What is a Healthy Work Environment?Healthy Work Environment\爀帀洀搀 屲A Healthy Work...
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What is a Healthy Work Environment? Lori Colineri DNP, RN, NEA-BC Senior Vice President and Chief Nursing Officer Southern Region
What is a Healthy Work Environment?Healthy Work Environment\爀帀洀搀 屲A Healthy Work Environment is one that is safe, empowering, and satisfying. Parallel to the Wor\൬d Health
Lori Colineri DNP, RN, NEA-BCSenior Vice President and Chief Nursing Officer
Southern Region
Presenter
Presentation Notes
A healthy work environment cannot occur without nurse leaders who support its importance, authentically live it, and engage others in its achievement (AACN, 2005). Kramer and Schmalenberg (2008) observed that only staff nurses can confirm whether initiatives planned and designed to improve the health of a work environment are successful. Accessible nursing leaders play a key role in helping to give nurses a voice in the improvement of patient care environments (AACN, 2005). This leadership must be available 24/7. Leaders can help create a deeply satisfying organizational culture at the unit level by engaging staff in the development of shared values in their work. This entails a paradigm shift from a more traditional commandandcontrol style of staff supervision toward a transformational style of leadership in which leaders enhance the motivation, morale, and performance of their follower groups. The positive relationship between this type of transformational leadership and satisfaction of staff is supported by research (Faila & Stichler, 2008).
ObjectivesTo define a healthy work environmentTo explore the AACN’s Social Determinants of Health in the 21st
CenturyTo discuss the Social Determinants of Health and Indicators of Healthy Work Life and HealthyTo examine the Work Environment for Nurses and the Relationship between Environmental factors, Staff and OutcomesTo define the roadmap for creating a healthy work environment
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Presentation Notes
To define a healthy work environment To explore the AACN’s Social Determinants of Health in the 21st Century To discuss the Social Determinants of Health and Indicators of Healthy Work Life and Healthy�To examine the Work Environment for Nurses and the Relationship between environmental factors, Staff and Outcomes To define the roadmap for creating a healthy work environment
A Healthy Work Environment According to the ANA:A Healthy Work Environment is one that is safe, empowering, and satisfying
A Place of “Physical, Mental, and Social Well-Being,” Supporting Optimal Health and Safety
….“A culture of safety is paramount”All leaders, managers, health care workers, and ancillary staff have a responsibility
• A sense of professionalism, accountability, transparency, involvement, efficiency, and effectiveness.
• All must be mindful of the health and safety for both the patient and the health care worker in any setting
• providing a sense of safety, respect, and empowerment to and for all persons.
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Healthy Work Environment ^md A Healthy Work Environment is one that is safe, empowering, and satisfying. Parallel to the World Health Organization definition of health, it is not merely the absence of real and perceived threats to health, but a place of “physical, mental, and social well-being,” supporting optimal health and safety. A culture of safety is paramount, in which all leaders, managers, health care workers, and ancillary staff have a responsibility as part of the patient centered team to perform with a sense of professionalism, accountability, transparency, involvement, efficiency, and effectiveness. All must be mindful of the health and safety for both the patient and the health care worker in any setting providing health care, providing a sense of safety, respect, and empowerment to and for all persons. Your work environment plays a large role in the ability to provide quality care. The atmosphere of a facility is critically important. It impacts everything from the safety of patients and their caregivers to job satisfaction. Studies consistently show how work environment issues, such as nurse staffing, are linked with patient outcomes, length of stay, and chance of death. ANA supports a healthy work environment for all nurses and patients.
Acute Care
Post-Acute Care
The NEW System of CARE
CARE = Clinical Alignment and Resource Effectiveness.
Hospital
Inpatient Rehab
Skilled Nursing Facility
Outpatient Rehab
Home Care
Acuity
AmbulatoryProcedure
Center
Retail Pharmacy
HomeWellness andFitness Center
Physician Clinic
Urgent Care
Center
DiagnosticImaging Center
E-visits
Community-Based Care
Changes in Healthcare Accountable Care Act 2010Pay for PerformanceService DeliveryTechnology
Decrease duplication of servicesImprove Care Coordination
Nurses' Bill of Rights• To maximize the contributions nurses make to society, it is necessary to
protect the dignity and autonomy of nurses in the workplace. • To that end, the following rights must be afforded:
– The right to practice in a manner that fulfills their obligations to society and to those who receive nursing care.
– The right to practice in environments that allow them to act in accordance with professional standards and legally authorized scopes of practice.
– The right to a work environment that supports and facilitates ethical practice. – The right to freely and openly advocate for themselves and their patients,
without fear of retribution. – The right to fair compensation for their work, consistent with their knowledge,
experience and professional responsibilities. – The right to a work environment that is safe for themselves and for their
patients. – The right to negotiate the conditions of their employment, either as
individuals or collectively, in all practice settings.
Presenter
Presentation Notes
To maximize the contributions nurses make to society, it is necessary to protect the dignity and autonomy of nurses in the workplace. To that end, the following rights must be afforded: Nurses have the right to practice in a manner that fulfills their obligations to society and to those who receive nursing care. Nurses have the right to practice in environments that allow them to act in accordance with professional standards and legally authorized scopes of practice. Nurses have the right to a work environment that supports and facilitates ethical practice, in accordance with the Code of Ethics for Nurses with Interpretive Statements. Nurses have the right to freely and openly advocate for themselves and their patients, without fear of retribution. Nurses have the right to fair compensation for their work, consistent with their knowledge, experience and professional responsibilities. Nurses have the right to a work environment that is safe for themselves and for their patients. Nurses have the right to negotiate the conditions of their employment, either as individuals or collectively, in all practice settings.
The Result of an Unhealthy Work Environment
Burn Out, Moral Distress, Turnover, Poor Outcomes
What is Moral Distress?
“Moral distress occurs when an individual’s moral integrity is seriously compromised, either because one feels unable to act in accordance with core values and obligations, or attempted actions fail to achieve the desired outcome.”
--Hamric, 2014
Research
• Moral Distress is experienced by many healthcare professionals– physicians have lower levels though some MDs higher
than RNs• Manifests at three levels:
– individual, team/unit, and system/organization• Correlated with:
– poor collaboration, – less satisfaction with care quality Lower ethical
climate, leaving or considering leaving a position, being in direct patient care
Hamric (2007, 2012, 2015)
American Association of Critical-Care Nurses (AACN)Healthy Work Environment Ingredients for Success
“ Healthy Work Environments are the cornerstone for keeping our patients safe from harm, when open communication and true collaboration come together our patients benefit”
Vickie Good, Springfield MO.
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Presentation Notes
MAGNET!!!�
Skilled Communication• There is a well-established link
between team communication, worker morale, and patient safety and Empirical Outcomes. – Poor team communication has
been directly linked to preventable medical errors, high nurse turnover rates, and low morale
• Organizations provide support and access to interprofesional education and coaching that develop critical communication skills
• Skilled communicators– Focus on finding solutions– Hear all relevant perspectives– Mutual respect to build consensus– Hold themselves accountable– Evaluate the impact of the
communication on clinical and financial outcomes and on the work environment
(Brinkert, 2010; Institute of Medicine, 1999; Vessey, DeMarco, & DeFazio, 2010).
Nurses must be as proficient in communication as they are in clinical skills
True Collaboration• Teams make fewer mistakes than
individuals• Teamwork is not solely a
consequence of co-locating individuals together.
• Organizations ensures access to structured forums for collaboration
• Employees embrace a culture of collaboration
• High level of personal integrity • Nurse and Physician leaders are
partners in modeling and fostering true collaboration
“I have my team. Like if you see everyone around me - I have my hair and makeup girl, my assistant. They're very calm, they're all about positive energy. There're no drama queens. Everyone wants everyone else to have a positive experience. There are no agendas. I think it creates a healthy environment and there are no boundaries to cross.”
Effective Decision Making“Staff need to be developed, directed, and empowered to find the best way to accomplish the organizational goals and achieve desired outcomes.”
Organizations ensure that nurses in positions from bedside to the boardroom participate in all levels of decision making
Staffing must ensure the effective match between patient needs and nurse competencies
Meaningful RecognitionNurses must be recognized and must recognize others for the value each brings to the work of the organization
Formal recognition processNominations form peersValidate that recognition is meaningful to those being acknowledgedEveryone is responsible for taking part in recognitionOrganization evaluates the recognition program
Authentic Leadership• Transformational Leadership• Genuine visible enthusiasm for
achieving and sustain the standards of a HWE
• Role Model behavior• Innovation• Respect• Mentoring
“The supreme quality for leadership is unquestionably integrity. Without it, no real success is possible.”
Dwight D. Eisenhower
Fully Embrace the imperative of a Healthy Work Environment AUTHENTICALLY…
Live it and engage others in its achievement
“Do not check your soul at the door when you cross the threshold of your workplace. Whether you are a custodian or a CEO practice work as sacred art. Respect comes not from the work you do, but the way you do your work.”
Mary Manin Morrissey
What is Leadership’s role?• A healthy work environment
cannot occur without nurse leaders who support its importance, authentically live it, and engage others in its achievement .
• Leaders can help create a deeply satisfying organizational culture at the unit level by engaging staff in the development of shared values in their work.
• The most valuable resources for each health care system are its staff.
Flexibility and adaptability
Plug into institutional anxietiesSpeak up about experiences of moral distress and find/use/sanction resources
(Hamric, 2017)
Presenter
Presentation Notes
A healthy work environment cannot occur without nurse leaders who support its importance, authentically live it, and engage others in its achievement (AACN, 2005). Kramer and Schmalenberg (2008) observed that only staff nurses can confirm whether initiatives planned and designed to improve the health of a work environment are successful. Accessible nursing leaders play a key role in helping to give nurses a voice in the improvement of patient care environments (AACN, 2005). This leadership must be available 24/7. Leaders can help create a deeply satisfying organizational culture at the unit level by engaging staff in the development of shared values in their work. This entails a paradigm shift from a more traditional command and control style of staff supervision toward a transformational style of leadership in which leaders enhance the motivation, morale, and performance of their follower groups. The positive relationship between this type of transformational leadership and satisfaction of staff is supported by research (Faila & Stichler, 2008).
A Public Health Issue
• It is of major importance for clinical nurses, nurse leaders, and policymakers to address the issue of staff health, not only for the well-being of those individuals but also for the health and sustainability of future health care services
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Presentation Notes
It is of major importance for clinical nurses, nurse leaders, and policymakers to address the issue of staff health, not only for the well-being of those individuals but also for the health and sustainability of future health care services (Gresh et al., We have moved from the Industrial Age through the Information Age to the Quantum Age, in which complexity and chaos are acknowledged, and systems thinking is required to explore and explain matters being studied. Healthy Work Environments as Determinants of Health 223 2015). The present and growing global nursing shortage can be seen as one of the epidemics of the 21st century. This shortage needs to be addressed just like any other health risk factor, no less serious than communicable diseases, smoking, and environmental pollution. Sustaining a competent and healthy nursing workforce is not a private issue but a public health issue and therefore should be the priority in any policymaking as well as in political and professional action. Recruiting and keeping competent professional nurses in health care, and providing them with the opportunity to practice to their full potentials within a healthy work environment, is a question of public health. Public health should be high on each government’s agenda, and healthy work environments should be every nurse leader’s
Determinants of Health and Indicators of Healthy Work Life and HealthyWork Environment for Nurses
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Presentation Notes
RNAO Registered Nurse Association of Ontario paradigm shift is occurring in the definition of health and therefore also in the determinants of health. Social determinants of health, considered by many to be the premises of good health and a purposeful life, are now the focus of attention in determinants of health. These determinants of health bring attention to the conditions in which people are born and live and work. Study findings from around the world confirm that the health and well-being of nurses and their patients is related to nurses’ work and work environments. Therefore, the working lives of nurses should be identified as an inseparable part of their personal lives, leading to consideration of work environments and thereby the quality of nurse’s work lives as determinants of health in the 21st century.TABLE 1. Determinants of Health and Indicators of Healthy Work Life and Healthy Work Environment for Nurses WHO Determinants of Health WHO Five Keys to Healthy Workplaces RNAO Conceptual Model for Healthy Work Environments for Nurses AACN Standards for Establishing and Sustaining Healthy Work Environment Income and social status Education Physical environment Social support networks Genetics Health services Gender (WHO, 2016a) 1. Leadership commitment and engagement 2. Involve workers and their representatives 3. Business ethics and legality 4. Use a systematic, comprehensive process to ensure effectiveness and continual improvement 5. Sustainability and integration (WHO, 2016b) Physical/structural policy components Physical work demand factors Organizational physical factors External policy factors Cognitive/psycho/socio/cultural components Cognitive/psycho/social work demand factors Organizational social factors External sociocultural factors Professional/occupational components Individual nurse factors Organizational professional/ occupational factors External professional/ occupational factors (RNAO, 2008) 1. Skilled communication 2. True collaboration 3. Effective decision making 4. Appropriate staffing 5. Meaningful recognition 6. Authentic leadership (AACN, 2016) Note. WHO 5 World Health Organization; RNAO 5 Registered Nurses’ Association of Ontario; AACN 5 American Association of Critical-Care Nurses. Nursing touches on all aspects of life and therefore health. Mortality and morbidity, the traditional measures of determinants of health and, until recently, the single determinants, are but two of numerous factors in a complex picture of health and well-being.
Taking Care of our Staff
• The workplace is an important setting for health protection, health promotion and disease prevention programs.
• The use of effective workplace programs and policies can reduce health risks and improve the quality of life for American workers.– Maintaining a healthier workforce can lower direct costs such as
insurance premiums and worker’s compensation claims. It will also positively impact many indirect costs such as absenteeism and worker productivity.
Presenter
Presentation Notes
The workplace is an important setting for health protection, health promotion and disease prevention programs. On average, Americans working full-time spend more than one-third of their day, five days per week at the workplace. While employers have a responsibility to provide a safe and hazard-free workplace, they also have abundant opportunities to promote individual health and foster a healthy work environment for more than 159 million workers in the United States (Accessed US Bureau of Labor Statistics April 12, 2016). The use of effective workplace programs and policies can reduce health risks and improve the quality of life for American workers. Maintaining a healthier workforce can lower direct costs such as insurance premiums and worker’s compensation claims. It will also positively impact many indirect costs such as absenteeism and worker productivity.1, 2
Evaluate the Work EnvironmentNDNQI RN Survey with Practice Environment Scale
– The PES-NWI is endorsed by the National Quality Forum (NQF)
– contains the Practice Environment Scale of the Nursing Work Index (PES-NWI)
Hospital Affairs; Nursing Foundations for Quality of Care; Nurse Manager Ability, Leadership, and Support of Nurses; Staffing and Resource Adequacy; and Collegial Nurse-Physician Relations
Evaluate the Work EnvironmentHealthy Work Environment Assessment
– Measured against the Ameriecan Association of Critical Care Nurses (AACN) Standards for Establishing and Sustaining Healthy Work Environments
– Identifies the systemic behhaviors that maintain patient safety, ensure optimal outcomes and support excellence in nursing practice
– Provides a• A baseline measurement of how an organization perceives the health of its
work environment• References to resources that will help improve the health of a work
environment• A tool to track progress in implementing the AACN Standards for Establishing
and Sustaining Healthy Work Environments
http://www.hweteamtool.org/main/index (link is external)
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Presentation Notes
Healthy Work Environment Assessment Description This assessment tool can be used for any health care environment to measure its health against the American Association of Critical-Care Nurses (AACN) Standards for Establishing and Sustaining Healthy Work Environments. These standards identify the systemic behaviors that maintain patient safety, ensure optimal outcomes, and support excellence in nursing practice. The AACN Healthy Work Environment Assessment provides: A baseline measurement of how an organization perceives the health of its work environment References to resources that will help improve the health of a work environment A tool to track progress in implementing the AACN Standards for Establishing and Sustaining Healthy Work Environments Free registration is required. Links to the QualityTool: This tool is available at http://www.hweteamtool.org/main/index (link is external) Developer: American Association of Critical-Care Nurses Funding Sources: American Association of Critical-Care Nurses; VitalSmarts, LC
Stress Relief
The Ultimate Goal
ReferencesAmerican Nurses Association (2017) Healthy Work Environment. http://www.nursingworld.org/workenvironment
American Association of Critical-Care Nurses (2016). AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence, 2nd Ed. www.aacn.org
Bragadottir, H., (2016). Identifying Indicators of Healthy Work Environments in Nursing as Determinants of Health in the 21st Century. Creative Nursing, Vol 22(4).
Clark, C. (2016). Development and Testing of the Healthy Work Environment Inventory: A reliable Tool for Assessing Work Environment Health and Satisfaction. Journal of Nursing Education . Vol. 55 (10)
Hamric, AB: A case study of moral distress. J Hospice & Palliative Nurse 2014; 16:457-463.
Kramer,M., Schmalenberg, C., Maguire, P. (2008). Essentials of a Magnetic work environment. Nursing: January 2008 -doi: 10.1097/01.NURSE.0000304729.97476.61
