Implementing AACN’s Healthy Work Environment Framework in an Intensive Care Unit

Abstract

Background Bedside nurse turnover in the United States is 15.9%, representing a national challenge that has been attributed to poor work environments. Healthy work environments are associated with improved nurse satisfaction and retention as well as positive patient outcomes; unhealthy work environments have the opposite effects. Objectives To implement the American Association of Critical-Care Nurses (AACN) healthy work environment (HWE) framework in an intensive care unit and to evaluate staff satisfaction, turnover, and tenure 2 years later. Methods A pre-post study design was used to evaluate implementation of the HWE framework in an intensive care unit in a large academic medical facility. Interventions for each of the 6 HWE standards were performed. The AACN HWE assessment survey was used to measure skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership in 2017 and in 2019. Results Nurse cohorts (n = 165 in 2017; n = 176 in 2019) had a mean age of 31 (median, 27; range, 23-63) years, were predominantly female (76%), and had a mean of 5 (median, 3) years of intensive care unit nursing experience. Statistically significant improvements were found in all standards except the skilled communication and overall measures. Registered nurse turnover remained stable and tenure increased by 79 days in this 2-year period. Conclusions Findings from this study suggest that interventions addressing the HWE standards are associated with improved staff satisfaction, turnover, and average tenure, further demonstrating the value of the HWE framework in improving retention.

Association of burnout and intention-to-leave the profession with work environment: A nationwide cross-sectional study among Belgian intensive care nurses after two years of pandemic

“…Second, hospitals with a better working environment, even in times of pandemic, have better results for the risk of burnout and intention-to-leave the job and profession than hospitals with a worse environment. This association has already been demonstrated in other studies and it seems that hospitals with a better work environment are better able to protect the wellbeing of nurses even in times of high stress (Alharbi et al, 2020;Kester et al, 2021;Lake et al, 2022;Sermeus et al, 2011;Van den Heede et al, 2019;Wei et al, 2018).…”

“…There is a large body of evidence that shows that nurse workload, the quality of the work environment, and patient care demands influence patient outcomes (Cho et al, 2015;Lake et al, 2020;Simonetti et al, 2021). A study in the United States (US) found that interventions that aim to provide better work environment standards (e.g., true collaboration, authentic leadership, collaboration, effective decision making, appropriate staffing, meaningful recognition) are associated with improved employee satisfaction, turnover, and average job tenure among ICU nurses (Kester et al, 2021).…”

Evaluating the Health of the Work Environment and the Perception of New Nurses During the Transition to Practice in Critical Care

“…This is based on the intention of nurses to stay in their current position, nurses remaining in the profession postpandemic, and the need for authentic leadership. 23,24 This study contributes to the evolving body of nursing knowledge. It has provided a more detailed understanding of the health of the work environment and perceptions of new nurses during the transition to practice.…”

“…Staffing has been identified as one of health care's most important and complex issues. 22,23 Although some immediate opportunities are within the frontline manager's control, staffing is a broader issue that must be addressed nationally. The National Staffing Think Tank is 1 broad-scale initiative that is working to identify priorities and practical strategies to inform the focus of future initiatives.…”

“…The National Staffing Think Tank is 1 broad-scale initiative that is working to identify priorities and practical strategies to inform the focus of future initiatives. 22,23 Interestingly, scores on the HWEAT were lower among certified nurses in certain areas. This may represent a greater understanding of the HWE standards among certified nurses and their insight into areas of opportunity that may not be apparent to noncertified nurses.…”