Creating a Healthy Work Environment

Abstract

Over the past year, I have become acquainted with the American Association of Critical-Care Nurses’ Standards for Establishing and Sustaining Healthy Work Environments (www.aacn.org/hwe) as our manager and staff strive to make our critical care units better places to work. I am a staff nurse and can already see the changes taking place in unit morale and staff retention.Our hospital has 2 critical care units that are separate from one another but share the same manager, educator, and clinical nurse specialist. One unit is a 15-bed intensive care unit (ICU) with medical-surgical-neurological patients. The other unit is an 18-bed adult critical care (ACC) unit—it was originally a progressive care unit but now the staff have been educated and trained to care for ICU patients. Staffing the 2 units requires a number of nurses and, consequently, we have many different personalities and skill levels providing nursing care for patients, in 2 distinct, high-stress environments.The ICU primarily deals with higher acuity patients and the ACC unit deals with more patient demands because a significant number of the ACC patients do not receive mechanical ventilation nor do they require the same level of care. Patient turnover is high, especially in the ACC unit, and the acuity is high enough on the ICU that frequently nurses on both units are not able to take lunch breaks. Adding to the complex, stressful environment is the reality that the 2 units will be merged into 1 unit within the next 5 years upon the completion of a new building at our suburban campus.In our shared governance committee, nurses, physicians, and other health care professionals can discuss problems and celebrations. The physicians, for the most part, have high regard for the nurses and vice versa. However, we needed to do more to ensure a healthy work environment for our staff. Our manager noticed that morale was low and that there was poor communication among employees and low satisfaction among the staff, particularly nurses. In order to help solve this problem, and to ease the transition to one combined unit, she suggested and helped us implement several strategies to make our work environment healthier.First, we started a healthy work environment committee, which meets monthly to discuss ways to raise staff morale. The committee plans monthly birthday celebrations and decides on ways to honor the nurses during nurse’s week. The hospital as a whole honors its nurses, but we believe it is important to recognize our critical care nurses, specifically. The committee also designs the interactive bulletin boards in the staff break rooms, deciding on specific themes to join the units. These bulletin boards often ask the staff to create something such as Valentine or Secret Easter Bunny treat bags. Sometimes the committee posts questions on the bulletin boards, such as “What do you love?” for February’s board or “What do you want for Christmas?” in December; the staff write their thoughts on corresponding die-cuts and post them on the boards for everyone to see. So far, there has been a good response, with many staff members expressing their creative side designing treat bags, as well as giving insight into their personal world with their responses to the questions.Each month, the committee votes for 2 “Stars of the Month.” The nominations are made by staff members, for colleagues who have gone above and beyond their job expectations to help others or to provide quality care. The nominations are blinded and then forwarded to the committee by our manager. Multiple nominations for the same employee are stapled together to prevent the committee from choosing the same employee twice. The committee reads the nomination forms and then decides which 2 nominations are most deserving of the award that month. The recipients of the “Star of the Month” award are then presented a prize (eg, movie tickets, Starbucks gift cards, or free meal passes for the hospital cafeteria). Our first vote was held in early April and we expect this award to gain momentum as staff sees the quality work that others around them are doing.We have also begun a monthly nursing-focused newsletter. It contains important information from our clinical nurse specialist and clinical educator, such as how to better prevent ventilator-associated pneumonia, central catheter blood stream infections, and catheter-associated urinary tract infections, and nursing-related jokes and cartoons. In an attempt to encourage our clinical competence and help more nurses earn their certifications, we also include CCRN/PCCN review questions in each newsletter.The newsletter contains a monthly section welcoming new and transferring staff to the units, as well as acknowledging accomplishments, such as earning certifications. Although the newsletter is not primarily staff driven, the response has been overwhelmingly positive; staff members repeatedly say how much they enjoy the newsletter and ask when the next issue will come out.Retention among our nurses has also not been high, with many new graduates coming to our hospital and orienting on our critical care units and then quickly finding a new job outside of our hospital system. To help solve this problem, we offer a long critical care internship, with new hires attending a lengthy classroom course focused on the Essentials of Critical Care Orientation, followed by an individualized orientation period. During the classroom time, the orientees are taught many of the clinical skills that they will need to function adequately as a critical care nurse. The new employees are paired with an experienced nurse who shows them the clinical skills in practice. This “practice time” on the unit allows the nurses to try out their new skills while being overseen by an experienced critical care nurse who can coach and guide them as they gain practice and knowledge.Our hospital also has a formal mentor program, to help improve nursing retention. In this program, one experienced staff member is paired with an inexperienced staff member from another shift, such as a weekend-option employee being matched with a weekday employee. The mentors offer coaching and career guidance, as well as provide a sounding board for the protégés. The protégés are given a “safe place” to talk when things are not going well on their shift, someone who can assist in solving problems, and a coach to help them in their clinical and professional skill development as well as to offer career guidance. The goal with this program is to prevent some of the issues that cause staff to leave, such as believing that no one cares what they think, that they are “not capable enough,” and simply resolving personality differences between staff members. We have started encouraging the critical care nurses to apply to this program, and so far the response has been good. More experienced nurses are eager to meet other staff that they might not otherwise associate with, and newer staff is eager to have someone off whom to bounce their ideas.As a result of these changes, the attitudes of the staff have begun to change. I now see more people smiling when they arrive on the units for work, and as people begin to get to know one another better, the amount of teamwork done has increased. Nurses no longer grudgingly help their colleagues. The atmosphere of the units has begun to change as well, from one of “why bother” to “we can do it!” I can see the results of the changes that are being made, and I feel that our units are well on their way toward being truly healthy work environments.“In Our Unit” highlights unique practices, innovations, research, or resourceful solutions to commonly encountered problems in critical care areas and settings where critically ill patients are cared for. If you have an idea for an upcoming “In Our Unit,” send it to Critical Care Nurse, 101 Columbia, Aliso Viejo, CA 92656; fax, (949) 362-2049; e-mail, [email protected].