Nursing is the largest health care profession in the U.S., with an estimated 4.2 million nurses registered nationally, according to the American Association of Colleges of Nursing.
Healthy work environments for nursing professionals result in better outcomes for both nurses and patients. Nurses who work in safe and healthy workplaces report greater job satisfaction and employee engagement and experience less burnout, according to an October 2022 report published in Critical Care Nurse.
This same report found that patients cared for by nurses working in healthy environments experience higher quality care and better outcomes compared to those cared for by nurses who operate in unhealthy work environments.
Establishing a healthy work environment among nurses is of utmost importance to reduce nurse turnover and improve care delivery. Explore how nurse leaders can play a vital role in building supportive environments and how they can leverage their advanced nursing education to do so.
What Is a Healthy Work Environment in Nursing?
Healthy work environments contribute to the well-being of nurses and their patients. But what is a healthy work environment? By understanding the different nursing workplace hazards and safety risks, nurse leaders can design and maintain healthier and safer work environments for their nursing teams.
Common Nursing Workplace Safety Hazards
As health care professionals, nurses have to uphold a high standard of safety in the workplace. According to the American Nurses Association (ANA), common hazards that can adversely affect nursing workplace safety include:
- Airborne diseases, such as influenza and tuberculosis
- Bloodborne pathogens, such as HIV or hepatitis B or C
- Chemical hazards, such as unsafe exposure to formaldehyde or aerosolized medications
- Injuries due to misuse or improper disposal of sharp objects (needles, scalpels, and other tools or devices that can puncture or cut skin)
- Electromagnetic radiation exposure from X-ray machines
- Building or facility contaminants, such as mold, carbon monoxide or radon leakages, and water contaminants
Nurses play a critical role in identifying and managing these safety hazards and preventing issues from occurring in the first place.
Nurses also need to understand and execute proper safety protocols in every patient interaction, including sterilizing and preparing facilities for patient intake. For example, nurses must be aware of the proper use of ethylene oxide, a common hospital sterilization agent that can cause cancer, chemical burns, and respiratory infections.
Identifying Unhealthy Work Environments for Nurses
Every day, medical errors arise from unhealthy workplace dynamics among health care professionals. When nurses feel unsupported, overworked, and overwhelmed, their care teams and their patients generally suffer. That’s because unhealthy work environments tend to breed distrust, confusion, and resentment among nurses and other members of health care teams.
To tell whether a nursing environment is healthy or not, it’s useful to look for warning signs of nurse fatigue and missed opportunities for communication and collaboration. Veteran nurses undoubtedly have experience working in suboptimal work environments, such as circumstances where:
- Less-experienced nurses fail to ask peers for help due to a workplace culture of bullying, resulting in patients not getting the care they need in a timely manner
- Physicians and nurses fail to communicate about changes in patient medication, leading to life-threatening complications
- Nurses, understaffed across large caseloads, have no resources to properly care for all of their patients during emergencies, causing additional patient injury and deterioration
- Rigid hospital policies prevent interteam decision-making, leading to tense staff relationships across different hospital care units that in turn may affect patient perceptions of care during a hospital stay
Some nursing specialties and roles may expose nurses to physical danger. For example, between 24% and 80% of psychiatric nurses will be assaulted by a patient during their career, according to Scienceline. Promoting a healthy work environment can minimize such hazards and promote physical, emotional, and social safety.
National Standards for Healthy Work Environments
Guidance from the American Association of Critical-Care Nurses (AACN) can help nursing teams identify ways to improve their organizations. The AACN’s six standards for healthy work environments combine evidence-based recommendations for improving nurse workplace safety and functionality.
Standard 1: Skilled Communication
Nurses need to be proficient in clinical skills — but some may not realize that nurses also must develop advanced interpersonal and communication skills such as:
- Conflict management
Nurses often need to share patient information asynchronously across shifts using electronic charts, email, and medical communication software. They also need to communicate with various other parties, including doctors, patients, and patients’ families.
Tasked with communicating with so many different groups, across many different mediums, nurses have huge responsibilities. Fast, accurate communication between nurses and the many individuals and teams they interact with can help foster a healthy work environment.
Standard 2: True Collaboration
Nursing is a field that requires sustained collaboration. At the individual level, nurses need to thoroughly understand their role and how they can support other nurses and health care professionals to deliver high-quality patient care.
At the group level, nursing teams must be open and able to work with different groups across their organizations, including doctors, administrators, caregivers, pharmacists, and emergency personnel, to name a few examples.
Standard 3: Effective Decision-Making
Healthy nursing environments also empower nurses to make decisions about the direction of their organization. Whether it’s leading operations, evaluating and making policy changes to clinical care settings, or requesting ongoing training on specific topics such as cultural competency, nurses must have a seat at the decision-making table.
Effective decision-making among nursing teams also entails:
- Clear processes that enable nurses to make decisions quickly based on accurate data
- Guidelines for collecting and analyzing data, including patient feedback
- Regularly planned meetings that foster performance improvement, goal setting, and conflict management
Standard 4: Adequate Staffing
The U.S. is a rapidly aging country, with baby boomers entering retirement and experiencing increased health care needs. At the same time, many nurses are retiring, leading to a nationwide nursing shortage.
Inadequate staffing can lead to serious issues in nurse work environments. Fewer nurses leads to an increased workload for each individual nurse, which can cause undue stress and potential burnout. Emergency Medicine News reported in 2022 that adding even one more patient to a nurse’s caseload was associated with a 23% increase in the odds of burnout.
The national nurse turnover rate is between 8.8 % and 37%, according to a 2022 study published by StatPearls. That means that thousands of nurses leave their jobs, and the nursing profession, each year, prompting nursing shortages that can hamstring health care organizations. Sufficient staffing is therefore key to fostering a healthy, functioning work environment for nurses.
Standard 5: Meaningful Recognition
Nurses are trained to put the well-being of their patients before their own, and the stress and strain of their job can take a toll over time. Even before the COVID-19 pandemic, nurses across the nation experienced staffing shortages, hazardous exposures to infectious diseases, bullying, and a lack of sufficient resources.
A nurse’s job can be physically and emotionally challenging, and nurses deserve to be recognized at work for their important contributions to patient health and safety. Research shows that nurses who are meaningfully recognized at work are more likely to remain on staff for longer, according to a report published by HealthLeaders Media.
Meaningful recognition helps nurses feel appreciated, valued, and respected. Recognizing hard work can take many different forms, and nursing teams may find that implementing several recognition initiatives at once can promote a supportive workplace:
- Recognizing nurses in the moment by saying “thank you” when a nurse goes the extra mile for a patient
- Written notes or thank-you cards that express appreciation
- Spotlighting nurses with a pattern of outstanding nursing practice in weekly, monthly, or annual emails or newsletters that honor nursing excellence
- Monetary bonuses, time off, or payments for continuing education seminars
These gestures of recognition should empower nurses as experts in order to be meaningful. As nurse researchers described in an October 2022 issue of Critical Care Nurse: “meaningful recognition is about more than accolades; it involves nurses being sought out and valued for their knowledge and experience when decisions are needed on clinical and organizational issues.”
Standard 6: Authentic Leadership
Nurse leaders create systems that promote healthy work environments for other nurses and inspire them to do their best work. Authentic leaders model nursing excellence: clinical communication skills, collaborativeness, and effective decision-making. Nurse leaders also know how to advocate for the resources nurses need to do their jobs well, such as sufficient nurse staffing, personal protective equipment (PPE), and competitive wages.
Authentic nurse leadership refers to a style in which the nurse leader is true to themselves and their values. They lead with integrity and a strong sense of purpose—explaining their decisions candidly and respectfully while empowering the nurses they lead to contribute to making the workplace safe and supportive for everyone.
Nurse leaders can make healthcare settings safer by:
- Implementing evidence-based practices
- Promoting interdisciplinary collaboration (for example, facilitating open communication between nurses and doctors)
- Using data to inform decision-making and improve outcomes
- Advocating for patient and nurse safety initiatives (such as training for responding to violence in a healthcare setting)
- Fostering a culture of safety that streamlines care and reduces the risk of errors
The Benefits of a Healthy Work Environment in Nursing
The benefits associated with a healthy work environment in nursing are significant. A positive environment can help mitigate the risks of nurse burnout and minimize the impact of staff shortages. These benefits also extend to patients:
- Increasing nurse participation in hospital policy decision-making has a positive effect on patient care, according to a 2022 study published in the Journal of Advanced Nursing.
- Raising the quality of nurse leadership has a positive effect on nurse-reported quality of care, according to a 2021 study published in the Journal of Research in Nursing.
- Developing strong nurse-physician relationships have a positive effect on patient care, according to a 2020 study published in the International Journal of Environmental Research and Public Health.
- Reducing nurse bullying has a positive effect on patient care, according to a 2022 literature review of workplace bullying among nurses published in the International Journal of Environmental Research and Public Health.
- Creating healthy work environments for nurses correlates with greater patient safety, according to the AACN.
Creating a Healthy Work Environment for Nurses
Effective nurse leaders develop and maintain policies and implement strategies for creating healthy work environments for nursing professionals. By leveraging their leadership, communication, and interpersonal competencies, nurse leaders can build safe, trustworthy environments that foster positivity and ultimately yield superior outcomes — for providers and patients.
The following tips are among the strategies nurse leaders can employ to ensure a healthy work environment for their staff.
Tip 1: Secure Sufficient Resources, Including Staff
Nurses cannot do their jobs without adequate resources, which include sufficient medical supplies, nursing staff, and administrative support. Nurse leaders can advocate for policy changes within their organizations to make this happen.
Tip 2: Address and Prevent Nurse Bullying
Nurse bullying is a phenomenon in which nurses attack and deride their colleagues. The saying “nurses eat their young” reflects an all-too-common experience of junior nurses being bullied by their peers or more experienced nurses; 44% of nursing staff have been bullied in a health care setting, according to a report from the Joint Commission.
Nurse leaders should take a zero-tolerance stance against bullying in the workplace. Bullying is both morally wrong and bad for workplace morale, so nurse leaders should do what they can to call out bullying when they see it or hear about it.
Tip 3: Establish Data-Collection and Feedback Systems and Use Them
Nurses work directly with patients, but anecdotal evidence may not be enough to sway administrators and outside care teams to give nurses the additional resources they need or identify whether interventions are reducing nurse bullying or making patient experiences smoother.
Leaders looking to promote healthy work environments for nurses must establish systems for regularly collecting data — from patients, medical charts, collaborators, and peers — and feedback to gain insight into how an organization is operating and what may need to be done to improve work life.
Tip 4: Invest in Ongoing Training
Nursing is a complex endeavor. In addition to clinical skills, nurses need an array of different competencies, from interpersonal communication to organization, emotional regulation, and conflict management.
Ongoing training can help nurses refine their skill set and improve their knowledge base so they can continue to provide a high level of patient care. It can also imbue nurses with the confidence to do their jobs day in and day out.
Nurses As Stakeholders in Healthy Work Environments
Nurses should also recognize that they are stakeholders in creating a healthy work environment. American Nurse Journal, the official journal of the American Nurses Association (ANA), explains that every nurse is responsible for contributing to a healthy clinical work environment.
One way that nurses can do this is by creating processes to keep their clinical spaces clean and safe. For example, nurses should undergo regular training regarding safe medication disposal, sanitization practices, and emergency health safety protocols. Nurses should also understand Occupational Safety and Health Administration (OSHA) requirements and processes governing their health care settings.
Another way that nurses can feel empowered to create healthy work environments is through professional development. ANA’s model traits and behaviors for nursing professionals that promote collaborative and effective nursing workplaces include:
- Willingness to listen and learn
Nurses who take responsibility for maintaining workplace safety, facilitating positive interactions with colleagues, and developing professionally as clinicians and care providers will find there are many ways to contribute to the creation of a healthy nursing environment.
Be an Advocate for Worker Health
Healthy work environments should be of the utmost importance for nurse leaders. A healthy environment contributes to the safety and well-being of nurses and their patients, so nurses have a vested interest in contributing to the health of their workplaces.
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