Download File

Practice Standards For A
Healthy Work Environment
By:
Christine Ausmus, Jessica Hekman, Lesley Morgan & Mariah Wallace
About the Standards
The American Association of Critical-Care Nurses (AACN) made a nine person panel to produce the six standards for
healthy work environment.
Fifty experts reviewed the standards.
The reason for these standards is the risky situations that can arise in the health care setting.
For example: You are a nurse in a 12 bed Emergency department. You are normally staffed with five RNs and two Emergency techs.
Today there was two sick calls and one of the techs quit and that position has not been filled. You are working short. You call your
department’s supervisor for help, no answer. You call the house supervisor for help, she is busy staffing the med/surg floors. There is
a patient coming in by ambulance, five current patients in rooms and six more to triage. What do you do? Unfortunately this is a
scenario that is real. The AACN noticed this and decided to do something about it.
The AACN developed six essential standards:
Skilled Communication
True Collaboration
Effective Decision Making
Appropriate Staffing
Meaningful Recognition
Authentic Leadership
(AACN, 2005)
These standards are in line with the Robert Wood Johnson Executive Nurse Fellows Program
(http://www.futurehealth.ucsf.edu/rwj/. December 3, 2004).
They also support the American Nurses Association Code of Ethics for Nurses.
American Nurses Association. Code of Ethics for Nurses with Interpretive Statements. Washington DC:
American Nurses Publishing: 2001.
These practices need to be implemented at all levels in the healthcare setting. When these practices
are implemented success will be noticeable with the hospital staff and patient satisfaction.
Standard 1
Skilled Communication
For any patient, in any setting, it is required that numerous professionals have successful
integration for optimal outcomes. This does not only encompass health care professionals.
This includes administrators, billers, and other axillary staff.
Being respectful and frequent interaction between professional’s aids in making
communication successful.
Skilled communication can be defined as “a two-way dialog in which people think and
decide together” (AACN, 2005, p. 16).
Breakdowns in communication are responsible for an alarming number of medical errors.
“Nearly three in four errors are caused by human factors associated with interpersonal
interactions” (AACN, 2005, p.16).
“Breakdown in team communication is a top contributor to sentinel events” (AACN, 2005,
p. 16).
Disrespectful and intimidating behavior in a medical setting leads to stress and job
dissatisfaction. Unfortunately, half of nurses report that “they have been subject to verbal
abuse and over 90% have witnessed disruptive behavior” (AACN, 2005, p. 16).
Communication is a part of everyday life and is vital to safe nursing care. There are two
main components to alter communication within nursing care: #1: Obtaining adequate
education on conflict management and communication and #2: rewarding workers who
successfully manage conflicts (AACN, 2005, p. 16).
(AACN, 2005)
Standard 2
True Collaboration
True collaboration is defined as “a process…. where joint communication and decision
making between nurses and other disciplines and among nurses themselves becomes the
norm” (AACN, 2005, p. 20).
Successful collaboration includes:

Skilled communication

Trust

Knowledge

Shared responsibility

Mutual respect

Optimism

Coordination
True collaboration ultimately benefits the patient and the nurse.
“Nurse-physician collaboration has been found to be one of the three strongest predictors
of psychological empowerment of nurses” (AACN, 2005, p. 20).
True collaboration builds trust and decreases medical errors by nurses and staff.
(AACN, 2005)
Standard 3
Effective Decision Making
“Nurses must be valued and committed partners in making policy, directing and evaluating
clinical care and leading organization, operations” (AACN, 2005 p. 24)
Most often when you go to a hospital or doctor’s office one of the first members of the
health care team that you see is the nurse. They collect data, such as vital signs and
information from the patient about signs and symptoms that they are experiencing, so
that the physician can diagnose and treat them properly. However, physicians do not
always view nurses as being an “intricate part of the decision making team regarding
patient care” (AACN, 2005, p. 24). This may cause nurses to become discouraged, and
discontent with their practice.
If nurses are not valued and recognized as being an important contributor of the care
team and allowed to be a part of the decision making, then patient safety and outcomes
can be jeopardized. In addition, it can have a negative impact on an organizations
bottom line. Professional care models, “which allow for nurses to have more control
over their practice” (AACN, 2005, p. 24), have been implemented in many institutions
and proven to be a successful tool in attracting and retaining nursing professionals.
(AACN, 2005)
Standard 3
Effective Decision Making
Key Concepts
In order to achieve this outcome, healthcare organizations must incorporate
the following elements into their organizations structure and framework:

Provide ongoing education and development opportunities for team members

Expect that all team members will incorporate organizational values and mission into
their decision making process

Allow patients and family members to be involved in decisions involving patient care

Hold individual team members accountable for possessing the required skills to do their
job effectively

Establish systems that will facilitate data-driven decisions and have a process in place
to evaluate the outcomes
(AACN, 2005)
Standard 4
Appropriate Staffing
“Staffing must ensure the effective match between patient needs and nurse competencies”
(AACN, 2005, p. 28).
Inadequate staffing can be one of the most harmful, and controllable factors, that can
jeopardize “patient outcomes and the safety and well-being of nurses” (AACN, 2005, p.
28). When not enough licensed professional nurses are available, patient care is
compromised, which can lead to medication errors, a decrease in the quality of care,
increased costs to patients and effect an organizations bottom line. It can also lead nurses
to decreased job satisfaction, burnout and a high employee turnover rate for the
organization.
Staffing appropriately can be a somewhat daunting, and difficult task for most employers.
However, being an advocate for the patient, nurses should demand appropriate staffing to
increase patient safety and outcomes.
Organizations needs to stop wasting time staffing according to “fixed nurse-to-patient
ratios” (AACN, 2005, p. 28) and begin looking at patient needs and acuity on an individual
basis. Systematic testing of staffing models should be developed, tested, assessed and
evaluated frequently in order to make ongoing staffing decisions related to patient
outcomes and organizational goals.
(AACN, 2005)
Standard 4
Appropriate Staffing
Key Concepts
In order to become successful in meeting appropriate staffing needs, healthcare
organizations must incorporate the following elements into their organizations
structure and framework:

Draft policies that require nurses to provide quality care based on ethical principles

Allow nurses to participate in the hiring process of new staff

Implement a formal process for the evaluation of the effect of staffing decisions and how it
effects patient outcomes and organizational goals

Adopt a system that will allow team members to evaluate how staffing decisions effect the
patient and the organization

Provide multi-level support services for nurses to utilize in their nursing practice so that they
deliver the best care possible to patients and families

Incorporate the use of technology to the delivery of patient care
(AACN, 2005)
Standard 5
Meaningful Recognition
“Treat people as if they were what they ought to be and you help them to become what they are capable of
being.”
-Johann Wolfgang von Goethe
Nurses must be recognized for their value and meaningfulness of one’s contribution to their
work.
A high number of nurses are dissatisfied with recognition that they do not receive from
employers.
Under recognition leads to discontent, decreased morale, decreased productivity, and
subpar patient care outcomes.
Three out of four AACN members rank recognition as a central element of a healthy work
environment.
Recognition should be meaningful and should be treated as a process to become a staple
within the work environment.
Recognition must be consistent and congruent to one’s contributions.
Effective recognition requires structure and processes to produce positive outcomes.
(AACN, 2005)
Standard 5
Meaningful Recognition
Key Concepts

The healthcare facility as a system in place to include processes and structures that
focus on recognizing team contributions that they bring to the workforce

Establish a process for employees to learn about recognition and how they can
participate

The recognition system extends from bedside to board members

Processes are included that validate the recognition that an individual is given

Each individual is responsible for being an active member in the recognition program

The employer regularly evaluates it’s system to prove efficient and effective
(AACN, 2005)
Standard 6
Authentic Leadership
“One of the most decisive functions of leadership is the creation, management, and when necessary, the
destruction and rebuilding of culture.”
-Edgar Schein
Nurse leaders are very important part of a healthy work environment. They include
managers, administrators, advanced practice nurses, and educators.
Nurse leaders must be effective communicators, team players, advocates for positive
change, and work toward collaborative practice.
In order to provide healthy work environments a commitment must be made in a
systematic development of nurse leaders.
(AACN, 2005)
Standard 6
Authentic Leadership
Key Concepts

The healthcare organization provides education to improve knowledge and enhance
abilities in communication, collaboration, and meaningful recognition.

Leaders demonstrate the understanding in how to maintain a healthy work
environment. They effectively implement and maintain standards to sustain a healthy
work environment.

The healthcare organization makes sure that nurse leaders are doing their job
appropriately. They also ensure the efforts of leaders by providing time, financial, and
human resources. Providing co-mentoring programs enhances leaders to become better
decision-makers.

Leaders and team members evaluate the impact of leadership processes and decisions
to work towards the goal of sustaining a healthy work environment.
(AACN, 2005)
Call to Action
“Individuals and organizations learn and evolve through conscious, deliberate action.
Deliberate actions is ethical. When the time to act has come, it is unethical not to do something.”
-David Thomas
The American Association of Critical-Care Nurses (AACN) developed these six standards to ensure
patient safety and care of the organization and its employees.
AACN asks all nurses, organizations and professional nursing associations to follow these
standards to create and maintain a healthy work environment.
The



call to action requires nurses and all health professionals to:
Personally participate in creating healthy work environments
Maintain relationships and hold others accountable
Problem solve and follow through with solutions
Healthcare organizations to:

Implement and follow standards

Establish structure for education and evaluation of these standards

Show by example
AACN and the community of nursing to:

Establish attention to the importance of healthy work environments

Promote these six standards within the environment

Develop resources to support organizations and individuals wqe
(AACN, 2005)
Vision of the Future
1. Skilled communication protects and advances collaborative relationships.
Doctors and nurses work together to provide the best patient care possible to promote a positive outcome. Taking the
doctors knowledge of medicine and the knowledge of assessment and illness is the best way to tackle a patient
problem.
2. True collaboration is an ongoing process built on mutual trust and respect.
Respecting each other’s knowledge and opinions promotes teamwork.
3. Nurse leaders create a vision for a healthy work environment and model it in all their actions.
Strong leadership promotes happy employees. Leaders who value your knowledge and time respect you and what you
do for patients. Recognizing and validating your work makes you want to stay and your job and are the best at what
you do.
4. Meaningful recognition acknowledges the value of a person’s contribution to the work of the organization.
Being praised for giving good patient and following your instincts validates the value of your worth as an employee.
5. Remaining focused on matching nurses’ competencies to patients’ needs points the way to innovative
staffing solutions.
Staffing in healthcare organizations can be very difficult. We face the challenge of balancing giving the best patient
care possible and staying within out staffing budget. Teamwork and being creative help us accomplish our goals.
6. Advocating for patients requires involvement in decisions that affect patient care.
Involvement with committees and organizations helps to promote advocacy for our patients.
(AACN, 2005)
American Association of Critical Care Nurses (AACN)
Mission, Vision, Values, Ethic of Care
Mission: Building on decades of clinical excellence, the AACN provides and inspires leadership to
establish work and care environments that are respectful, healing and humane.
Vision: AACN is dedicated to creating a healthcare system driven by the needs of patients and
families where critical care nurses make their optimal contribution.
Values:
Be accountable
Advocate
Act with integrity
Collaborate
Provide leadership
Demonstrate stewardship
Embrace lifelong learning, inquiry, and critical thinking
Promote innovation
Commit to quality and excellence at all levels
Generate commitment and passion to the organizations causes and work
Ethic of Care: AACN’s mission, vision and values are rooted in an ethic of care that acknowledges
the interrelatedness and interdependence of individuals, systems and society. An ethic of care
respects individual uniqueness, personal relationships and the dynamic nature of life. Essential to
an ethic of care are compassion, collaboration, accountability and trust.
(AACN, 2005)
A message from Lesley Morgan, RN:
I work in an outpatient surgery department at Pennock Hospital in Hastings, MI. I also
work at Pennock’s Endoscopy Center located in the Health and Wellness building.
This is what we want JCAHO to look like after they have inspected our hospital. JCAHO comes to Pennock
every other year. We are given a time frame that they will appear. It is usually a three month time frame and
they will be in our hospital for three days. They are looking at our polices and procedures, making sure we are
a safe environment. They are making sure we are disposing of biohazards safely. They were just at Pennock
this last summer. We were initially inspected in January and we had some areas that needed to be improved,
so they made a return visit in August. We had some issues with our Endo Center. JCAHO practice standards
influence my nursing practice by keeping out patients safe and making sure our work environment is safe. I
know the areas that we were cited on had to do with labeling of medications, time outs for procedures and
clean and dirty storage. Thankfully these were all small things that were easily fixed and the next time JCAHO
come we passed with flying colors.
A message from Mariah Wallace, RN:
I have been a registered nurse on the Labor and Delivery Unit at Mid Michigan Health for over three years. I have
had the opportunity to see how numerous nursing practice standards have influenced patient care on my unit and
within the hospital itself. These standards also affect employees and job satisfaction as well.
As a registered nurse, wherever you are employed, you will have a set of practice standards to follow. One set of
standards, JCAHO, has had a large impact on my care as a nurse. JCAHO practice standards influence my nursing
practice by regulating the care I give my patients, making guidelines for nursing practice, and creating rules for
the facility in general.
Mid Michigan Health is a new partner with The University of Michigan. The biggest change that comes along with
this partnership is the push for all RN’s to have a BSN. On my floor, the majority of the nurses are ADN’s. There is
actually little incentive, besides having a job that we are given to obtain our BSN’s. I have now seen nurses
pursue different avenues with these changes in place, pursuing a higher education.
When we anticipate a visit from JCAHO, we are all on our best behavior. In a way, this is comical. However,
JCAHO is an important factor in improving standards for patients. JACHO provides guidelines for emergency
procedures, guidelines for safe biohazard disposal and safe nursing practice. JCAHO influences how the nurses
function and promotes the best patient outcomes.
Thinking of the IOM’s recommendations for a better health care system and JCAHO standards, nurses have the
potential to be the most influential and powerful component in patient safety and health care reform. Nurses
have an immeasurable amount of potential!
A message from Christine Ausmus, RN
I have seen a very different side of the practice of nursing since beginning work at a state correctional
facility, which is very similar to public health nursing. Prisoners are still human beings, and no matter
how heinous the crime(s) they committed may have been, and they still have a right to basic health care.
My belief is that no matter where you practice, all practice standards affect you daily. However, the
recommendations, as outlined and explained in the Institute of Medicine (IOM) October, 2010 brief, is
what I feel will influence my practice the most going forward.
Budget cuts have eliminated many registered nurse positions at correctional facilities across the State. In
addition, tuition reimbursement to assist employees in reaching educational goals and expanding their
knowledge base, has been discarded.
As the healthcare needs of prisoners becomes more complex, it is imperative that the State of Michigan,
follow the footsteps of many other healthcare institutions, and invest back into its employees to become
better prepared to care for those patients.
The first two recommendations of the IOM brief discuss nurses being able to achieve higher education and
receive quality training, and using that education and training to practice to their full extent. The
turnover rate for registered nurses within the State of Michigan is extremely high. In part, from a lack of
education. The State only requires nurses to obtain a ADN for employment. Many nurses do not continue
with their education because there are no resources available to assist them, in addition, there is no
incentive to achieve a higher education as the State does not require it to maintain employment as a
nurse. This needs to be changed in order for the State to achieve the IOM recommendations, and retain
registered nurses to provide quality comprehensive care to the prison population.
A message from Jessica Hekman, RN:
The six standards that makeup a healthy work environment is all very important.
Each standard plays a specific role into creating the best possible work environment.
Employees that follow these standards make work enjoyable which in turn makes patient care a
priority.
The standards that most affect my nursing practice would be skilled communication, meaningful
recognition, and authentic leadership.
 Open and effective communication is vital in our line of work. It takes time and practice to
become skilled at communication. In my 10 years as a nurse, I have adopted the motto “mean
what you say and say what you mean.” If you are unclear always ask for clarification and never
assume anything.
 Meaningful recognition is the key to a HWE. Being valued at your job and being recognized for
your hard work enables you to keep wanting to do your job well and pushing yourself to do better.
When your worth and others are acknowledged it boosts self-esteem and morale which makes your
floor or unit run smoothly.
 Authentic leadership is an important practice. Nurse leaders are not just managers or
administrators. They are bedside nurses, clinical and patient care nurses. Nurse leaders are nurses
who lead in their own practice by setting an example and following the six practice standards and
holding others accountable to those standards.
References
American Association of Critical-Care Nurses (AACN). (2005). Standards for Establishing and
Sustaining Healthy Work Environments: A Journey to Excellence. pp. 1-43. Retrieved from
http://www.aacn.org/WD/Practice/Content/standards.content?menu=Practice
American Association of Critical-Care Nurses. Strategic Market Research Study. Aliso Viejo, Calif:
American Association of Critical-Care Nurses: 2003
American Nurses Association. Code of Ethics for Nurses with Interpretive Statements.
Washington DC: American Nurses Publishing: 2001.
Institute of Medicine (IOM). (October, 2010). The Future of Nursing: Leading Change, Advancing
Health. Retrieved from http://www.iom.edu/Reports.aspx?Search=Future%20of%20Nursing
McClure, M. Hinshaw, A.S. Magnet Hospitals Revisited: Attraction and Retention of Professional
Nurses. Washington, DC: American Nurses Publishing; 2002