Transformation in Action: Improving Outcomes Together Through a Healthier Work Environment

As an organization committed to optimizing healthcare systems for patients, families and nurses, AACN understands the current imperative to improve the health of hospital work environments or risk the failure of our healthcare system.

To support healthcare organizations nationwide in taking bold action to transform their workplaces for the better, AACN is launching its Healthy Work Environments (HWE) National Collaborative. This education, mentorship and co-learning program will guide hospital-based teams in creating healthier work environments together that lead to improved quality indicators, job satisfaction and retention, and organizational outcomes.

Developed in partnership with implementation scientists and researchers, this pioneering program leverages a proven framework for creating and maintaining a healthy work environment with implementation science strategies to make change that sticks. The HWE National Collaborative provides a unique opportunity to achieve concrete, measurable progress in operationalizing evidence-based standards in daily practice to truly improve the health of your work environment.

Why Do Healthy Work Environment Standards Matter?

A growing body of research shows that creating and maintaining a healthy work environment is critical to ensuring a strong future for America’s healthcare system. The AACN Healthy Work Environment (HWE) Standards provide an evidence-based framework for establishing and sustaining a healthy work environment that supports excellence in care delivery and staff satisfaction and retention. These essential standards are based on workplace improvement concepts backed by nearly 20 years of data.

  • Impact of HWE

  • The Evidence

  • Overcoming Barriers

At no other time in healthcare’s history has there been more turbulence, rapid change or complexity. Mounting evidence reflects that unhealthy work environments resulting from these and other factors contribute to medical errors, ineffective delivery of care and conflict and stress among healthcare professionals. The link between healthy work environments and patient safety, staff retention and recruitment, and a hospital’s bottom line is irrefutable.

Creating a healthy work environment enables nurses and the healthcare team to provide the highest standards of compassionate patient care while being fulfilled at work. Research reveals that a healthy work environment can lead to more engaged staff, decreased burnout, lower turnover and better patient care. By identifying and replacing unhealthy systemic behaviors with the HWE Standards, organizations can achieve a culture where safety is the norm and excellence the shared goal.

There is still much work to do.

In 2021, AACN conducted its fifth National Nurse Work Environments Study. The study reports a dramatic decline in the overall health of the work environment along with higher nurse turnover rates and notably lower nurse satisfaction — all of which raise significant concerns about the future of our healthcare system and the livelihood of the nursing profession.

On the bright side, these surveys show that nurses working in units where the HWE Standards have been or are being implemented report significantly better quality of care, satisfaction with their role and profession, emotional health and fewer plans to leave the bedside.

A few notable insights from the survey include:

  • 67% of respondents plan to leave their current profession in the next three years
  • Only 40% of respondents indicated they were very satisfied with being a registered nurse
  • Only 47% of the respondents agreed with the statement "My organization values my health and safety”

However, among respondents who worked in a unit with HWE Standards (vs. those in non-HWE Standard units):

  • Only 26% intended to leave (vs. 52%)
  • Only 36% experienced moral distress (vs. 58%)
  • 44% reported better staffing (vs. 16%)

View more survey results

While many healthcare leaders understand the importance of a healthy work environment, they know how challenging it can be to take those first steps, rally their teams and implement their vision. Creating and sustaining a healthy work environment requires intentional effort and concrete action steps. It is a journey, not a sprint, that requires long-term organizational culture change throughout all levels of the organization.

In the years since launching the Healthy Work Environment initiative and HWE Standards, AACN has developed a variety of tools and resources to support healthcare leaders and organizations in achieving a healthier workplace. However, feedback from our community of nurses, clinical and practice advisory groups, volunteers and national conference attendees indicate that significant barriers to implementing the standards remain.

AACN’s HWE National Collaborative addresses and helps hospitals overcome the most common barriers to implementation, including:

  • Being overwhelmed with where or how to start
  • Not knowing who to ask or where to turn to for help
  • Competing priorities for valuable resources — such as time and money
  • Figuring out how to translate evidence and theory into actual daily practice
  • Securing support from all levels of the organization to drive and sustain a healthy work environment

Reap the Benefits of a Healthier Work Environment Through Collaboration

Organizations participating in the AACN Healthy Work Environments National Collaborative will experience benefits on many levels. On a programmatic level, hospital teams will:

  • Have access to the knowledge, expertise and ideas of healthy work environment leaders and a network of healthcare leaders and clinicians from across the country, all with the same goal
  • Receive hands-on support in taking concrete steps to implement the HWE Standards at their facility
  • Leverage implementation science to make changes that “stick”
  • Measure progress and impact using AACN’s validated HWE Assessment Tool (HWEAT)

Program participants can also benefit from the improved outcomes associated with a healthy work environment.

Nurses & Teams
  • Higher job satisfaction
  • Higher engagement levels
  • Less burnout and compassion fatigue
  • Less moral distress related to missed or delayed patient care
  • Ability to provide the highest quality care
  • Better quality of care
  • Better survival rates
  • Increased safety
  • Fewer hospital-acquired conditions and other adverse events
  • Decreased length of stay
  • Fewer readmissions
  • Better quality outcomes
  • Higher reimbursement rates
  • Improved nurse and patient satisfaction
  • Lower nurse/employee turnover
  • Improved business — more patients, higher profits

Program At-A-Glance

The HWE National Collaborative is a two-year hospital-based education, mentorship and co-learning program. Each participating organization assembles a team with members from three units across the hospital, including executives, leaders, physicians, educators, nurses and allied health professionals.

Program content is delivered mostly virtually on a monthly basis with one or more in-person national sessions to encourage collaboration and connection while maximizing convenience.

The program requires hospital leadership commitment to their team’s consistent participation as well as collecting and sharing pre- and post-program data for research purposes.

The Healthy Work Environment Standards

AACN's has identified six essential components that contribute to a healthy work environment. Known as The Healthy Work Environment (HWE) Standards, these workplace concepts serve as evidence-based guidelines to transform hospital culture. The healthiest work environments integrate all six standards to support the achievement of effective and sustainable outcomes for patients, nurses and healthcare team members, and the hospital organization.