An Evidence-Based Roadmap to Healthy Work Environments for Nurses: Closing a Gap in the Literature through Development of a Toolkit

Aim:  The aim of this pilot study was to evaluate the effectiveness of an evidence-based toolkit aimed at improving the health of nurses’ work environments.

Background: Unhealthy work environments contribute to medical errors, ineffective care delivery, conflict, and stress. As a result, the American Association of Critical Care Nurses established the six essential standards required for healthy work environments to exist.  However, no step-by-step guide exists to assist leaders with implementing each of the standards required for a healthy work environment. The lack of guidance for implementing the standards has led to a small percentage of hospital leaders reporting that healthy work environments have been created within their respective organizations.

Theoretical Framework: The Path-Goal theory was used as the theoretical framework for this project, and is based on the foundational belief that a leader has the ability to adjust his or her style and behaviors to influence employees and the work environment. 

Data Collection: Nursing leaders used the toolkit to address the health of the critical care work environment in a Magnet organization. The leader completed a Likert questionnaire to evaluate the toolkit. Staff perceptions of the environment were also assessed using a validated web-assessment tool.

Data Analysis: The leader rated the toolkit’s usability, clarity, and applicability as “very good” or “good” for each standard, and reported that she would be very likely to utilize the toolkit for future change implementation and to recommend the toolkit to other nursing leaders. The leaders concentrated on the standard of meaningful recognition since this was the only standard that fell below the national benchmark in the Time 1 assessment. The Time 2 data revealed a score of 3.31, which was higher than the national benchmark of 3.23.  

Conclusions: Providing nursing leaders with evidence-based resources to guide change implementation is vital to the success of creating healthy work environments in hospitals across the United States. Dissemination of this toolkit will provide step-by-step, evidence-based guidance and support that has been unavailable up to this time, which could lead to increased adoption of the standards and improved organizational cultures that support nurses with a healthy work environment.

Implications for Nurse Management: Nurse managers are fundamental to promoting change and ensuring positive work environments exist, but need resources to guide their efforts. This toolkit closes a gap in the literature and augments leaders’ efforts to create HWEs.

Keywords: healthy work environment, toolkit, staff perception, nurse leader, evidence-based practice