A Healthy Work Environment: Essential in Providing Quality Health Care Kimberly Lett DeVry University ENGL135: Advanced Composition Fall term 2010 A Healthy Work Environment: Essential in Providing Quality Health Care The delivery of healthcare has evolved and changed over the years and with the advances in science and technology, the ability to provide safe, quality care to all patients has been impacted by the changes.
With the rising healthcare costs and decrease in reimbursement for care provided, organizations must look for ways of cost containment to maintain viability for the future. Fabre (2005) noted that administrators are struggling to maintain financial stability and retain competent nurses during these difficult financial times. Organizations are being evaluated and reimbursed based on their patient care outcomes; as such the nurse’s role is critical in helping to identify potential safety risks to patients and the prevention of medical errors. As hospitals have responded to financial pressure from Medicare, managed care , and other private payers, registered nurses have become increasingly dissatisfied with the working conditions in hospitals” (Fabre, 2005, p. 20). One of the many challenges in healthcare today, is the need for organizations to recognize and facilitate the improvement of the work environment. The need for competent, qualified nurses in any organization is imperative for providing safe, quality care to the clients. For this reason the critical role that nurses have in providing patient safety should not be underestimated.
The Institute of Medicine (2004) reported “ research is now beginning to document what physicians, patients, other healthcare providers, and nurses themselves have long known: how well we are cared for by nurses affects our health, and sometimes can be a matter of life or death” (p. 2). The importance of a healthy work environment has been recognized as a key component in maximizing organizational performance, contributing to a decrease in the nursing shortage within an organization and is vital in providing quality care to the clients they serve.
The growing concern for the nursing shortage continues to be a major issue affecting the profession and attention is being given to the stressful nature of the work environment. Several national surveys were completed in 2002 and 2004, identifying reasons for the ongoing nursing shortage, one of the major concerns centered on the work environment (Florida Center of Nursing, 2006). Organizations are looking at ways of restructuring the work environment, enabling staff nurses the opportunity to participate in decisions that impact their ability to practice.
McDonald, Tullai-McGuinness, Madigan, and Shively (2010) remarked that workplaces that have a supportive work environment have noted success in recruitment and retention of their work force, citing an increase in job satisfaction and improved patient outcomes. With nurses making up the largest percentage of professionals working in a hospital setting, organizations now recognize the importance of the nurses’ role and measures to improve the workplace are being developed.
Lowe (2002) noted “ diagnosing the extent of work environment problems in healthcare is the first step in designing strategies to improve the quality of healthcare workplaces” (p. 49). Hospitals looking to improve on the work environment must first have an understanding of the nurses’ perception of their workplace environment. Kramer and Schmalenberg (2008) noted “the perspective of clinical nurses at the front line as to what constitutes a healthy work environment is essential if interventions to improve practice environments in hospitals are to be implemented” (p. 57).
Once an organization is able to identify distinctive characteristics that have an impact on staff and their environment, they are then able to proceed in developing strategies to improve the work culture. All members of the healthcare team, including staff, management,
To help facilitate and guide organizations, professional groups have designed several programs available for their use in fostering a healthy work environment (Florida Center of Nursing, 2006). The American Nurses Credentialing Center (ACNN) sponsors the Magnet Recognition Program, which focuses on the development of nursing practices and evaluates the environment where nursing is practiced. This program is well recognized by organizations throughout the country, as the Magnet Journey and is considered to be one of the highest achievements that organizations can obtain (Broom, & Tilbury, 2007).
Organizations that strive to achieve the Magnet designation, acknowledge the link between a healthy work environment and the development of an organization of nursing excellence. Hospitals utilizing the Magnet concept demonstrate the following characteristics; (a) authentic leadership, (b) skilled communication, (c) effective decision making, (d) quality patient care processes, (e) collaboration and teamwork among all healthcare workers, (f) professional growth and accountability, (g) clinically competent staff and (h) adequate staffing levels (Shirey, 2006).
All the above components are essential and linked to the effectiveness of a quality work culture. An online survey of clinical nurses, conducted by the AACN, were asked to identify factors that had an impact on their satisfaction with nursing as well as potential reasons that might cause them to leave the profession ( Ulrich et al. , 2006). Leadership style was identified as a key component affecting nurses’ satisfaction with their job. Nursing leadership is a crucial element to the work environment of nurses, as it is the leaders who can bring about positive changes to the environment (Florida Center of Nursing, 2006).
The importance of effective leadership from all levels of management in any organization is essential in developing and promoting collaboration with their employees. A manager’s ability to foster leadership growth, and recognize the importance and expertise of the nursing staff will have a major advantage in retention of competent nurses in their units. In essence, leaders who can motivate and provide opportunities for their staff, and demonstrate a high level of role model behavior, have higher levels of staff participation and commitment to the organization.
Authentic leadership is characterized as one that establishes relationships which are based on trust, respect, and can be considered genuine and believable (Shirey, 2006). Leaders that demonstrate excellent management styles are participatory, coaching and mentoring, they encourage and value staff members and support staff involvement in decision making that has an impact on their work environment (Tomey, 2008). The importance of effective leadership, with staff and management working together, is noted by their ability to create a shared vision for the organization through collaboration and continuous improvement of the work environment.
Shirey (2006) noted “authentic leadership was described as the glue needed to hold together a healthy work environment” (p. 256). Another influential factor in the workplace is skilled communication among all levels of the healthcare team. Key components when utilizing one’s communication skills include verbal and nonverbal interactions and enhanced listening skills, all are vital in ensuring effective communication. Because communication happens continuously in the workplace between employees, managers and customers, it plays a vital role in the development of healthy relationships.
Fabre (2005) noted that nursing staff expect sincerity, trust and good communication from all levels of leadership within the organization. Communicating openly and honestly allows for individuals to deal with one another in a respectful manner, build trust and have an appreciation for each other. A healthy relationship among co-workers enhances the communication process, allowing collaboration and teamwork, which in turn leads to a decrease in medical errors and fosters a safe environment for patient care.
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) remarked that the 80% of medication errors and 70% of sentinel events that occurred in delivery of patient care were directly related to ineffective communication among the care providers (Florida Center of Nursing, 2006). Interactions among nurses, physicians, patients and managers, all have a direct impact on the quality of care delivered. In order to provide optimal patient care, it becomes crucial for all members of the healthcare team to communicate effectively with one another.
Interpersonal relationships and collaborative teamwork among nurses, physicians and other members of the healthcare team are crucial to the delivery of quality care to the patients (Parsons, & Cornett, 2005). Another important aspect of a healthy work environment is one where nurses are supported and feel empowered to participate in decision making. Ulrich et al. (2006) reported the Institute of Medicine advocates for frontline staff to be involved and entrusted in the decision making and delivery of the patient care provided.
When nurses are given the opportunity to participate in clinical and organizational decisions and receive support for their efforts, it fosters personal accountability and autonomy for all staff involved. Empowerment of the nursing staff establishes the groundwork for a positive workplace with collaboration and meaningful communication, enabling professional development and growth within the organization (Parsons, & Cornett, 2005).
Organizations that promote staff involvement in the development of policies and procedures, fosters support for the nurses’ ability to use their critical thinking skills in determining what is the best plan of care for their patients. Nurses need to feel safe and secure in their work environment to be effective in utilizing their critical thinking skills. Kouzes (as cited by Fabre, 2005) remarked “the key to unleashing the organization’s potential to excel is putting that power in the hands of the people who perform the work (p. 7).
When staff members are engaged and feel valued as member of the team, a true sense of autonomy is present in their daily care of patients. Fabre (2005) remarked it is extremely important for nurses to be autonomous, allowing them the ability to make decisions about direct patient care in their daily practice. One such method for getting staff members involved is through the use of shared governance committees within their units. Direct care nurses participating on these councils, are involved with decision making regarding positive patient care models as well as nursing satisfaction and retention (Florida Center of Nursing, 2006).
Nurses working in positive work environments demonstrate mutual respect for one another, show consistent professional collaboration among all team members and function as high performance team members in their organizations. Vollers, Hill, Roberts, Dambaugh, and Brenner (2009) noted “nurses affect patients’ outcomes by their direct actions and their influence over the actions of other” (p. 24). It becomes easier for employees to recognize and accept the need for change, problem solve and decrease stress in their workplace. Another important aspect relating to nursing satisfaction is the importance of professional development.
Organizations that are recognized for their high standard of patient care acknowledge the importance of their nursing staff and provide opportunities for personal and professional growth. Successful organizations offer various learning avenues for their employees. Emphasis is placed on orientation for new staff members, in-service education, continuing education as well as formal education and career development (Tomey, 2008). Nurses recognize that continuing education and competency go hand and hand and is imperative for professional development as well as patient safety.
Individuals, who are given the opportunity to grow and develop their skills and abilities within an organization, will be happier and more productive at work. Another avenue of development for nursing is certification in their specialty. A certified nurse provides a level of expertise at the bedside when caring for his/her patients. Ulrich et al. (2006) noted the correlation between certified nurses and improved patient care; nurses were able to quickly identify the problem and intervene appropriately to the issue at hand.
Nurses who embrace the idea of lifelong learning are able to adjust to the ever changing needs in healthcare and are much more satisfied in their job roles. Personal and professional growth is valued in organizations, where managers are committed to providing time and resources for staff learning and educational opportunities (Institute of Medicine, 2004). A shift in management thinking, from controlling to guiding staff, becomes an important step for staff development which in turn improves quality of nursing care. A common concern that nurses have with their current work environment is one of inadequate staffing levels.
Hospitals that employ the concepts of magnet empower their nurses to make decisions about appropriate staffing levels. Management and staff nurses work together to build safe staffing strategies to meet the needs of the individual units. This collaboration between staff and management, builds trust, empowers the nursing staff and enables nurses to feel they have personal accountability for the success of their organization (Fabre, 2005). Organizations have struggled with trying to determine the number of nurses needed to provide safe, quality patient care and do so in a cost effective manner.
The Institute of Medicine (2004) remarked that experts have recognized that healthcare organizations need to be aware, that overemphasis on efficiency and productivity may have a negative impact on patient safety. With the added stress of providing care for sicker patients with fewer nurses at the bedside, less time is available for nurses to meet all the physical, mental and psychosocial needs of the patients. Morgan and Lynn (2009) remarked “being pressed for time and energy, nurses describe their work in terms of survival; the luxuries of meaningful care interactions with patients are forgone” (p. 07). Often nurses feel they have time to only perform the minimum amount of basic care; and patient education, basic comforting and advocating for the patient is omitted. The lack of resources in staffing as well as a poor working environment is extremely dissatisfying to the nursing staff and impacts patient outcomes. “Research indicates that nurse staffing has a definite and measurable impact on patient outcomes, medical errors, length of stay, nurse turnover, and organizational outcomes” (Florida Center of Nursing, 2006, p. 5).
There is no single action that guarantees a foolproof solution to patient safety during one’s hospitalization, but consideration of staffing levels has played a critical role in providing that safe care. Buchan and Aiken (2008) noted an association between higher nurse staffing ratios and a decrease in medical complications and patient mortality. Staff nurses recognize high risk situations and patient safety concerns, when understaffed they are often times unable to prevent these catastrophic incidents. Safety is a patient’s right and they deserve the nurse’s best efforts.
Fabre (2005) noted that the success of nurses as well the healthcare organization is dependent on a positive healthy work environment. Patient safety needs to be the most important goal for any organization. Culture does matters and a healthy work environment makes the difference in an organization’s performance. The importance of promoting health, through the use of wellness programs, as well as prevention of illness for employees in an organization should not be overlooked. Staff should be supported and encouraged to participate in their own health management.
Burton (2008) remarked “it is intuitively obvious that unhealthy, stressed employees will cost a company something in terms of absenteeism and decreased productivity” (p. 3). A positive work environment fosters healthy lifestyles, behaviors and enables individuals to develop coping skills to deal with stress on a daily basis. The financial benefits versus the cost of creating a healthy work environment can be cost neutral. Many of the magnet concepts, if developed in the workplace, are done with no direct costs to the hospitals.
Changes in leadership styles, supportive and respectful behavior towards staff and empowering nurses in the decision making does not cost the organization money (Burton, 2008). All these factors will have a significant impact on the work environment; improving the physical and mental wellbeing of staff members. Patients trust and recommend hospitals because of the nursing care they receive. Fabre (2005) noted an important reminder to hospitals; patients tell their family, friends and neighbors about the care, good or bad, they received while a patient in their organization.
Excellent patient care coupled with patient satisfaction is what attracts people to an organization. Healthcare organizations that demonstrate and promote healthy work environments will become the employer of choice in their communities. Burton (2008) noted that administrators of an organization cannot argue the fact that their reputation is extremely important in the community in relation to the success of their facility. Patients do notice the difference and when hospitals are able to recruit and retain the best nurses in the community; this nursing excellence has the ability to drive the success of the organization.
Whether an organization chooses to seek Magnet designation or not, the concepts can still be utilized in any organization towards the development of a healthy work environment. It is important that organizations recognize the need for development of strategies that foster a healthy work environment, where staff are valued and acknowledged for their contributions and have a desire to work in their facilities. The association between a healthy work environment and the health and wellbeing of the nursing staff correlates to the impact on the quality of care provided to the patients they serve.
It is evident that the continuity of patient care, recruitment and retention of competent nursing staff and organizational viability are all greatly impacted by the nurses’ work environment. Maintaining a healthy workplace remains a challenge in healthcare and must be seen as an ongoing process. Healthcare organizations that are able to develop and sustain quality workplaces will be able to meet the demands of healthcare in the future by retaining competent nursing staff and meeting the health needs of their communities. . References Broom, C. , & Tilbury, M. S. (2007).
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