Healthy Work Environment Standards: Is Your Unit Up To Par?
Beth Ulrich, EdD, RN, CHE, FAAN, Editor

The Board of Directors of ANNA recently endorsed the Healthy Work Environment (HWE) Standards developed by the American Association of Critical-Care Nurses (AACN). These standards are described in JoAnne Gilmore’s President’s Message in this issue of Nephrology Nursing Journal.

I have had the privilege over the last 5 years of working on a series of national surveys of RNs that address the status of nursing work environments and, this past year, of serving as the co-investigator of a national survey of critical care nurses to determine the status of critical care work environments 1 year after the implementation of the AACN standards. These surveys have all asked RNs themselves how they view the environments in which they work.

What We’ve Learned
What we learned in the series of national studies is that in many organizations the work environment is getting better. It’s not always great and there are many opportunities for improvement, but it is, in general, better. In studying the results of the surveys, some basic questions surface that need to be asked to determine the health of any nursing work environment. You might find them helpful as you assess the environment in which you work or an environment in which you are considering working.

How Does Your Work Environment Rate?

• Communication & Collaboration: Do RNs communicate and collaborate with each other? With physicians? With other members of the healthcare team? What happens when you disagree? Is there a formal resolution process?
• Decision-Making: Do RNs have substantive opportunities to participate in decision making, especially where patient care is concerned? When you have ideas on improving patient care or the work environment, does someone listen and pay attention?
• Respect: Do RNs feel respected by the people with whom they work? What indicates respect?
• Abuse and Disrespectful Behavior: Does the organization have a zero tolerance policy? Is it followed? Is verbal abuse and physical abuse tolerated? What about sexual harassment and discrimination? Do you feel safe at work?
• Staffing: Is there an adequate staff (number, competence, and available time) to meet the needs of the patients and the organization? Are staffing policies (time off, floating, etc.) fairly administered? Are you able to get all your work done – the work that requires your knowledge and critical synthesis skills    as well as the simpler task work? Are theright people being hired when vacanciesoccur? Do they get oriented properly?Professional Development: Does the organization provide either directly or through the funding of attendance at outside programs the continued professional development of RNs including continuing education and formal education? Does the organization support nursing specialty certification and recertification?
• Recognition: Are RNs recognized in a way that is meaningful to them for their accomplishments and work well done?
• Leadership and Management Competence: How competent are your frontline manager and administrator? Do they support and create Healthy Work Environments?
•  Excellence: Does the organization support excellence in practice? Are patient care practices evidence-based? Is excellence rewarded?

Summary
Every RN should be able to work in a safe and healthy environment. Certainly, much of the foundation for such an environment rests with an organization’s leadership. But it takes the commitment of every RN to make it happen 24/7.

If you did a mini-assessment on your current work environment using the questions above and found it wanting, you have choices to make. First, do you stay silent or do you move the issue forward and seek change? Second, if you advocate for and try to drive change and it doesn’t work, do you stay or do you go? Healthy work environments for nurses will only become the norm if nurses refuse to settle for less.

Beth Ulrich, EdD, RN, CHE, FAAN
Editor
E-mail: BethUlrich@aol.com