What does it take to create a satisfying, healthy work environment for nurses? According to one national recognition program — Pathway to Excellence® — it is factors such as nurses having a say over their practice, workplace safety initiatives, recognition for a job well done and a culture that promotes work-life balance.
These positive elements of a healthy work environment are playing out at facilities nationwide, including those within CHI Health, a network of 15 acute care hospitals, more than 150 clinical locations, two psychiatric facilities and other health care sites throughout greater Nebraska and southwest Iowa.
Currently, four CHI Health hospitals have earned the American Nurses Credentialing Center’s Pathway designation by meeting 12 specific standards essential to an ideal nursing practice environment. And more facilities within CHI Health are working toward this national recognition, according to Jane Carmody, DNP, MBA, RN, CENP, chief nursing officer at CHI Health and a Nebraska Nurses Association member.
“We have about 5,000 nurses in numerous locations across the area, and we are committed to spreading nursing excellence throughout that region,” Carmody said. “We’ve laid out the challenge that, by 2020, every [eligible] care location will have gained the Magnet® or Pathway designation.”
Sharing ideas, solutions and concerns
One of the crucial Pathway standards focuses on nurses having control of their practice through shared governance and other mechanisms.
Carmody said all CHI Health hospitals have a structure in place in which nurses can participate in their own unit-based, practice-related councils, as well as a practice partnership council, in which nurse representatives from every unit meet with other staff at their site of care to address entity-wide issues.
CHI Health also has innovative, system-wide practice area councils, where staff from EDs, ICUs or med-surg units, for example, come together to share best practices, determine policy and address any concerns. This structure serves to reduce the need for a variety of other committees and creates a more systematic approach to improving patient care and nurses’ work environment.
“Because of Pathway [and its control-of-practice standard], nurses feel empowered to make decisions that affect every area of our work environment,” said Susan Schiffbauer, BSN, RN, a resource nurse at CHI Health Bergan Mercy. “Nurses are much more visible throughout the hospital and are able to throw out ideas, have them looked at, and then potentially implemented.”
The practice area councils serve to share best practices and provide a place for innovative thinking and suggestions. One such suggestion came from an ICU bedside nurse at Bergan Mercy, according to Schiffbauer. The nurse and his co-workers were concerned about potentially spreading infectious organisms by using the usual, automatic blood pressure cuffs from one patient to the next. So he worked with purchasing and other departments to determine the availability and costs of disposable BP cuffs. He took it to his unit-based council, and a designated nurse “champion,” then shared the idea with a larger hospital-wide committee. Now disposable cuffs (which follow patients from wherever they are admitted to wherever they are transferred) are standard house-wide.
Another nurse-developed idea that took root began in the behavioral health unit at CHI Health Immanuel, said Allison McKamy, BSN, RN-BC, who previously was a staff nurse on that unit and served on the Behavioral Practice Area Council.
“We have patients coming onto the unit who hide razor blades and other things on themselves, which is a huge safety issue,” McKamy said. “We found that staff were not conducting the searches in the same way.”
So the unit nurses created a written, standardized policy detailing a two-person safety search, as well as a video that explained the process step by step.
These ideas illustrate shared governance in action, and they also exemplify CHI Health Pathway facilities’ commitment to another standard, which calls for the work environment to be safe and healthy.
On the path toward safe and healthy
Now a front-line, resource team nurse (float pool nurse) who works throughout the facility, McKamy noted that Immanuel, like other CHI Health hospitals that earned Pathway designation, has a range of assistive lifting devices and encourages staff to use them. There also are ceiling lifts in designated rooms in the rehab unit. And facilities have a strong needlestick prevention program.
On the behavioral health unit, nurses wear “Code 10” pendants that when activated, automatically alert various staff, including security, that a patient’s behavior is escalating toward violence.
“I always tell my patients that safety is our No. 1 priority,” McKamy said. “These measures keep patients and staff from getting hurt.”
And about 18 months ago, CHI Health embarked on the Catholic Health Initiatives national program called “SafetyFirst,” which includes daily huddles at every site of care around safety issues potentially affecting patients, employees, families and visitors.
“Whatever we find during those huddles is addressed within 24 hours – such as patient falls or an employee injury,” Carmody said. “And then we have evolved the site huddles into a system-wide, weekly call huddle where we can also talk about near misses and share and learn from safety issues system-wide.”
Another work environment focus: staffing
Nurses generally work 12-hour shifts, and they self-schedule over a four-week time period so they can plan around their home life in a realistic way.
“We have a staffing excellence strategy team – a key effort to ensure we have enough nurses and team support on the units of care,” Carmody said.
At CHI Health Bergan Mercy, critical care unit nurses can decide on the skill mix when more staff is needed, such as an RN, a bath aide or a nurse’s aide, said Juanita Sieben, MS, RN, PCCN-BC, an RN specialist and educator for critical care.
Spending more time with patients, and managing that time, also is key for nurses. One strategy to ensure nurses can provide high quality, safe care — with kindness and compassion — has been the implementation of an evidence-based “nursing care bundle,” Carmody reported. Developed by one of the practice area councils, the bundle includes nurse leaders rounding on patients, patient-centered hand-offs, unit huddles and coordinated discharges.
“We also have implemented hourly rounding (another one of the nursing care bundle practices), which helps minimize nurses having to run around,” said Kimberly Cuevas, BSN, RN, lead charge nurse supervisor for oncology and med-surg at Immanuel. Besides grouping patient care activities, nurses tell patients they will return in an hour and ask them to keep a running list of questions they may have or things they might need that can be addressed during the next round.
More on health and work-life balance
These CHI Health facilities also meet the Pathway standard of promoting nurse health and work-life balance through a range of activities.
CHI Health offers a variety of workshops on stress-reduction, smoking cessation and other health-focused activities, as well as an online wellness portal, McKamy said. Through that portal, nurses and other staff can track their nutrition, hydration, exercise and even volunteer activities, and accrue points that reduce their health insurance cost. CHI Health also offers “HeartMath” – a biofeedback method that helps staff reduce their stress.
As a mother of three, McKamy said having a day care center on-site has been a huge satisfier. “I can visit my children if I need to, and it is cost effective,” she said.
Bergan Mercy offers staff relaxation rooms and a lactation room for new mothers. The facility also has daily “quiet time” from 2 to 4 p.m.. Lights are turned off, patients aren’t scheduled for activities, and nurses have a chance to catch up on their work, according to Sieben.
Cuevas, who has two children, said the flexible, self-scheduling has allowed her to routinely volunteer at her kids’ school. Further, meeting schedules were changed to better accommodate working parents.
Recognition and leadership
When pursuing Pathway to Excellence, nurses help document how their workplace environment meets the required standards. They also participate in a survey and are asked, for example, whether there is a process in place to communicate staffing concerns; whether the CNO and nurse managers advocate for them and the issues they raise; and if nurse-driven initiatives are recognized. Facilities must receive a favorable score – at least 75 percent – on 75 percent of the survey items.
Although Bergan Mercy met the standards, nursing staff and leadership decided to focus on ways they could improve in certain areas, such as nurse recognition, Sieben said. As a result, Bergan Mercy began nominating their nurses for several national recognition awards, including DAISY and “40 under 40,” and created their own programs, such as the Humpty Dumpty award, which recognizes units that have decreased the number of patient falls. Several nurses and units have been honored already through these programs.
Both Sieben and Schiffbauer also point to the importance of nurse leaders routinely rounding on units — which helps to meet another Pathway standard.
“They are much more visible to nurses, asking them what they want changed, what is working,” Schiffbauer said.
Ensuring nurses are recognized for their work and having leaders who are accessible to staff and willing to break down barriers to move nurses’ ideas and concerns forward have helped build camaraderie and a sense of community within Bergan Mercy and other Pathway-designated CHI Health facilities.
“Nurses make decisions together,” said Rachel Schweikert, BSN RN, ONC, an ortho unit supervisor and chair of the Practice Partnership Council. “And they aren’t isolated on their units anymore.”
— Susan Trossman is the senior reporter for The American Nurse.
Pathway to Excellence®
For information, visit www.nursecredentialing.org/pathway.
ANCC Pathway to Excellence Conference™
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