It is well known that many U.S. healthcare organizations face a significant nurse staffing challenge, and as leaders and administrators seek solutions, we must emphasize an essential element of nurse recruitment and retention — establishing and sustaining healthy work environments (HWEs).
The most recent “National Nurse Work Environments” study, conducted in 2021 by the American Association of Critical-Care Nurses (AACN), shows that the health of nurse work environments across the country has declined dramatically. In that study, 67% of nurses reported plans to leave their current positions due to high levels of job dissatisfaction, moral distress, and inappropriate staffing. For this reason alone, it is well past time for organizations to address this HWE challenge.
Fortunately, implementing “AACN Standards for Establishing and Sustaining Healthy Work Environments” (HWE standards) effectively increases nurse retention and job satisfaction while improving patient, nurse, and hospital outcomes.
What Are the AACN HWE Standards?
The HWE standards are Skilled Communication, True Collaboration, Effective Decision-Making, Appropriate Staffing, Meaningful Recognition, and Authentic Leadership. The standards offer an evidence-based approach to creating a healthier work environment. AACN’s study results indicate teams that have implemented these standards (even those that just started the work) report better results than those that did not implement them:
Teams that Implemented the HWE Standards:
- Report higher nurse well-being scores
- Indicate greater job satisfaction
- Experience less moral distress
- Are less likely to leave their current position
- Report improved staffing with an appropriate skill mix
- Report higher quality of patient care
- Score higher on every HWE standard
Why Is an HWE So Important?
In addition to AACN’s 2021 study findings, a significant body of research underlines the importance of healthy nurse work environments. A meta-analysis by Lake, et al and a systematic review completed by Wei and colleagues are just two examples of research that supports the correlation between HWEs and positive patient, nurse, and hospital outcomes. From the mounting research that now spans nearly two decades, we know the following:
Nurses Who Work in HWEs:
- Report increased job satisfaction
- Describe less missed or delayed patient care
- Report lower levels of burnout and compassion fatigue
- Are more likely to stay in their current job
- Report less staff turnover
- Report high levels of engagement
Patients Cared for in HWEs:
- Experience less mortality and failure to rescue
- Have better survival rates from in-hospital cardiac arrest
- Encounter fewer hospital-acquired conditions and adverse events
- Are better informed and prepared for discharge
- Encounter fewer readmissions
- Report better overall quality of care
- Have decreased length of stay
Hospital Systems with HWEs:
- Report better quality outcomes
- Achieve higher reimbursement rates (as a result of positive outcomes)
- Have better patient and nurse satisfaction scores
- Increase business – more patients and higher profits
- Indicate lower rates of nurse turnover
- Have fewer sick calls
Bold Action Is Required
Without immediate and bold action, work environments may worsen, which will further imperil our national healthcare system. Responses from the more than 9,000 nurses who answered AACN’s 2021 survey indicated significant declines in the health of the work environment compared with AACN’s previous 2018 survey:
Nurse Well-being Declined
- Nearly 40% of RNs rate their emotional health poorly.
- 52.8% of RNs report that their organization does NOT value their health and safety.
- 48% of RNs report feeling moral distress either “frequently” or “very frequently.”
- The number of RNs experiencing moral distress “very frequently” doubled from 11% in 2018 to 22% in 2021.
- 72% of RNs report having experienced at least one form of abuse (verbal, physical, discrimination, or sexual harassment).
Quality of Care Decreased
- The perception of “good” or “excellent” quality of care has fallen 13 percentage points since 2018.
- 53% of RNs report that the overall quality of care has declined.
- The number of RNs who report the quality of care has become “somewhat worse” or “much worse” grew by 16 percentage points.
Staffing is a Problem
- Only 46% of RNs report their unit ensures an effective match between patient needs and nurse competencies.
- Just 25% of RNs report being appropriately staffed on a regular basis.
- Ratings on the Appropriate Staffing standard fell 15 percentage points since 2018.
Job Satisfaction Fell
- Job satisfaction decreased by 18 percentage points since 2018.
- Satisfaction with the nursing profession fell for the first time (only 76% of RNs reporting satisfaction with being an RN compared with 92% in 2018).
- 67% of RNs plan to leave their current positions in the next three years, compared with 54% in 2018.
- Of those RNs planning to leave, 82% report adequate staffing would make them reconsider.
Take the First Step
The first step to remedy these issues is to assess the work environment using the AACN Healthy Work Environment Assessment Tool (HWEAT). Recently updated to provide a more informative analysis, the new assessment tool highlights unit and organizational influences on the work environment and dives deeply into each of the six standards. The free assessment features 24 web-based questions, takes less than 15 minutes, and comes with a department report with national benchmarking data and a comprehensive toolkit to guide the next steps. Gathering assessment baseline information in this way helps identify department strengths and opportunities while enabling the team to track progress over time.
Review the report as a team, and develop an implementation plan to ensure everyone’s voice is heard. This procedure is key to engaging team members and driving meaningful change.
A Call to Action
Establishing HWEs is everyone’s responsibility. The work is not easy, but the benefits of doing so are increasingly clear, as are the consequences of inaction. When nurses work in unhealthy environments, patient and family outcomes, nurse well-being, and staff retention decline. With a national nursing shortage projected to be from 200,000 to 450,000 nurses by 2025, the viability of our healthcare system is at stake. It’s time for everyone to begin this important work.
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