Improving Healthy Work Environments Through Specialty Nursing Professional Development

Introduction and Background: A healthy work environment is an interrelated system of people, structures, and practices enabling nurses to engage in work processes and relationships identified by Magnet hospital clinical nurses as standards of quality care to patients in hospitals (AACN, 2016). In healthy work environments, nurses are able to make their maximum contribution to their patients and the organization. According to the American Association of Critical Care Nurses (AACN), the six standards of a healthy work environment include skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership. Prior research has associated healthy work environments with nurse empowerment, engagement, and organizational commitment (Dolansky & Moore, 2013; Huddleston & Gray, 2016). Much of nursing literature on this topic focuses on assessment of healthy work environments and outcomes of healthy work environments. Few studies have evaluated the impact of unit-based acute care interventions on healthy work environments. The authors aimed to investigate the impact of a unit based intervention in three acute care nursing units on staff nurse perception of healthy work environments.

Purpose: The purpose of this study was to administer a pre and post healthy work environment survey among staff nurses working in acute care units in a Magnet hospital in southeastern Louisiana. A professional development education intervention was delivered to staff nurses, which was tailored for each hospital unit's nursing specialty and patient population. The professional development was framed around the AACN healthy work environment standards, and reinforced communication techniques to enhance teamwork (Huddleston, 2014).

Methods: This study used a one group pre-test, post-test experimental design where subjects completed an assessment before and after an educational intervention. Between March and May of 2018, participants completed demographic questions as well as a valid and reliable, web based AACN healthy work environment assessment survey instrument (AACN, 2015). The healthy work environment survey consists of 18 questions, three for each standard (skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership). The sample included staff nurses working in three acute care units. The healthy work environment survey, along with demographic questions (gender, age, ethnicity, years worked in nursing profession, years worked in acute care nursing practice, years in current nursing unit, highest educational level achieved, and presence/absence of certification) was sent via email to staff nurses. Following collection of this baseline assessment, a professional development educational intervention was developed and delivered to the staff nurses. The intervention included 4 to 8 hours of face-to-face education and addressed the following specialty focused education tailored based on patient populations served on each unit (cardiac boot camp; pulmonary and sepsis care, and stroke/renal care). In addition to the specialty focused education, staff nurses received information on nurse certification and Team STEPPS® techniques for feedback and conflict management (Agency for Healthcare Research and Quality, 2018). Between 2 and 6 weeks following the intervention, the post test was sent to participants via email for re-assessment. Both the pre and posttest participation was voluntary. No identifying information was collected, and the study was Institutional Review Board (IRB) approved.

Results: A total of 53 staff nurses working among three acute care inpatient units completed the pretest, intervention, and posttest. The results were analyzed using SPSS Statistics Software Version 24. The means for each of the 18 questions in the healthy work environment survey increased from the pre to post test. Significant t tests for a p < 0.05 were noted for 10 of the 18 items. These results demonstrated a positive impact of the professional development education intervention on staff nurse healthy work environment perception. Limitations of this study include the limited external generalizability due to limited sample size in one hospital and potential bias due to voluntary participant survey participation.

Conclusions and Recommendations: Improving nurse work environments has been shown to lead to nurse empowerment, nurse satisfaction, and increased patient safety (Brungest & Foley-Brinza, 2014). This study demonstrated the benefit of a professional development staff nurse intervention in improving nurse perception of a healthy work environment. This intervention study could serve as a resource for nursing units aiming to improve staff nurse perception of healthy work environments.