The CNO's Ultimate Guide to a Healthy Work Environment

A healthy work environment is crucial to building a sustainable health system.

What is a healthy work environment?

A large part of nurse dissatisfaction involves working in poor conditions. Nurses are overworked because of staffing shortages, they’re exhausted by heavy workloads, and they’re often dealing with workplace violence and other external disruptors.

A healthy work environment is necessary for nurses to thrive, and for patients to get the highest quality care and experience when visiting a health system. Here’s how CNOs can create better conditions for their nurses.

Characteristics

Healthy work environments exist when several conditions are met, according to Deana Sievert, Chief Nursing Officer at Ohio State Wexner University and Ross Heart Hospitals. First and foremost, nurses need to be challenged to practice at the top of their licensure.

“When we talk about having meaningful, purposeful work that [nurses] need [to] have a healthy work environment,” Sievert says, “I think being able to practice at top of licensure is one of those key things.”

Nurses also need to feel like their voices are respected and heard as part of the team, and not just on the front lines, she says. Respect needs to come from the top, in the C-Suite and the board rooms, all the way to the bottom.

Shared governance models are also critical.

“That has to be saturated throughout the organization,” Sievert says, “simply because of the impact that [nurses] have on patient care, and the volume of [nurses] that exist in organizations.”

Additionally, healthy work environments have clear and proportional escalation pathways that equip nurses to solve problems. This could apply to patient care or to concerns with recruitment or competitive wages. Sievert also points out that high team engagement is critical, and can help staff approach issues in a healthier way.

“I think an engaged team is really the key,” she says. “If they’re not engaged, I don’t think that it’s even an option to have a healthy work environment.”

AACN standards 

The American Association of Critical-Care Nurses (AACN) has outlined six essential standards that provide evidence-based guidelines for nurses to be successful. They are:

• Skilled communication
• True collaboration
• Effective decision making
• Appropriate staffing
• Meaningful recognition
• Authentic leadership

The AACN believes that healthy work environments are those in which these six guidelines are fully integrated and are helping to create “effective and sustainable outcomes for both patients and nurses,” According to Vicki Good, Chief Clinical Officer at the AACN.

“They’re all equally important and they all interrelate,” she says, “so you can’t have one without having the others present.”

From the CNO perspective, Sievert says she is pleased with the AACN guidelines, and that the organization has done a good job adding meaning behind each standard and outlining how to accomplish them.

“I think honestly our colleagues at the AACN have done an amazing job of really trying to capture those buckets,” Sievert says, “and that’s a task to capture the parts of a healthy work environment.”

Sievert says there is an opportunity for the AACN to amplify concerns with nurse well-being and self-care at work, not just when they go home.

“I think we could do a better job at incorporating [self-care] into the day-to-day work environment,” she says.

Sievert thinks the AACN should also focus on workplace violence. 

“I know we’re all really struggling with [workplace violence],” Sievert says, “and I think that it would be great if we call that out maybe a little bit more.”

Outcomes

A healthy work environment offers many benefits to nurses. Such an environment improves recruitment, retention, and patient care, and there are less safety incidents.

“I think the literature is strong on this,” Sievert says. “The research shows that [hospital acquired conditions] improve.”

Good agrees, stating that the research shows the impact of healthy work environments on maintaining staff and patient outcomes.

“The evidence is clear that having a healthy work environment is [a] cornerstone to nurse well-being and retention,” Good says, “but now the research even demonstrates [the impact on] our patients.”

There are intangible benefits as well. Nurses and patients feel safer, and there is a stronger connection between leadership and nurses. Sievert emphasizes that in her career, she’s had a much stronger connection with her frontline teams, and vice versa, in healthier work environments.

“That whole body of teamwork really connects and moves things forward,” she says. “It makes all of our jobs easier [when] you’ve got that bidirectional flow of communication.”

Good concurs, citing that patient outcomes improve, there is less nurse turnover, burnout and moral distress decrease, and both the perception and actual quality of care improve.

“Not only does the perception of quality of care go up,” Good says, “[but] the actual quality of care goes up when you have a healthy work environment.”

Solutions

So how can CNOs create healthy work environments?

It starts with being the voice for the nurses, Sievert states. CNOs and CNEs represent nurses during meetings every day, in front of directors and managers in the boardroom.

“It’s definitely about being their voice because they don’t get that opportunity,” Sievert says, “and they rely upon that CNO [or] CNE role to be that voice.”

CNOs need to be able to represent nurses in the right way. This means being aware of the issues they face on a daily basis, and staying connected with nurses to understand what they need. Leaders must also be able to communicate feedback from those board meetings to the frontlines, and keep their teams posted with current updates.

“I think [it’s important to make sure] that you close that loop,” Sievert says, “because otherwise, I think our staff lose faith in regard to what we’re actually advocating for and what we’re working on.”

Good believes that CNOs should be role models for creating healthy work environments, and specifically for good communication, collaboration, and effective decision making. Leaders should also mentor nurses and ensure that they are fundamentally involved in decision making and establishing the framework for a healthy work environment.

“[CNOs] have to foster the visibility and enthusiasm for establishing a healthy work environment,” Good says.

Good also recommends building the AACN standards into performance management systems for nursing staff, so that healthy work environment behaviors become the expectation. To further spread those principles, the AACN has created a program called the Healthy Work Environment (HWE) National Collaborative.

According to Good, the HWE National Collaborative is a mentorship and co-learning program that includes nurses, physicians, administration, and ancillary services all working together to build healthy work environments. The two-year program launches in April 2024, and will be in 45 hospitals across the country.

“We will provide coaches, guidance, educational sessions, and mentor sessions to encourage and help the teams problem solve,” Good says, “and [to find out] what the biggest issues they need to solve for are in their work environment to improve it.”

Good says this kind of work is unprecedented on a national level.

“The national studies have shown us that the work environment has got to be improved,” Good says, “but there’s not a global approach to it.”

The program will cover many topics, and the AACN expects to see positive outcomes in recruitment and retention, staff and patient satisfaction, and workplace violence prevention. Good says the goal is also to disseminate research on why focusing on the work environment is going to impact all of those issues, and to teach organizations how pull together teams to work towards a common goal.

Lastly, Good hopes the collaborative will teach health systems how to implement healthy work environment standards.

“They’ve been out there for almost 20 years,” Good says, “[and] we’ve continued to struggle in how we disseminate them and operationalize them.”

To learn more about the HWE National Collaborative, visit the program page here.