To Have a Healthy Work Environment, Mind the Gap


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Staffing. Burnout. Retention. Quality. You don’t often speak to direct care nurses or nurse managers about their units without these common themes emerging. They’re all elements associated with the health of the nursing work environment — a topic that the American Association of Critical-Care Nurses (AACN) has been studying for over a decade. 

Last year, AACN conducted an online survey of more than 8,000 nurses to collect data about the health of their work environments and how it affects patient and nurse outcomes. 

AACN’s survey revealed positive associations between implementing AACN’s six healthy work environment (HWE) standards and outcomes like patient care quality, staffing and nurse retention. 



The survey also uncovered a gap in perception between how nurse managers feel about the health of their work environment and how direct care nurses feel. There’s also a difference in their awareness of AACN’s HWE standards and whether they believe these standards are implemented on their unit. 
  • Just 42% of direct care nurse respondents rated patient care quality in the work unit as excellent, compared to 60% of nurse managers.
  • Only 54% of direct care nurse respondents were aware of AACN’s HWE standards, while nearly 75% of nurse managers were aware of them. 
  • 22% of direct care nurses reported that HWE standards are implemented on their unit, compared with 32% of nurse managers. 

Why the Gap?

After examining the data and analyzing my own experience as a former nurse manager, I suspect it’s because of different accountabilities.

Direct care nurses have a frontline perspective. They focus on how they’re taking care of patients and their families, the day-to-day activities of the unit and how events and challenges influence their daily patient care decisions. They’re immediately impacted by staff shortages, high nurse-to-patient ratios and nurse turnover. 
Conversely, nurse managers need to have more of an umbrella view. In addition to trying to meet the needs of their staff, they look at the health of their work environment in relation to the organization, while assuring that they meet fiscal responsibilities and expected quality measures.

In other words, direct care nurses are trying to assist patients through their recovery, and managers are busy ensuring that the unit thrives.

A Place to Start

All workplaces can be healthy, but improvements require an understanding of the factors that contribute to unhealthy work environments, as well as a commitment to embracing solutions. A step-by-step approach can guide your team, unit or organization. 

You can start by:

1. Fostering mutual understanding: The HWE standards of meaningful recognition and skilled communication can make an impact here. In an environment that embraces the value of meaningful recognition, both leaders and team members understand that everyone is responsible for playing an active role in the organization’s recognition programs and meaningfully acknowledging contributions. In addition, skilled communicators focus on finding solutions and achieving desirable outcomes. These are ways to share what it’s like to stand in each other’s shoes.

2. Leveraging the power of nurse managers. The nurse manager position is very influential. They have one of the toughest positions, because they need to serve the needs of the nurses, patients and families in the unit while meeting the objectives of the executive team. Nurse managers should team with direct care nurses to mutually and objectively evaluate the impact of leadership processes and decisions on the organization’s progress toward creating and sustaining a healthy work environment.

3. Empowering the staff: Managers can empower staff through unit-based councils, staff meetings and one-on-one meetings. They help people be open and transparent about what is going on in the unit so the entire team is onboard with a solid understanding of the unit’s goals, needs and direction.

After all, building and sustaining an HWE is everyone’s responsibility, and collaboration is key. Direct care nurses can’t do it alone, nurse managers can’t do it alone. It has to be a partnership. 

Are you ready to learn more? You can dive into our survey results, download AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence or explore AACN’s free HWE assessment tool. Answer a few questions, and your unit’s assessment survey tool is ready to use.

Published on : Mon, 13 Jan 2020



burnout, staffing, American Association of Critical Care Nurses, AACN, retention, quality A recent survey by American Association of Critical-Care Nurses evaluates AACN's six healthy work environment standards and their impact on care quality, staffing and nurse retention.

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