More than a decade ago, the American Association of Critical-Care Nurses (AACN) shed light on a historically overlooked yet potent influencer on the quality of patient care: the human factor. AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence broke ground by outlining six specific workplace conditions necessary to cut down on medical errors, enhance the effectiveness of care delivery, and reduce conflict and stress among health care professionals.
“Each standard is considered essential in that effective and sustainable outcomes do not emerge when any standard is considered optional,” the association explained in its second edition of the standards, published earlier this year.
The standards are not pie-in-the-sky demands for cushier workplaces. Rather, each of the six principles is backed by research linking it to better patient outcomes and personal fulfillment for nursing professionals.
Consider the Healthy Work Environments standards a reputable guide to how your organization can improve outcomes through aligning itself with the evidence.
“Nurses must be as proficient in communication skills as they are in clinical skills,” AACN explains.
Indeed, skilled communication is essential for staff to provide top-notch care and avoid medical errors.
Breakdowns in communication are one of the most common reasons for sentinel events, data from The Joint Commission show. Also, patients are at risk for medical errors and other unintended forms of harm when nurses opt to take calculated risks rather than communicate with colleagues because they feel unsafe or that others do not want to listen—something that studies suggest happens regularly.
“Nurses must be relentless in pursuing and fostering true collaboration,” according to the standards.
The evidence is clear that poor collaboration has a negative effect on patient safety and outcomes, not to mention the damage it does to patient and family satisfaction, professional staff satisfaction, nurse retention, and cost, AACN points out. In its To Err Is Human report, the Institute of Medicine, categorized a lack of interprofessional cooperation as a cultural barrier to safety in hospitals.
“Nurses,” the standards continue, “must be valued and committed partners in making policy, directing and evaluating clinical care, and leading organizational operations.”
Nurse involvement in decision making is linked not only with improved job satisfaction but also with better patient outcomes, according to a 2012 study in the Journal of Nursing Administration. What’s more, failure to incorporate experienced nurses in clinical and operational decisions could lead to harmful and costly errors, AACN adds.
“Staffing must ensure the effective match between patient needs and nurse competencies,” the Healthy Work Environments report continues.
A trio of recent studies suggests when RNs in healthy work environments provide a higher proportion of care hours, the result is better outcomes for patients.
“Further evidence confirms that the likelihood of serious complications or death increases when fewer registered nurses are assigned to care for patients,” AACN reports. “Research also acknowledges a relationship between educational preparation, specialty certification, and clinical nursing expertise.”
Overworked nurses, on the other hand, can experience dissatisfaction and burnout, contributing to nurse turnover, poorer quality of care and even decreased hospital profitability.
“Nurses must be recognized and must recognize others for the value each brings to the work of the organization,” the standards state.
A growing body of literature points to a link between suboptimal care outcomes and a lack of meaningful recognition in nursing. Other evidence shows that hospitals that reward nurses for expertise are successful at attracting and retaining their nurses.
“Nurses consistently rate recognition from patients, families and other nurses as the most meaningful,” the standards explain. “It reaffirms nurses’ positive contributions, emphasizing the impact of nursing care and increasing awareness of nurses’ unique contributions to health care.”
“Nurse leaders must fully embrace the imperative of a healthy work environment, authentically live it, and engage others in its achievement,” explains the final of the six Healthy Work Environments standards.
This principle points to the key role of nurse leaders in creating healthy work environments and retaining satisfied nursing staff. Unfortunately, the second edition of the standards suggests that hospitals may be slipping in this dynamic.
“Results of the 2013 AACN critical care nurse work environment survey indicate a decline in nurses’ perception that frontline nurse managers and chief nurse executives fully embrace the concept of a healthy work environment and engage others in achieving it,” AACN reports.
Better preparation and support for nurse leaders may help turn things around, the report suggests.
How do you see healthy work environments contribute to better patient outcomes in your workplace?