Building a Healthy Work Environment

Apr 01, 2019

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Overall, implementing the healthy work environment standards has promoted our ability to be creative and think differently about problem-solving as a team, and we’re continually motivated to improve the quality of care and patient outcomes.

Kelly Kester, Stacey O’Brien, Heather Pena

Why did you choose to use the HWE standards in your project?

After talking to our nurses in the CTICU, we found that they wanted better recognition for their work and sought improved communication. We needed a framework that could help us reach our goals of improving overall nurse satisfaction and retention.

AACN’s evidence-based HWE standards best fit our goals. They provided the tools and resources to support nursing leadership and staff in promoting a consistently positive work culture, and we really valued the framework’s focus on the human factor.

What role did the HWE standards play in your project?

Our CTICU Healthy Work Environment Committee, which was initiated by bedside nurses and nurse leadership, focused heavily on AACN’s HWE standards. As a group, we felt strongly that the standards would help to accomplish our purpose: supporting nurse retention and job satisfaction.

Among the six standards, meaningful recognition was consistently discussed and evaluated, because it was the most important to our staff, particularly preceptors. We committed to recognizing this group in a unique way at least twice per year due to their feedback and the value that they bring to the team.

To improve Skilled Communication between leaders and nurses, the leadership team utilized a Stoplight Report, and the HWE committee sent out a newsletter sharing staff recognition, introducing new hires and promoting unit activities. To improve communication skills among bedside nurses, all preceptors and charge nurses attended a class focused on the basics of communication. In addition, we hosted a unit-based class to further support preceptors in communicating effectively, particularly when providing verbal and written feedback to orientees.

Our unit also felt that True Collaboration should be a critical focus. As a CTICU, we work with many other departments and wanted to identify ways to better collaborate. The HWE committee began holding an annual softball tournament in 2014 to raise money for the American Heart Association. It allows us to gather many departments throughout the hospital, build relationships and get to know each other in a fun environment.

Last, our leadership team prioritized Appropriate Staffing to ensure that we had an adequate skills mix and staffing levels necessary to consistently deliver safe and effective patient care. Nurse Manager Kelly felt strongly that there were opportunities to improve our hiring and onboarding practices, which could impact nurse turnover. We partnered with nurse recruitment, included bedside nurses in the interview process and increased transparency regarding staffing opportunities and progress. As a result, we significantly decreased CTICU turnover and stabilized our staffing.

Could you tell us more about improving hiring strategies? Which elements were vital to success?

Nursing leadership partnered with our nursing recruitment department to develop specific candidate screening, which ensured that we identified the most appropriate candidates for the interview process. Interviewees were asked to participate in a two-hour shadowing experience with a unit preceptor to gain a better understanding of how a nurse functions on the unit and giving them a more realistic view of how a CTICU operates. Shadowing also enabled preceptors to meet and assess interviewees.

Nursing leadership utilized behavioral interview strategies to help determine the best candidates to hire and then sourced preceptor feedback regarding interviewees to form a shared hiring decision.

Can you share examples of how your project has moved nurses toward a healthier work environment?

Nursing turnover decreased by 17.1 percent over a four-year period, nurse satisfaction has increased by 6 percent, and teamwork and staff recognition scores climbed by 3 percent.

You can feel the increased staff engagement. More nurses are eager to share their ideas and be involved in projects, and non-nursing CTICU staff members have joined them, including respiratory therapists, pharmacists and advanced practice providers. We continue to see increased numbers of nurses climb our clinical ladder. Overall, implementing the HWE standards has promoted our ability to be creative and think differently about problem-solving as a team, and we’re continually motivated to improve the quality of care and patient outcomes.

It sounds like it was a successful team effort. Who participated in the project?

Our work was a collaborative effort between bedside nursing, nurse recruitment, chaplain services, palliative care services, nursing leadership and other CTICU staff including physicians, advanced practice providers, respiratory therapy, pharmacy, physical and occupational therapy, and nutrition services. The HWE standards helped us build a culture that promotes recognition and resilience for all unit staff.

What suggestions do you have for other nurses hoping to implement a similar project in their hospital or unit?

We suggest identifying all available resources at your organization and using them creatively. For example, our organization offers pet therapy to patients, so we contacted that team and had therapy dogs brought over for staff. It’s also important to gain support from stakeholders early on and set realistic goals, so you see incremental progress. Last, having a strong partnership with your nursing leaders is critical to developing sustainable practices, such as ongoing recognition, stable staffing and consistent communication.

AACN’s six HWE standards,, provide clear, evidence-based guidelines for creating a healthy work environment. The six interdependent standards are skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition and authentic leadership.