Tackling Issues in the Work Environment: The role of Healthy Work Environments Best Practice Guidelines

1. Tackling Issues in the Work Environment:The role of Healthy Work Environments Best Practice Guidelines Irmajean Bajnok, RN, PhD – Director, International Affairs and Best Practice Guidelines Program & Centre for Professional Nursing Excellence Registered Nurses’ Association of Ontario June 4, 2009 Nurses’ Association of New Brunswick

2. Presentation Overview To describe the background to the HWE BPG Program, including a conceptual framework for healthy work environments To briefly discuss the HWE guidelines with a focus on teamwork and staffing To discuss background and results from the HWE BPG Pilot Evaluation To Share specific HWE BPG implementation successes

3. What is a healthy work environment for nurses? “A healthy work environment for nurses is a practice setting that maximizes the health and well-being of nurses, quality patient outcomes and organizational and system performance”.

4. Why Develop HWE BPGs? Recruitment and retention Nurses’ environments and patient and system outcomes Evidence based management practice

5. Principles for Guideline Development Strongest evidence available Systematic reviews by JBI Level of evidence identified Semi-annual literature review & semi-annual internet search Overall review at least every five years Meaningful to practicing nurses Relevant to all nurses Commonly defined terms & definitions

6. Project Objectives Increase awareness of HWE elements Assist nurses in creating HWEs Provide stakeholders with HWE strategies Achieve sustainable outcomes

7. Target Audience for HWE Guidelines Nurses in all roles Interdisciplinary Team Members Non-nursing Administrators, Policy makers and Governments Professional Organizations and Labour Groups Public

8. GUIDING FRAMEWORKS Clinical BPG MethodologyConceptual Model for Healthy Work Environment

9. Planning Guideline Choice Development Expert panel Systematic Review Best Practice Guidelines Methodology Draft Guideline Stakeholder Review Revision & Finalize Dissemination Implementation

10. HWE BPG Guideline Recommendations Individual Recommendations System Recommendations Organization/Team Recommendations

11. Office of Nursing Policy

12. Underlying Assumptions of Model HWEs basic to quality, safe patient care Model applies to all settings & roles in nursing Outcomes affected by individual factors or combinations of factors Professional/occupational components unique to each profession; other components generic for all professions/occupations

13. Physical/Structural Policy Components External Policy Factors Legislative, trade, economic & political influences external to the organization Organizational/Physical Factors Physical characteristics & environment of organization Organizational structures & processes created to respond to physical work characteristics & demands Physical Work Demand Factors Require physical capabilities & effort External Policy Factors Organization/Physical Factors Physical Work Demand Factors Nurse Patient Organizational Societal Outcomes

14. Cognitive/Psycho/Socio Cultural Components Individual Cognitive/Psycho/Social Work Demand Factors Require cognitive, psychological and social capabilities & effort (e.g. problem solving, effective coping skills, communication skills) Organizational Social Factors Organizational climate, culture & values External Socio-cultural Factors Consumer trends, care preferences, family roles, diversity of the population & providers, changing demographics Individual Cognitive/ Psycho/Social Work Demand Factors Nurse Patient Organizational Societal Outcomes Organizational Social Factors External Socio-Cultural Factors

15. Professional/Occupational Components Individual Nurse Factors Personal skills, knowledge & attributes which determine response to work demands Organizational Professional/ Occupational Factors Nature & role of the profession/ occupation (e.g. level of autonomy scope of practice) External Professional/Occupational Factors Policies and regulations (e.g. standards of practice, certification, ethical recruitment) Nurse Patient Organizational Societal Outcomes Individual Nurse Factors Organizational Professional Occupational Factors External Professional Occupational Factors

16. Evaluation of Guidelines Draft Guideline – Stakeholder Review Process Evaluation for Panel Pilot Evaluation: Implementation Broad System Uptake

17. Implementation Strategies Individual (Champions, conference, Institutes) Organizational (BPSOs, ACPFs) System Provincial National International Goal is to support nurses as Knowledge Professionals.

18. Six Foundational HWE BPG Guidelines Developing & Sustaining Nursing Leadership Chair: Dr. Heather Laschinger Developing & Sustaining Effective Staffing and Workload Practices Chair: Dr. Linda O’Brien-Pallas Embracing Cultural Diversity in Health Care Chair: Rani Srivastava Professionalism in Nursing Chair: Dr. Andrea Baumann Collaborative Practice Among Nursing Teams Co-chairs: Dr. Diane Doran & Leslie Vincent Workplace Health, Safety and Well-being of the Nurse Chair: Dr. Mary Ferguson-Paré

19. Guidelines Nearing Completion Preventing and Managing Violence in the Workplace Practice Education in Nursing Guidelines In Progress • Preventing Nurse Fatigue in Health Care • Interprofessional Collaboration in Health-Care Future Guidelines • Managing Conflict in Health-Care Teams

20. THE HWE GUIDELINES

21. CONCEPTUAL MODEL FOR DEVELOPING & SUSTAINING NURSING LEADERSHIP Broad External Factors Sociocultural Context Professional/Occupational Context • Organizational Supports • Valuing of • Professional Nursing • Human Resources • Information/Decision • Support Transformational Leadership Practices Building relationships and trust Creating an empowering work environment • Healthy Outcomes • Nurse • Patient/Client • Organization • System influence influence Creating an environment that supports knowledge development and integration • Personal Resources • Professional Identity • Individual Attributes • Leadership Expertise • Social Supports Leading and sustaining change Balancing competing values and priorities

22. Embracing Cultural Diversity in Health Care: Developing Cultural Competence Diversity is MORE than: An immigrant issue A color issue A language / religion issue It is about differences in values, beliefs, worldviews, and access to resources

23. Professionalism in Nursing • Consists of ….. • eight evidence-informed attributes of professionalism • organizational characteristics that support effective professional practices • successful strategies for enabling professional behaviours

24. Purpose: Provides organizational systems and supports required Promotes the importance of fostering a climate and culture which supports the promotion of health, well-being and safety of nurses Describes impacts→ patient safety and satisfaction Workplace Health, Safety and Well-being of the Nurse 24

25. Collaborative Practice Among Nursing Teams Nurses within the Context of the Inter-Professional Team • Nurses practice in and contribute to the context of an inter-professional work environment involving many professionals. Although we recognize the interprofessional nature of our work, the focus of this guideline is to help you on the journey to excellence in teamwork within nursing, embedded in the larger context of the interprofessional environment. 

26. Where Does Collaboration Occur Among Nursing Teams? • Collaboration occurs: • communicating patient information • planning care • intervening • assistance with procedures • unit/ team management • monitoring team activity • ….and much more

27. Recommendations • Individual • Team • Organization • System

28. Model of The Patient Care Delivery Systems Factors that Affect Staffing and Workload H E A L T H Y W O R K I N G E N V I R O N M E N T INPUTS THROUGHPUTS OUTPUTS • Patient/Client Characteristics • Provider Characteristics • Nursing • System Characteristics • System Behaviors • Patient/Client Characteristics • Provider Characteristics • Nursing • System Characteristics • System Behaviors Nursing Care Processes Environmental Complexity Factors • Patient/Client Outcomes • Provider Outcomes • Nursing • System Outcomes Source: Evidence Based Standards for Measuring Nurse Staffing and Performance (O’Brien-Pallas et al, 2004)

29. Staffing levels and schedules support the delivery of safe, effective and ethical nursing care including: Providing sufficient levels of appropriately skilled nurses to meet client care requirements Maximizing continuity of care and caregiver Enhancing the stability of the nursing profession by maximizing the number of permanent (full-time and part-time) positions Developing schedules and rotations to meet the baseline workload requirements Workload & Staffing Principles

30. Staffing levels and schedules support the delivery of safe, effective and ethical nursing care, including: Providing mechanisms and staffing to meet fluctuating patient/client acuity and workload, as well as replacement Being responsive to staff work-life considerations and the impact on recruitment and retention Being efficient from a cost perspective, including minimizing the use of overtime and agency staffing Being perceived as fair and equitable by all categories of nursing staff Complying with relevant collective agreements, organizational policies, scopes of practice Workload & Staffing Principles 30

31. Recommendations Framework Overall Commitment of Organization to Workload and Staffing & Involvement of Nursing at the Senior Level Organizational Level Workload Considerations as Part of all Strategic & Contingency Planning Using Input from Nursing in All Roles Strategic Staffing Decisions Tactical Staffing Decisions Logistical Staffing Decisions Operational Level Governments Standards, Research, Ethical System Level 31

32. HGHLIGHTS OF PILOT EVALUATION AND RESULTS

33. Pilot Implementation Evaluation Eight (8) Pilot sites in Ontario Centre for Addiction & Mental Health Headwaters Health Centre Kingston General Hospital & Hotel Dieu Hospital Queensway Carleton Hospital Saint Elizabeth Health Care Sunnybrook Health Sciences Centre William Osler Health Centre York Central Hospital Evaluation of Implementation of guidelines Evaluation of effectiveness of recommendations

34. Nurse Survey Findings Pre-Implementation 3 Months Post-Implementation: Overview of results 6 Months Post-Implementation Overview of Results

35. Implementation Makes a Difference Of the Total 101 Individual Nurse Recommendations Across HWE BPGs: 80% increased in presence in nursing work environments and nursing practice from pre-implementation to 6 months post-implementation

36. Nurses Reported….

38. Using the HWE BPGs

39. Continue to Apply and Worth

40. Key Trends Nurses value all elements of healthy work environments A focus on implementing the recommendations makes a difference for nurses Nurses also perceive patients receive better care Recommendations were a fit with the workplace context Nurses indicate they will continue to focus on the elements of a healthy work environment

41. How the Guidelines Can be Used Start with what fits the culture Assessment of current practices & policies Competency/performance assessment Design of organizational development programs Assess system gaps & discuss evidenced based strategies

42. Collaborative Practice Success Story Taking Ownership of Team Challenges Affecting Workload

43. WE DID IT and IT WORKED!! Workload and Staffing Success Story

44. Collaborative Practice Success Story Opening Up a “Closed” Unit

45. Collaborative Practice Success Story TACKLING A TOXIC TEAM

46. NON NURSING WORK EASES THE WORKLOAD PRESSURE Workload and Staffing Success Story

47. Key Points for Success • Engage Staff • Create a vision & communicate to all • standing agenda item on committees • Link to strategic planning • Support of senior admin • Ensure strong leadership • designated coordinator • Engage the Nurse Managers • ensure adequate staffing/replacement • Share and celebrate successes!

48. What have we learned? This is a very important area to nurses and to our patients We made this area important to governments and other policy makers We have different types of evidence for these guidelines, and there are gaps in the research This work is possible and critical if we want to achieve nursing excellence

49. Healthy Work Environment Best Practice Guidelines:Enable Evidence Based Management Decision Making for Quality of Care and Quality Of Work LifeThey Do Make the Difference!

50. Questions and Discussion