Krystenn Fowler, Terise Gavar, Amy Gagne, Francine Nesheim, Michelle Wronski, and Gary Webster

1. Krystenn Fowler, Terise Gavar, Amy Gagne, Francine Nesheim, Michelle Wronski, and Gary Webster Ferris State University (NUR320)

2. 1 Healthy Work Environment A Healthy Work Environment (HWE) is important for the overall health of nurses, for successful nurse recruitment and retention, and for the quality and safety of patient care. (Kupperschmidt, 2010). It is a place for healing and where employees are committed to give the best care and experience for their patients to their fullest potential as health care workers.

3. 2 Healthy Work Environment In 2004, six standards were developed by the American Association of Critical Care Nurses (AACN) to establish and sustain healthy work environments (HWE). According to AACN, healthy work environments "support and foster excellence in patient care and are imperative to ensure patient safety, enhance staff recruitment and retention, and maintain an organization’s financial viability. It also recognizes the inextricable links among the quality of a nurse’s work environment, excellent nursing practice, and patient care outcomes." (Vollers, Hill Roberts, Dambaugh & Hill, 2009).

4. The six standards that represent Healthy Work Environments are all dependent on each other 3 True Collaboration Appropriate Staffing Effective Decision Making Authentic Leadership Meaningful Recognition Skilled Communication

5. 4 Skilled Communication "Nurses must be as proficient in communication skills as they are in clinical skills" (AACN, 2005). Krystenn Fowler, RN

6. 5 In order for nurses to become a skilled communicator, they should follow the Five-Factor Model for Becoming a Skilled Communicator from Parse's Theory of Becoming. Skilled Communication Factor 1 Becoming (aware of) Self-Deception Factor 2 Becoming Reflective Factor 3 Becoming Authentic Factor 4 Becoming Mindful Factor 5 Becoming Candid Krystenn Fowler, RN

7. 6 Skilled Communication Krystenn Fowler, RN

8. 7 True Collaboration "Skilled communication, trust, knowledge, shared responsibility, mutual respect, optimism and coordination are integral to successful collaboration" (AACN, 2005). Gary Webster, RN

9. 8 True Collaboration Elements • Ongoing Communication • Willing Participation • Brainstorming • Teamwork • A Common Purpose • Trust • A Plan for Achieving the Goal • A Diverse Group • Mutual Respect • A Written Agreement • Effective Leadership (McKinney, 2012) Gary Webster, RN

10. 9 Effective Decision Making "Nurses must be valued and committed partners in making policy, directing and evaluating clinical care and leading organizational operations" (AACN, 2005). Francine Nesheim, RN

11. 10 Effective Decision Making Facts • Nurses need to be involved in decision making regarding patient care for them to be an effective advocate. • Members of the multidisciplinary team, including doctors, pharmacists, hospital administrators and even nurses place patient safety primarily the nurses' responsibility. Yet a small percentage of doctors view nurses as part of decision making. • When physicians fail to incorporate the experienced perspective of nurses in clinical and operational decisions, many costly errors may occur, patient safety is jeopardized, thus threatening the financial viability of healthcare organizations. (AACN, 2005). Francine Nesheim, RN

12. 11 Suggestions • Work group led by staff and supported by leadership. Group should be allowed time to participate and explore all ideas and suggestions. • Meetings should allow staff members opportunity to air their views about changes within the unit. • A town hall style meeting for the staff to come and talk with management and leadership allowing input from all staff. These should allow for all staff to share their views. • Leadership may even have to encourage the staff to share their views, without fear of ramifications. (Blake, 2012). Effective Decision Making Francine Nesheim, RN

13. 12 Appropriate Staffing "Staffing must ensure the effective match between patient and nurse competencies." (AACN, 2005). Terise Gavar, RN-BA

14. 13 Appropriate Staffing • Through the healthcare institute, ethical principles are demonstrated by the nurses through their excellent patient care. • By participating in the planning and education of staffing procedure, nurses can make the pairing of patients' needs to nurses' competencies. • The healthcare organization is able to compensate when a nurse is not at the appropriate skill level or personality to meet the needs of the patient/family, by giving the assignment to a more fitting nurse. • The organization is able to access technology to more appropriately assist with the placement of nurses to patient needs. • Providing support for the nursing staff at every level of care is proven beneficial for the patient, family and staff. (American Association of Critical-Care Nurses, 2005). • The standard of appropriate staffing must be the first step of using the six standards. (Kerfoot, Garrick and Israel, 2007). Terise Gavar, RN-BA

15. 14 Meaningful Recognition “Nurses must be recognized and must recognize others for the value each brings to the work organization" (AACN 2005). Michelle Wronski, RN

16. 15 Meaningful Recognition Currently there is no “set” or “approved” way to give recognition to all nurses. Each facility or company will determine what the consensus of the staff prefer for recognition. Key concepts and Barriers • Giving and receiving feedback • Personality profiles • Teamwork • Communication and conflict resolution • Generational differences • Mentoring Critical Elements • Comprehensive system in place for recognition • Systemic process for all team members • The system reaches from bedside to Board table • Validation for recognition is meaningful to person being acknowledged • Continuous evaluation of effectiveness Michelle Wronski, RN

17. 16 Authentic Leadership "Nurse leaders must fully embrace the imperative of a healthy work environment, authentically live it and engage others in its achievement." (AACN, 2005). Amy Gagne, RN

18. 17 Amy Gagne, RN

19. 18 Authentic Leadership • The healthcare organization facilitates the efforts of nurse leaders to create and sustain a healthy work environment by providing the necessary time and financial and human resources. • The healthcare organization provides a formal co-mentoring program for all nurse leaders. Nurse leaders actively engage in the co-mentoring program. • Nurse leaders role model skilled communication, true collaboration, effective decision making, meaningful recognition and authentic leadership. • The healthcare organization includes the leadership contribution to creating and sustaining a healthy work environment as a criterion in each nurse leader’s performance appraisal. Nurse leaders must demonstrate sustained leadership in creating and sustaining a healthy work environment to achieve professional advancement. • Nurse leaders and team members mutually and objectively evaluate the impact of leadership processes and decisions on the organization’s progress toward creating and sustaining a healthy work environment. AACN, (2005). Amy Gagne, RN

20. 19 Authentic Leadership • The healthcare organization provides support for and access to educational programs to ensure that nurse leaders develop and enhance knowledge and abilities in: skilled communication, effective decision making, true collaboration, meaningful recognition, and ensuring resources to achieve appropriate staffing. • Nurse leaders demonstrate an understanding of the requirements and dynamics at the point of care and within this context successfully translate the vision of a healthy work environment. • Nurse leaders excel at generating visible enthusiasm for achieving the standards that create and sustain healthy work environments. • Nurse leaders lead the design of systems necessary to effectively implement and sustain standards for healthy work environments. • The healthcare organization ensures that nurse leaders are appropriately positioned in their pivotal role in creating and sustaining healthy work environments. This includes participation in key decision making forums, access to essential information and the authority to make necessary decisions. AACN, (2005). Amy Gagne, RN

21. 20 Krystenn Fowler, RN I currently practice on the Clinical Decision Unit (CDU) at St. John Macomb Hospital. I feel that it is definitely a healthy work environment. I am lucky to say that my co-workers are wonderful. Everyone is a team player, we communicate well, and patient care comes first. I enjoy going to work and always doing things to my fullest potential. I feel that with it being a healthy work environment everyone is influenced to do their best and we are always trying to come up with ways to make things even better! A healthy work environment is very important and I would not be able to say all of these things if the environment was not good.

22. 21 Francine Nesheim, RN In the OR at SJMO, HWE practice standards influence my nursing practice by collaborating as part of a team (Anesthesiologists, nurse anesthetists, surgeons, scrub techs, nurse manager and educator). This teamwork we share in the OR is the cornerstone of quality and demonstrates the best clinical outcomes, patient satisfaction, patient safety and job enjoyment. We participate in perioperative shared governance for brainstorming ideas, and participate in twice monthly educational opportunities (third Wednesday and first Friday late starts). And we love celebrations!

23. 22 Terise Gavar, RN-BA In my current practice area of cardio-thoracic surgical unit at Munson Medical Center in Traverse City HWE practice standards influence my nursing practice by ensuring the six standards noted by AACN. I use skilled communication by speaking the language that the person I am talking to is able to understand. I work as a team member to ensure our patients get the highest quality of care that they deserve and my employer demands. I recognize my fellow employee every day for the great and over the top care that they give to the patients unselfishly. I speak up when I feel the assignment is not appropriate for a nurse or team and inform the charge nurse of any significant changes in my patient so they can make safe assignments for the next shift.

24. 23 Amy Gagne, RN In my current practice area of NTICU (Neuro Trauma Intensive Care Unit), at Covenant, HWE (Healthy Work Environment) practice standards influence my nursing practice by the committees that I am on. My favorite committee is the Evidence Based Nursing Practice Committee. Everyone works as a team to find the most up to date information on what policies we carry in the hospital and we have very strong bonds. Patient care is definitely a priority and everyone on the committee has fun doing what we do because it benefits the patient and we have good outcomes from it.

25. 24 Gary Webster, RN In the OR at Memorial we utilize the concepts of Healthy Work Environment (HWE) everyday. We have weekly staff meetings for addressing educational needs, communicating changes to policies and/or procedure and voicing any concerns that have arisen. We collaborate among the surgical staff in the rooms as well as with the pre and post operative staff for patient care. Additionally we collaborate with the emergency room staff and intensive care staff for our trauma patients. Staffing needs are evaluated and adjusted on a case to case basis to place staff according to knowledge base to provide the best care possible. We have an open, written peer to peer staff recognition board that is posted in our lounge for all to see and use. Finally we have several interdisciplinary committees such as the Shared Governance Committee that assess any leadership or policy concerns. The committee has representatives from multiple disciplines to prevent any aspect of patient care being overlooked.

26. Michelle Wronski, RN How does HWE apply to my current practice? A healthy work environment is extremely important in that if I do not feel comfortable in my work environment then it makes my job that much harder. I currently work in Hospice and at times my position is stressful. With the added stress of an difficult work environment it will pull away from my time and energy I need to give to my patients and families. My families and patients are my primary focus and if I can't give them all they need at such a difficult time in their lives I would feel like I have failed as a nurse for them.

27. 25 Remember... Celebrate Successes along the way Positive Feedback Positive Encouragement Potlucks Kindness Francine Nesheim, RN

28. 26 References American Association of Critical-Care Nurses (2005). AACN Standards for establishing and sustaining Healthy Work Environments. Retrieved from http://www.aacn.org/WD/Practice/Content/standards.content?menu=Pr actice# Blake, N. (2012). Practical Steps for Implementing Healthy Work Environments. American Association for Critical Care Nurses. 23, 1 p. 14-17, doi: 10.1097/NCI.0b013e318240a44e Clevenger, K. (2008). Promote a healthy work environment with meaningful recognition. Nurse Manage, 39, (10), 8. doi: 10.1097/01.NUMA.0000338301.95007.cf Kerfoot, K.M., Garrick, R., Israel, M. (2007, April). Creating healthy work environments: Appropriate staffing. Chest Physicians: American College of Chest Physicians. Retrieved fromhttp://www.chestnet.org/downloads/about/chestPhysician/0407.pdf

29. 27 References Continued Kupperschmidt, B., Kientz, E., Ward, J., Reinholz, B., (2010). A healthy work environment: It begins with you. The Online Journal of Issues in Nursing, 15(1), 3. doi: 10.3912/OJIN.Vol15No01Man03 McKinney, Michael (2012, March 12) The 11 essential elements needed to achieve true collaboration [Blog post]. Retrieved from http://www.leadershipnow.com/leadingblog/2012/03/the_11_essential_el ments_need.html Sherman, R., & Pross E. (2010). Growing Future Nurse Leaders to Build and Sustain Healthy Work Environments at the Unit Level. The Online Journal of Issues in Nursing 15(1). Retrieved from http://www.medscape.com/viewarticle/723409 Vollers, D., Hill, E., Roberts, C., Dambaugh, L., & Brenner, Z. (2009) AACN's Healthy Work Environment Standards and an empowering nurse advancement system. Critical Care Nurse. 29, 20-27. doi: 10.4037/ccn2009263