On 2016 Nov 25, University of Kansas School of Nursing Journal Club commented:

Team Members: McKee, M., Baker, M., Barnthouse, K., Janner, H., Hess, A., Severson, D, & Yungmeyer, A. (Nursing Class of 2017)

Background

Our team selected this article to review since it is relevant to the concepts covered in Section II of our course, Development of a Microsystem Leader, as it aims to explore issues found within the current nursing clinical microsystem. The article was found using CINAHL and it described how nursing and leadership from a large military trauma center developed and implemented evidence based change to create a standardized healthy work environment using the AACN Essential Standards for Establishing and Sustaining Healthy Work Environments: Improved Communication, Collaboration, Decision making, Appropriate Staffing, Staff recognition, and Authentic and transformational leadership skills (Nayback-Beebe, Forsythe, Funari, Mayfield, Thoms, Smith, Bradstreet, & Scott, 2013). Over recent years, many clinicians have focused on patient outcomes and the work environment in acute care setting, however few study have been done looking at the military health care setting. The main effectors of nurse satisfaction, intent to leave, and perceptions of poor quality of care are considered as unfavorable factors in nurse practice environments (Nayback-Beebe et al., 2013).

Methods

The article discusses the effects of the implementation of evidence-based leadership initiatives that aim to promote a healthier work environment. Using the military health care facility, the unit practice council first implemented quality improvement measures on their unit, and led to the evidence-based project involving the participation of the interdisciplinary patient care team. The research team compiled a PICOT question using the AACN Standards for Establishing and Sustaining Healthy Work Environments on what evidence-based leadership initiatives can be instituted in the IMCU to create a sustainable, healthier nursing work environment (Nayback-Beebe, et al. 2013). The group used the Iowa Model of Evidence-Based Practice to Promote Quality of Care, and collected, critiques and synthesized evidenced-based, long term solutions and identified leadership strategies that promote healthier work environment. The use of PICOT question allowed for the process improvement to foster a multidimensional research approach that included a staff survey, group sessions that allowed employees to express their views of old and new implementations, and staff/patient turnover data. The Likert-scale questionnaire was also used to determine nurse ratings on unit morale, unit stressors, and staff behavior as a result of the nurse work environment (Nayback-Beebe et al., 2013).

Findings

Survey results revealed that 59% of participating staff members rated staff morale in the IMCU as “poor” impacted by stressors on the unit by 96% of participants. These stressors included scheduling, poor communication, staff negativity, and lack of trust in leaders. It was also reported that 38% of staff members had witnessed a reportable event that failed to be documented in a Patient Safety Report. Moreover, 45% of staff members responded that they were dissatisfied or very dissatisfied with their scheduling, and 79% perceived a lack of recognition for positive contributions among the IMCU staff (Nayback-Beebe et al., 2013). Additionally, benchmarks were not met on pain management, fall risk, and medication reconciliation.<br> In order to supplement the planning process of achieving a healthy work environment, the team utilized the well-established AACN guideline to implement changes over a six month period. Interventions were based on the responses of the survey, as well as AACN’s six standards for creating a healthy work environment. After only three months of implementation within those six standards of a healthy work environment, dramatic improvements were seen in all areas. IMCU staff members reported an increase in positive feedback, communication, and teamwork, as well as a greater focus on patient care. Patient falls decreased by 75%, patient safety reports decreased by 20%, and all previously unmet benchmarks had improved from baseline. Evaluation of this evidence-based project showed positive outcomes in terms of nursing retention, patient and nursing satisfaction, and nursing quality indicators (Nayback-Beebe et al., 2013).

Implications to Nursing

It is evident in this selected literature that creating and maintaining a healthy work environment is crucial to nursing as it influences all levels of practice, including staff morale and patient outcomes. It was imperative for the unit to take a step back and identify factors contributing to the unhealthy work environment in order for change to happen and improvements to be made. This study demonstrates the process of utilizing evidence-based techniques in enhancing nursing practice and demonstrates the impact of establishing the AACN Standards for Establishing and Sustaining Healthy Work Environment within the healthcare system. While a barriers were found within the study, it remains a great resource for both the organization and nurses in creating a healthy work environment in their own unit (Nayback-Beebe et al., 2013). On a personal level, having a knowledge of what makes a healthy work environment is important to us as graduating nursing students since it is our goal to work on a unit that reflects these characteristics. It is essential to informed on what changes can be made to promote a healthy work environment and what are the processes of implementing those changes consists of. This article is very informative on both the knowledge and skills necessary to make changes that can be accomplish in the microsystem. We think that the consideration of evidence-based practice and the establishment of all of AACN Standards for Establishing and Sustaining Healthy Work Environment are necessary elements in creating and maintaining a healthy work environment. For changes to be made within a microsystem, each individual involved should be well informed on the process and involve in experience the change process that will have a positive impact in the system. Before we can improve the whole microsystem, we have to improve its parts. Each specific problem must be addressed. This perspective is important for microsystem leaders in order to make change to be effective. As future nurses, we can utilize the techniques from this study in terms of improving our own work environment and put emphasis on the establishment of trust with others and how to become authentic leaders. Overall, this literature has reinforced our understanding of a healthy work environment and serves as a reminder that small changes have potential to lead to tremendous outcomes.

Reference Nayback-Beebe, A. M., Forsythe, T., Funari, T., Mayfield, M., Thoms, W., Smith, K., Bradstreet, H, & Scott, P. (2013). Using Evidence-Based Leadership Initiatives to Create a Healthy Nursing Work Environment. Dimensions of Critical Care Nursing, 32(4), 166-173. doi: 10.1097/DCC.0b013e3182998121.

On 2016 Nov 25, University of Kansas School of Nursing Journal Club commented:

Team Members: McKee, M., Baker, M., Barnthouse, K., Janner, H., Hess, A., Severson, D, & Yungmeyer, A. (Nursing Class of 2017)

Background

Our team selected this article to review since it is relevant to the concepts covered in Section II of our course, Development of a Microsystem Leader, as it aims to explore issues found within the current nursing clinical microsystem. The article was found using CINAHL and it described how nursing and leadership from a large military trauma center developed and implemented evidence based change to create a standardized healthy work environment using the AACN Essential Standards for Establishing and Sustaining Healthy Work Environments: Improved Communication, Collaboration, Decision making, Appropriate Staffing, Staff recognition, and Authentic and transformational leadership skills (Nayback-Beebe, Forsythe, Funari, Mayfield, Thoms, Smith, Bradstreet, & Scott, 2013). Over recent years, many clinicians have focused on patient outcomes and the work environment in acute care setting, however few study have been done looking at the military health care setting. The main effectors of nurse satisfaction, intent to leave, and perceptions of poor quality of care are considered as unfavorable factors in nurse practice environments (Nayback-Beebe et al., 2013).

Methods

The article discusses the effects of the implementation of evidence-based leadership initiatives that aim to promote a healthier work environment. Using the military health care facility, the unit practice council first implemented quality improvement measures on their unit, and led to the evidence-based project involving the participation of the interdisciplinary patient care team. The research team compiled a PICOT question using the AACN Standards for Establishing and Sustaining Healthy Work Environments on what evidence-based leadership initiatives can be instituted in the IMCU to create a sustainable, healthier nursing work environment (Nayback-Beebe, et al. 2013). The group used the Iowa Model of Evidence-Based Practice to Promote Quality of Care, and collected, critiques and synthesized evidenced-based, long term solutions and identified leadership strategies that promote healthier work environment. The use of PICOT question allowed for the process improvement to foster a multidimensional research approach that included a staff survey, group sessions that allowed employees to express their views of old and new implementations, and staff/patient turnover data. The Likert-scale questionnaire was also used to determine nurse ratings on unit morale, unit stressors, and staff behavior as a result of the nurse work environment (Nayback-Beebe et al., 2013).

Findings

Survey results revealed that 59% of participating staff members rated staff morale in the IMCU as “poor” impacted by stressors on the unit by 96% of participants. These stressors included scheduling, poor communication, staff negativity, and lack of trust in leaders. It was also reported that 38% of staff members had witnessed a reportable event that failed to be documented in a Patient Safety Report. Moreover, 45% of staff members responded that they were dissatisfied or very dissatisfied with their scheduling, and 79% perceived a lack of recognition for positive contributions among the IMCU staff (Nayback-Beebe et al., 2013). Additionally, benchmarks were not met on pain management, fall risk, and medication reconciliation.<br> In order to supplement the planning process of achieving a healthy work environment, the team utilized the well-established AACN guideline to implement changes over a six month period. Interventions were based on the responses of the survey, as well as AACN’s six standards for creating a healthy work environment. After only three months of implementation within those six standards of a healthy work environment, dramatic improvements were seen in all areas. IMCU staff members reported an increase in positive feedback, communication, and teamwork, as well as a greater focus on patient care. Patient falls decreased by 75%, patient safety reports decreased by 20%, and all previously unmet benchmarks had improved from baseline. Evaluation of this evidence-based project showed positive outcomes in terms of nursing retention, patient and nursing satisfaction, and nursing quality indicators (Nayback-Beebe et al., 2013).

Implications to Nursing

It is evident in this selected literature that creating and maintaining a healthy work environment is crucial to nursing as it influences all levels of practice, including staff morale and patient outcomes. It was imperative for the unit to take a step back and identify factors contributing to the unhealthy work environment in order for change to happen and improvements to be made. This study demonstrates the process of utilizing evidence-based techniques in enhancing nursing practice and demonstrates the impact of establishing the AACN Standards for Establishing and Sustaining Healthy Work Environment within the healthcare system. While a barriers were found within the study, it remains a great resource for both the organization and nurses in creating a healthy work environment in their own unit (Nayback-Beebe et al., 2013). On a personal level, having a knowledge of what makes a healthy work environment is important to us as graduating nursing students since it is our goal to work on a unit that reflects these characteristics. It is essential to informed on what changes can be made to promote a healthy work environment and what are the processes of implementing those changes consists of. This article is very informative on both the knowledge and skills necessary to make changes that can be accomplish in the microsystem. We think that the consideration of evidence-based practice and the establishment of all of AACN Standards for Establishing and Sustaining Healthy Work Environment are necessary elements in creating and maintaining a healthy work environment. For changes to be made within a microsystem, each individual involved should be well informed on the process and involve in experience the change process that will have a positive impact in the system. Before we can improve the whole microsystem, we have to improve its parts. Each specific problem must be addressed. This perspective is important for microsystem leaders in order to make change to be effective. As future nurses, we can utilize the techniques from this study in terms of improving our own work environment and put emphasis on the establishment of trust with others and how to become authentic leaders. Overall, this literature has reinforced our understanding of a healthy work environment and serves as a reminder that small changes have potential to lead to tremendous outcomes.

Reference Nayback-Beebe, A. M., Forsythe, T., Funari, T., Mayfield, M., Thoms, W., Smith, K., Bradstreet, H, & Scott, P. (2013). Using Evidence-Based Leadership Initiatives to Create a Healthy Nursing Work Environment. Dimensions of Critical Care Nursing, 32(4), 166-173. doi: 10.1097/DCC.0b013e3182998121.