintentionally, due to factors such as cultural and language differences or directly through disrespectful and even violent behaviors.
  4. Hostility in the workplace – abuse, bullying, disrespect, incivility and violence – by other nurses, members of the healthcare team, physicians and administration was commonly reported.
  5. Support from leadership. Complex challenges inherent within the current healthcare environment can result in a perceived misalignment of hospital administration versus the needs of frontline nurses for optimal patient care.

What Next?

We are committed to continuing to work with the AACN community to determine how to bridge the ideal described in the AACN Healthy Work Environment Standards with the realities of today’s workplace. Our efforts include addressing these barriers through education, advocacy work and participation in multiple national forums such as the National Academy of Medicine’s Action Collaborative on Clinician Resilience and Well-Being.

We also recognize some workplaces are thriving. Amid the discussions of barriers and challenges, aspects of positive change and best practices continue to surface. These positive trends demonstrate nurses’ ability to innovate, facilitate change and build resiliency. Examples include the increasing evidence of meaningful recognition through programs such as the AACN Beacon Award for Excellence, The DAISY Award for Extraordinary Nurses and unit-based recognition initiatives.

We have also uncovered innovative approaches to address common issues and staffing solutions that break down traditional boundaries through AACN Clinical Scene Investigator (CSI) Academy projects. We look forward to working with our community to develop strategies, identify resources and curate solutions that expand upon and disseminate positive examples.

As an AACN member, you play a critical role each day in addressing barriers and driving positive change. Some ideas that you’ve shared with us include:

  • Participating in leadership development education to advance and hone the skills necessary to influence change.
  • Driving actions to further the development and sustainability of healthy work environments.
  • Engaging in and enhancing relationships with hospital leaders to better understand one another’s perspectives and develop win-win solutions.
  • Exploring opportunities to collaborate with other disciplines and/or organizations to address common goals and eliminate barriers to practice.


AACN Standards

AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence
Establishing and sustaining healthy work environments must be a priority if nurses are going to make their optimal contributions in caring for patients and patients' families. The ingredients for success — skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition and authentic leadership — are described in “AACN Standards for Establishing and Sustaining Healthy Work Environments.”

On-Demand Webinars

Identify and Overcome Barriers to Nursing Practice
Lays a foundation of knowledge for the bedside nurse regarding the effect of the current healthcare environment, so that nurses can effectively reduce barriers to practice

Patient-Focused Collaboration: Strategic Alliances That Work
Presents the impact of communication/collaboration on patient care and offers effective communication strategies

Bullying in the Workplace: It Harms More Than the Bullied
Examines the concept of bullying, its effect in the workplace and strategies for addressing unacceptable behavior

Critical Impact: How Work Environments Affect Nurses, Patients
Discusses the health of our work environments, the impact on patient outcomes and initiating a conversation on the unit

CE Articles

Moral Resilience: A Capacity for Navigating Moral Distress in Critical Care

Burnout and Resilience Among Nurses Practicing in High-Intensity Settings

Compassion Satisfaction and Compassion Fatigue Among Critical Care Nurses

The Critical Care Work Environment and Nurse-Reported Health Care Associated Infections