Health Promotion for Nurses’ Work Environments

If you are like many nurses I know, you tend to put yourself last. First come your patients, followed by your family and friends, and then you ... if there is time. We help others before we help ourselves, and too often this takes a toll on our personal health and well-being.

For years, there have been calls to action for nurses and other healthcare professionals to prioritize self-care, personal health and wellness. The call for self-care has been amplified since the start of the COVID-19 pandemic. While it is easy to talk and write about self-care, it is challenging to make it part of our daily lives, especially when many of us are operating in crisis mode. The impact on our physical and mental health may be catastrophic for nurses, healthcare organizations and society. Friends and colleagues, please take care of yourselves.

Healthy Work Environments

I have similar concerns about the health of our work environments. For almost two decades, progressive and critical care nurses have understood the importance of creating and sustaining healthy work environments (HWEs). There is no shortage of evidence demonstrating the positive outcomes of HWEs. However, translating this evidence into practice may present challenges. The concept of an HWE might seem abstract, and efforts to address AACN HWE standards such as True Collaboration and Authentic Leadership might seem daunting. Assessing and addressing work environment opportunities might be on our to-do lists or something we plan to address after we take care of the needs of our patients, families and friends.

Today it is more important than ever to prioritize the health of our work environments. Just as we need to support nurses’ personal health and well-being, we must remain vigilant about the health of work environments and optimize the evidence-based standards impacting our practice settings. If the state of our workplaces is overlooked, even in times of crisis, the effects may be devastating for patient care and the nursing profession.

Work Environments Are Living Beings

I like to think of the work environment as a living being. It is an organism that is constantly evolving. Each work environment has a unique personality. There are good days and bad days, strengths and opportunities. The work environment is composed of nurses, physicians, therapists, management, administrative and support staff who work in the practice setting. Patients and families receive care in the work environment, and practices, policies and procedures, and social norms guide the operations. These interconnected variables breathe life into work environments that are not perfect, just like the people, policies and systems that make it up.

Vigilance Is Key

I recently had my annual physical with my nurse practitioner (NP). I was dreading it, because I had not been as vigilant about my health and well-being as I needed to be. At my appointment, I had to stand on the scale, and despite my wishful thinking otherwise, I had gained about 15 pounds in a year. I talked about it with my NP, and we came up with a plan, including more frequent monitoring.

In many ways, optimizing the health of work environments is similar to optimizing our own health. When we fail to be vigilant and not pay close attention to the health of our work environments, we may very well wake up one day and say, “Oh no, what happened.” Several years ago, my organization implemented an annual HWE assessment in all practice settings. The goal was to provide a system where areas step on the “HWE scale,” see where they stand and take action when appropriate.

As with our health and well-being, if we want to see positive outcomes, we may need to change to get the desired results. Finding the time to exercise, plan our meals and use meditation apps are interventions that might help. It may be easier to put off going to an annual physical, and sometimes it might be easier to not want to know the results of the HWE assessment, but without integrating this practice into our work, we may be left to wishfully think that our work environments will become, or remain, healthy on their own (and they will not).

COVID-19 has impacted your work environment in some way. Last year, I had several colleagues question whether or not we should be conducting our annual HWE assessment because of the pandemic. I believe there is no more important time to take inventory and prioritize the health of our practice settings. If we wait for things to return to “normal” before we evaluate or take steps to improve our work environments, we might find ourselves with much bigger hills to climb.

Health Is the Operative Word

Last year, I attended a colleague’s HWE presentation for her department. She said something that I thought was profound. “We are striving for healthy work environments, not utopia work environments.” I have many conversations about HWEs with nurses and interprofessional colleagues, and I often return to my colleague’s words. Sometimes we may resist exploring our work environments because our goals feel out of reach. If we strive for perfection, we set ourselves up for failure because the perfect work environment does not exist.

Health is the operative word in HWE. The answer to the question “Is your work environment healthy?” is not yes or no. Rather, it is open-ended, as certain aspects are strong, and other areas need improvement. These strengths and challenges will change over time, and this is why it is so important that assessment and intervention become a longitudinal process. As we implement interventions, they may or may not contribute to improvement, and new opportunities might arise. Creating HWEs is an ongoing process with no finish line.

When we approach work environment conversations as a journey rather than a destination, two things occur. First, success becomes achievable. We are simply looking for an area to improve rather than fixing all that is broken. Second, it sets the expectation that this work is ongoing. Creating an HWE is not a project with an end. It is an ongoing and iterative process with the accountability of all team members.

If we go back to our personal health, imagine setting a plan to achieve a goal. Success means reaching that goal. However, if we view our goal as a finished project and revert to the same habits, we will lose the gains we made. On the other hand, we might view it as an ongoing process and follow our goal with a new goal. When we approach creating HWEs as a project, we might have short-term success, but we also need to think about sustained improvement.

So how do we start? Here are some practical steps to contribute to creating HWEs from an individual and a practice-setting perspective.

For Individuals:

Self-care: We need to take care of ourselves. As nurses, we must address our physical and mental health — schedule time to participate in activities that bring us joy. Self-care not only has positive outcomes for the individual, but when we take care of our physical and mental health, we are more able to be fully present and invested in patient care and our work environments.

Seek help: As we continue to support patients with COVID-19, we also need to normalize mental healthcare for nurses. If you are struggling, I urge you to care for yourself before caring for your patients, family and friends. If your organization has an employee assistance program, access it or reach out to your primary care provider to see if counseling would benefit your health and wellness.

Self-reflection: The HWE journey needs to begin with each of us looking in the mirror and answering a question: “What am I doing to contribute to the health of my work environment?” How do you show up for patients, families and colleagues? We need to be honest with ourselves and think about how we present ourselves in our practice settings. Are you someone who positively influences your colleagues and your environment?

For the Practice Setting:

Assess: If your practice setting has not evaluated your work environment’s health recently, now is a good time. If you are in a position to make it happen, great. If not, discuss it with your leaders. Ideally, assessment will be a collaborative effort between leaders and staff. The AACN HWE Assessment Tool is user-friendly and does not require statistical or in-depth data analysis.

The tool focuses on the six evidence-based AACN HWE standards: Skilled Communication, True Collaboration, Effective Decision-Making, Appropriate Staffing, Meaningful Recognition and Authentic Leadership. Approach the assessment as if it’s your practice setting’s annual physical. Use the results to generate discussions about areas of strength and opportunities for improvement. View a video about my unit’s experience with the HWE Assessment Tool at this link.

Involve all team members: The assessment tool has been validated for interprofessional use. Healthcare is collaborative, and all team members should be invited to participate in the assessment and contribute to the ongoing dialogue. Build HWE discussions into staff meetings, and launch interprofessional work groups to work on HWE efforts throughout the year.

Start with one HWE standard: Collaborate with your team to pick one priority and set realistic goals Just as we would not ask patients to make multiple changes to address their health at the same time, we need to begin with specific achievable goals. Thinking about addressing every single work environment issue at once can be daunting. Picking one HWE standard to work on for a certain amount of time is more manageable. An added benefit is that since the HWE standards are interrelated, starting with one often enhances the others. And the critical elements associated with each HWE standard can guide your action steps, both at the individual and organizational level. Use your setting’s HWE assessment, and gather input from staff to inform which standard your team will target. Use staff meetings or HWE committee meetings to encourage staff to offer ideas. Pick one initiative to implement, map out achievable action steps, track their progress and, most importantly, stay the course; change takes time.

Repeat the process: Set a schedule for reevaluation. At my organization, March is HWE assessment month, which sets the expectation that leaders and staff in practice settings will learn how initiatives impact the HWE standard. Reevaluation also provides updated data to guide HWE work for the next year. Perhaps you implemented an initiative to promote meaningful recognition. At the next assessment, your setting’s meaning recognition score might improve, and then the team decides to work on skilled communication based on the assessment results.

Conclusion

Nurses and their colleagues rose to meet the demands of the COVID-19 pandemic, often at the expense of our physical and mental health. Now is the time to promote personal well-being and the health of our work environments to ensure the best outcomes for our patients and our profession.

Has your practice setting and/or organization implemented initiatives associated with the HWE standards? Share your story in the comments below.