Healthy Work Environments

By Rose O. Sherman, EdD, RN, FAAN

“All workplaces can be healthy if nurses and employers are resolute in their desire to address not only the physical environment, but also less tangible barriers to staff and patient safety”. The American Association of Critical Care Nurses

A nursing student who is getting ready to graduate in May recently asked me what a healthy work environment should be like. She also wondered how she could tell if a unit environment was healthy when she was interviewing for a position. These are interesting questions. Today in nursing, we frequently talk about healthy work environments and assume that we have a shared mental model of what that should be.

Key Components of a Healthy Work Environment

At the beginning of this decade, the American Association of Critical Care Nurses made a commitment as an organization to actively promote the creation of healthy work environments. In their now widely used work, they identified 6 standards for establishing and sustaining healthy work environments. These included:

1. Skilled Communication – A nurse’s proficiency in communication is as important as clinical skills.

2. True Collaboration – Nurses must be relentless in pursuing and fostering collaboration.

3. Effective Decision Making – Nurses must be valued and committed partners in making policy, directing and evaluating care and leading organizational operations.

4. Appropriate Staffing – Staffing must ensure the effective match between patient needs and nurse competencies.

5. Meaningful Recognition – Nurses must be recognized and recognize others for the value that each brings to the work of the organization.

6. Authentic Leadership – Nurse Leaders must full embrace the imperative of a healthy work environment, authentically live it and engage others in its achievement.

The Evidence about the Impact of a Healthy Work Environment

There is growing evidence in the nursing literature about the positive impact of healthy work environments on staff satisfaction, retention, improved patient outcomes and organizational performance. Many organizations have launched efforts to improve their work environments. Achievement of Magnet designation is considered to be the gold standard for hospitals who seek to build professional practice environments that are healthy and support the work of nurses. Findings from a growing body of nursing research have provided evidence supporting that Magnet® hospitals have increased patient and nurse satisfaction, improved recruitment and retention of nurses, and improved patient outcomes.

The Role of Nurse Leaders in Building Healthy Work Environments

Although much work has been done to identify what needs to happen in practice environments to maximize the health and well being of nurses, the achievement of these standards has proved challenging for many organizations in the current turbulent health care environment. The establishment of a healthy work environment requires strong nursing leadership at all levels of the organization but especially at the point of care or unit level where most front line staff work and patient care is delivered. Nurse 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 more transformational and authentic style of leadership.

Signs of a Healthy Work Environment

So how can you tell if a nursing unit has a healthy work environment? Kramer and Schmalenberg made the important observation from their research that only staff nurses can confirm whether initiatives planned and designed to improve the health of a work environment are truly successful. If you are interviewing or considering employment, some key questions to reflect on include the following:

Is the hospital or agency Magnet designated or on the Magnet journey?
How much time and energy does the nurse manager/director give to the selection of new staff members?
Are nursing staff involved and engaged in the selection process?
During unit tours, are you introduced to staff members and what is the response?
Are there visible signs of staff achievements/recognition such as postings of certification?
How much time is invested in staff orientation?
What are the opportunities for professional development?
Do staff appear to work well as a team and interact with each other?
What is the response to questions that you ask about staffing?
Do you have a sense that there is pride in nursing and professionalism in this organization?
How is the follow-up communication after your interview managed?

When I walk on units, I do an environmental scan that includes some of the above elements. I have learned through experience that much can be learned by just observing. The advice that I gave to our student was to consider the above questions and to pay close attention to both the verbal and non-verbal ques in the environment. Are first impressions sometimes wrong? They can be but more often they turn out to be a very good indication of what you can expect if you are selected and accept positions.

Read to Lead

American Association of Critical Care Nurses (2005). AACN Standards for Establishing and Sustaining Healthy Work Environments. AACN Healthy Work Environments

Kramer, M. & Schmalenberg, C. (2008). Confirmation of a Healthy Work Environment. Critical Care Nurse, 28(3), 56-63.