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Finding A Healthy Work Environment for Nurses
Nurses today are in the enviable position of having numerous choices for employment. Choosing the right professional position, whether your first or a subsequent job, can be both an exciting and a daunting experience. There are many factors to consider, including the desired specialty, shift preferences, part-time or full-time, type and location of the organization, available orientation and continuing education options, and salary and benefits.
Hospitals, in particular, are competing with each other to attract new graduates and experienced nurses to their staffs. While all of the above considerations are important, many organizations are looking to distinguish themselves by creating healthy work environments that not only help attract nurses but also help retain them. Increasingly, nursing leaders are turning to the American Nurses Credentialing Centerís (ANCCís) Magnet Recognition Programģ to assist them in this process. Currently, there are slightly more than 200 Magnet-designated facilities in the country, with a few international sites as well. You can view the list of Magnet facilities on the ANCC website, www.nursingworld.org/ancc/magnet/index.html, to find hospitals in your area or across the country.
While a seemingly small number of hospitals have earned this Olympic gold medal for nursing, many more organizations are actively on the journey. To achieve Magnet designation, organizations must demonstrate levels of excellence in 14 Forces of Magnetism. Additionally, some hospitals are adopting the Magnet forces as guidelines for improving their work environments even if they choose not to pursue official designation. As it turns out, not only are Magnets good places for nurses to work, but they are also good places for patients to receive care. What a winning combination!
These claims are supported by a growing body of evidence derived from research conducted independently. Emerging from the studies is the fact that Magnets have several important characteristics that set them apart from the crowd. The ANCC cites that these critical qualities include support for continuing professional development, high levels of staff empowerment, control over the practice environment, visible and supportive nurse leaders, lower mortality rates, increased patient satisfaction, and lower nurse turnover and vacancy rates. This impressive array of characteristics creates a strong case for considering what the Magnet journey has to offer.
So, how can you use this information to guide you when seeking employment or when participating in improving your work environment? Here you can glimpse the 14 Forces of Magnetism to help you learn more about the process and, most importantly, what to look for and consider in your work life.
Force 1: The quality of nurse leadership
Strong nursing leadership is a key component of a healthy work environment. Nurse executives and managers advocate for the staff nurses so that they have the resources they need to provide patient care. Get to know who the chief nurse executive (CNE) is and find out her (or his) vision for nursing. Take advantage of opportunities to share your observations and experiences through attendance at town hall meetings or at the CNEís walking rounds. The evidence of strong leadership can be felt at the patientís bedside when nurses have a voice in decisions about care. So the next time you are asked to join a team updating practice standards or to evaluate a new product, participate Ė because you are contributing to improving care for patients and supporting the important role of nursing in the organization.
Healthy workplaces also measure how satisfied nurses are with multiple aspects of the practice setting. Ask to see or hear about what these surveys show for the hospital or unit you are working in or considering for employment. Do not expect perfection, but rather focus on what is being evaluated or changed as a result so that improvements can be made. For example, one unit may be setting up email access for all staff members as a result of an identified need to improve communication of important updates and changes in a timely manner.
Force 2: Organizational structure
This force focuses on how the hospital sets up its leadership and management structure. In general, the fewer the levels between the CNE and the staff, the better, but this can vary based on the size and complexity of the organization. Perhaps the most important aspect of this force is that it requires an active process of shared decision making to be in place. Some facilities have established shared governance models or nursing councils that provide a way for staff nurses to be involved in decisions that affect care or other issues such as education, preceptor development, and career advancement programs.
Check out what your organization has to offer: How are staff members selected to participate? What groups are you most interested in: clinical practice, education, perhaps research? Ask prospective employers about initiatives or changes that have been made based on how they involve nurses in shared decision making.
Force 3: Management style
Healthy workplaces have leaders who are visionary and accessible to staff nurses. As you interview for a position, remember that this is also an opportunity for you to check out the organization. Ask the manager about his (or her) leadership style and how he gets feedback from nurses about patient care, nursing practice, and the work environment. Your relationship with your manager is a very important one, so compatibility of styles and priorities are important aspects to consider.
Other staff members can share their experiences of working on the unit, too, lending insights that might not always be evident during interviews. There is no one right style of leadership. The important thing to remember is that the best workplaces actively seek out staff nursesí participation in improving care through a variety of ways. Find out how you can join in!
Force 4: Personnel policies and programs
Salaries, benefits, and scheduling practices are all vital pieces of information to gather when choosing the job that is right for you. You will find that the best employers are competitive with the local market, support the professional development of nurses, and offer creative ways to maintain a healthy work/life balance. Be sure to explore how units are staffed, including how the facility responds to changes in the workload: Do they use float nurses, agency personnel, and/or overtime?
Many organizations are working aggressively to eliminate mandatory overtime and monitor work hours to assure that staff are sufficiently rested between tours of duty. This helps promote safety for staff and for patients. You can expect to be assisted with making assignments that are based on patient needs and staff competencies, including how to delegate to other members of the team. As our patient populations and workforce are becoming increasingly diverse, high-performing organizations are assuring that staff members are prepared to provide care that is culturally competent. Innovative educational programs and resources, such as cultural diversity ambassadors, are being created in some organizations to assist staff with this important aspect of the work environment. Find out about the range of cultures or special populations of patients served and how efforts are being made to ensure that their needs are met.
Another aspect of this force relates to the performance appraisal process. Instead of just relying on the traditional manager-employee annual evaluation, greater emphasis is being placed on self-evaluations and peer review. Organizations vary in how they accomplish this and may actually be trying several different methods on different units to determine what will work best. All of these activities are designed to engage the nurses in a thoughtful review of their own practice and offer an opportunity to provide input into the practice of teammates. Having competent and caring coworkers is a critical factor in how nurses feel about their ability to deliver quality care. Peer review contributes to the sense of teamwork and professional accountability.
Force 5: Professional models of care
Magnet hospitals have a model of care that clearly demonstrates nursesí authority and responsibility for providing and coordinating patient care. Again, as with some of the other forces, it is important to acknowledge that one model is not necessarily better than all the others. You will find organizations implementing primary nursing or patient-centered care or relationship-based care, to name just a few.
Key to any chosen model of care is the degree to which staff nurses were involved in its development, implementation, and evaluation. These models also take into account the stateís nurse practice act and other professional standards. Hint: Take some time to read the practice act for the state where you intend to practice. Look for places where staff nurses are encouraged to innovate to improve care delivery, such as incorporating nursing assistants in walking rounds or flexing schedules so that working hours coincide with peak patient-care activity levels.
Force 6: Quality of care
Nurses want to provide high-quality care. Healthy workplaces know that and ensure that there are quality-monitoring activities in place that involve nursing leaders and staff in the process. This includes a strong focus on patient safety, such as adherence to the Joint Commission on Accreditation of Healthcare Organizationís National Patient Safety Goals or enhancing safety through effective communication models such as the SBAR (Situation-Background-Assessment-Recommendation) tool. High-performing organizations promote a culture of safety that empowers staff to report hazards or unsafe practices without fear of punishment. Hotlines and anonymous reporting mechanisms are available. Look for places that have implemented the guidelines from the American Nurses Associationís safe patient handling project for increasing the use of equipment to minimize staff and patient injury related to lifting, moving, and transferring.
Increasingly, it is becoming expected that care decisions be based on the latest research and scientific evidence. Policies, procedures, and standards of care and practice should all be evidence-based. To be most effective, hospitals are encouraging staff participation in these activities and providing resources such as advanced practice nurses and unit-based Internet access. Requirements for nursing research have surpassed merely using research-based evidence to guide practice to conducting actual nursing research. Staff nurses are being mentored in the research process and are identifying and exploring answers to a wide variety of clinical problems. This mentoring is available from nurse researchers or advanced practice nurses who may be on staff or work as consultants or as part of a hospital/school of nursing partnership. Amazing work is being done at the unit level, as nurses search for answers to clinical questions. So, be sure to ask about the use of evidence-based practice and the degree to which the facility is participating in nursing research activities.
Force 7: Quality improvement
The tracking and trending of high-quality data is an integral component of healthcare organizations. Magnet hospitals and those on the journey collect information about a number of quality indicators such as fall injuries, pressure ulcer prevalence, and urinary tract infections. This enables them to benchmark or gauge how they are doing compared with other similar units and organizations across the country.
To make a significant difference in outcomes, nurses at all levels have to be knowledgeable about and involved in the process. Keeping staff informed about the results of quality monitoring and engaging them in needed improvements is vital. Find out which indicators your hospital or unit is addressing, and look for ways to participate in the improvement plans. Donít be surprised to see staff nurses collecting data, presenting results in formal and informal ways, and leading interdisciplinary improvement teams!
Force 8: Consultation and resources
Patient care and the healthcare work environment are very complex. Having access to internal or external experts in the field is a valuable asset. In particular, staff nurses can benefit greatly from consultation with advanced practice nurses. This supports staff in managing complex patients and guides them in using evidence-based interventions. Additionally, healthy workplaces encourage nurses to be involved in professional organizations, where they can find opportunities for networking, information sharing, and leading-edge initiatives.
Specialty organizations are wonderful places to keep abreast of changes in your chosen practice arena through conferences, journals, and websites. Inquire about how your present or future employer is involved in professional and community organizations outside of nursing, too. Many facilities support the efforts of their employees to provide time and services to groups like Habitat for Humanity, Big Brothers, and the American Red Cross. What an important way to demonstrate a commitment to the spirit of community service!
Force 9: Autonomy
This force addresses a nurseís ability to assess patient needs and to provide care based on competence, professional expertise, and knowledge. Achieving this goal requires organizations to have policies and procedures that guide nursing practice based on national standards. It is essential for nurses to have access to the latest literature and information.
Things to look for are access to the Internet, libraries, and other literature sources. Are reference texts and specialty journals available and accessible to staff? These resources, plus opportunities to develop and maintain competence, are essential for providing care as an individual clinician and as a member of the interdisciplinary team.
Force 10: Community and the healthcare organization
Nurses have much to offer and to gain from professional and community partnerships. Seek out organizations that have made strides in developing relationships of this nature. In particular, partnerships between schools of nursing and practice settings often mean opportunities to participate in some innovative programs, such as summer student extern programs, development of preceptor skills, and nursing research activities.
Units that focus on particular specialties, such as cardiology or mental health, often have relationships with the local affiliates of corresponding agencies such as the American Heart Association or the National Alliance for the Mentally Ill. All of these outreach and partnering activities contribute to the support of better patient outcomes and of community needs. Whether as individuals or in groups, nurses, through their involvement, demonstrate leadership and commitment to the good of the community. It is no wonder that nurses are ranked number one on the list of the most trusted professionals. Check your job description to see if it includes an expectation of community service. Discuss with your manager the possibility of participating in community-focused activities such as organizing food drives or disaster relief supplies.
Force 11: Nurses as teachers
Every day, nurses are teaching. This activity may involve nursing students, colleagues, or patients and families. Teaching activities are supported and encouraged in Magnet organizations. Staff nurses are assisted in this important aspect of their role through inclusion of teaching activities in job descriptions and rewards through clinical advancement and plentiful development opportunities.
Of critical importance to new graduates is the attention being paid to ensuring a smooth transition from student to professional nurse. Innovative internships and residency programs are being developed and implemented to assist new graduates at this critical juncture. Programs vary in length and content, but most provide some combination of classroom/computer-based instruction and guided clinical experience. Many facilities have specialized programs for preparing new graduates for work in critical care and specialty areas such as the operating room or the emergency department Ė areas previously closed to nurses with limited experience.
When considering your first position, ask questions about the orientation and residency programs available to you. It can be very helpful to talk with current nurse residents or others who recently completed the course to learn more about their experiences as participants.
Force 12: The image of nursing
The image nursing has within an organization often reflects the degree to which nursing leaders and staff can influence patient-care decisions and resource allocations. The stronger and more positive the image, the more essential nursing will be viewed by other members of the organization. This is a good position to be in. Healthy work environments promote positive relationships between nursing and other departments so that time and energies are spent on providing care to patients and families and not on interdepartmental squabbles.
One way to assess the image of nursing is to look at how nurses are portrayed in the publications and promotional materials of the facility. Are nurses represented? Are they conspicuously absent? Do articles and materials contain descriptions of nursing innovations and research? Are nurses involved in interdisciplinary projects? Does the organizationís website include information about the nursing service and not just a listing of employment opportunities? Ask to see the annual report for nursing, as it will give you a good overview of important activities such as the publications and presentations made by staff, awards and recognitions, earned degrees and certifications, nursing research projects, and promotions and appointments. Historically, nurses have shied away from promoting their value and accomplishments, but those days are over!
Force 13: Interdisciplinary relationships
Teamwork is the essential ingredient for successful workplaces. Increasingly, the importance of clear communication and positive working relationships among all members of the team is being linked to enhanced quality and patient safety.
Healthy workplaces actively take steps to ensure that relationships are based on mutual respect and that disrespectful behaviors are not tolerated. Interdisciplinary team members all have an important role to play in patient care; no one can do it alone. While Magnet designation does focus on nursing service, the entire organization has to be involved and must work together to create a culture of excellence.
Do you see evidence of teamwork and collaboration on your unit? If not, explore ways to make it happen. Maybe the pharmacists can add some important considerations to reduce patient falls. Invite physicians to provide input into the development of clinical policies and standards of care and practice as well as the approval process. Rarely can quality-improvement teams succeed without all the key players being involved. Remember that teamwork is a two-way street: Be a good team member, follow through on assigned tasks, and offer your perspective and opinion on important issues.
Force 14: Professional development
To accomplish all the goals outlined in the other forces, it is evident that healthy workplaces support professional development. The safe practice of nursing requires continuous learning. This can be achieved through a variety of ways, such as formal academic education, service-based learning, and continuing education.
Magnet hospitals have abundant learning opportunities for their staff and offer generous financial support packages, such as tuition reimbursement, to facilitate participation. Certification is encouraged and often rewarded through career development programs and financial incentives. When evaluating an organization, inquire about education programs beyond orientation. Are there clinical educators and advanced practice nurses available to provide educational services? What resources are there for nurses working nights and evenings? Can learning needs be met through online programs? Are any local colleges and universities offering on-site courses? What career paths are open to nurses who obtain advanced education and certifications?
When all is said and done, the Forces of Magnetism guide hospitals on the pathway to excellence but can also be used by individual nurses to help them identify characteristics of healthy workplaces. Knowing the forces and what they stand for enables staff nurses to contribute in a meaningful way to improving the quality of care for patients and the quality of the work environment for themselves and for their team members.
About the Author: http://www.modrnnurse.com