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Strengthening Healthy Work Environment Outcomes Via Interprofessional Direct Care Champion Roles

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Abstract

Objective: To provide an organization-wide, systematic approach to creating and sustaining healthy work environments (HWEs) through frontline interprofessional staff education and coaching engagement. Background: HWE has been an overarching concept in the organization's nursing professional practice model since 2014; however, few practice settings routinely translated survey findings to improve the work environment's health via local interprofessional direct care team members. Methods: The program used a participatory approach where HWE champions committed to participate in centralized professional development activities and local quality improvement initiatives to bolster the health of area work environments. Results: Fifty-one champions representing 44 practice settings participated in the professional development program. Mean HWE scores for all standards increased from year 1 to 2, with 15 practice settings seeing categorical improvement. Meaningful recognition and true collaboration were the standards most often targeted for improvement. Conclusion: The HWE champion role appears to be a promising strategy for engaging frontline interprofessional staff in the assessment and implementation of initiatives to improve the health of work environments.

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A healthy nurse work environment is a workplace that is safe, empowering, and satisfying. Many research studies were conducted on nurse work environments in the last decade; however, it lacks an overview of these research studies. The purpose of this review is to identify, evaluate, and summarize the major foci of studies about nurse work environments in the United States published between January 2005 and December 2017 and provide strategies to improve nurse work environments. Databases searched included MEDLINE via PubMed, CINAHL, PsycINFO, Nursing and Allied Health, and the Cochrane Library. The literature search followed the PRISMA guideline. Fifty-four articles were reviewed. Five major themes emerged: 1) Impacts of healthy work environments on nurses' outcomes such as psychological health, emotional strains, job satisfaction, and retention; 2) Associations between healthy work environments and nurse interpersonal relationships at workplaces, job performance, and productivity; 3)Effects of healthy work environments on patient care quality; 4) Influences of healthy work environments on hospital accidental safety; and 5)Relationships between nurse leadership and healthy work environments. This review shows that nurses, as frontline patient care providers, are the foundation for patient safety and care quality. Promoting nurse empowerment, engagement, and interpersonal relationships at work is rudimental to achieve a healthy work environment and quality patient care. Healthier work environments lead to more satisfied nurses who will result in better job performance and higher quality of patient care, which will subsequently improve healthcare organizations' financial viability. Fostering a healthy work environment is a continuous effort.
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To test the impact of the implementation of Magnet principles of improving nurses' work environments. Magnet hospital designation developed in the USA in the 1980s to recognise hospitals that had created excellent patient care environments and supported the professional practice of nursing. A pilot initiative in England was the first test of the applicability of Magnet standards outside the USA. Research methods included surveys of nurses in the demonstration hospital in a predesign and postdesign and comparisons to survey results of nurses practicing in a national sample of 30 National Health Service Trusts. Prior to beginning the Magnet journey, the demonstration hospital had a nurse work environment that was somewhat less positive than the national sample NHS hospitals. Nurses practicing in the demonstration hospital were somewhat less satisfied with their jobs than nurses in other NHS hospitals. Following a two-year period during which the evidence-based Magnet standards were implemented and Magnet Designation was awarded, the quality of the nurse practice environment had improved significantly, as had job satisfaction of nurses and their appraisals of the quality of patient care. The quality of the nurse practice environment after Magnet designation was better than that of a national sample of NHS trusts. Improved nurse outcomes were because of the improved practice environment rather than staffing enhancements. Implementation of the Magnet hospital intervention was associated with a significantly improved nursing work environment as well as improved job-related outcomes for nurses and markers for quality of patient care. Nurses can use Magnet principles to improve the quality of their work environments.
Article
The impact of interventions designed to improve the nursing work environment on patient and nurse outcomes was examined. Nursing work environments have been characterized as contributing to patient outcomes as a result of organizational management practices, workforce deployment, work design, and organizational culture. This quasi-experimental study involved 16 unit managers, 1,137 patients, and 296 observations from registered nurses over time. After participation in the intervention, study nurses reported higher perceptions of their work and work environment. Demographic nurse, unit, and hospital characteristics also had an impact on the work environment and outcomes. Findings in this study highlight the importance of understanding factors in the work environment that influence patient and nurse outcomes.
Identifying champions in the workplace to increase morale
  • L Reilly
Reilly L. Identifying champions in the workplace to increase morale. 2019. https://www.icslearn.co.uk/blog/posts/2019/ january/identifying-champions-in-the-workplace-to-increasemorale/. Accessed March 10, 2021.
AACN standards for establishing and sustaining healthy work environments: a journey to excellence
Keeping patients safe: Institute of Medicine looks at transforming nurses' work environment
Keeping patients safe: Institute of Medicine looks at transforming nurses' work environment. Qual Lett Healthc Lead. 2004; 16(1):9-1.
American Association of Critical-Care Nurses. AACN standards for establishing and sustaining healthy work environments: a journey to excellence
American Association of Critical-Care Nurses. AACN standards for establishing and sustaining healthy work environments: a journey to excellence. Am J Crit Care. 2005;14(3): 187-197.