Programs That Support a Healthy Work Environment

Peter Buerhaus and several others have projected a nursing shortage between now and 2020, when many baby boomers retire.1 The Bureau of Labor also projects a 19% increase in the need for nurses by 2022.2 Nursing programs are growing, but there will still be a shortage of nurses, and it is important to retain experienced nurses in the workplace to assist in training the new graduates. Retaining experienced nurses requires leaders to develop programs that support a healthy work environment (HWE)—a vital component for retaining these experienced nurses.Nurses encounter challenges on a daily basis, and they look to their leaders and organizations to have policies in place to assist in addressing these issues. Nurses need to know that they are valued partners with organizations committed to programs that support them physically and emotionally. Many general issues must be confronted in ensuring a HWE, such as improvements in decision-making, communication, and collaboration and provision of authentic leadership and meaningful recognition. Additionally, having programs in place to address fatigue management, safe handling of patients, and staff safety/violence prevention demonstrate the organization’s commitment to this partnership with nurses. Examples of programs that support a HWE are described in this issue’s column.Fatigue is the body’s response to sleep loss or to prolonged physical or mental exertion. Contributing factors include, but are not limited to time on task, time and shift period duration, time since awake when beginning the duty period, acute or chronic sleep debt, circadian disruption, multiple time zones, and shift work.3Questions exist regarding how long nurses should be working and the safety of working multiple days in a row. Staffing and scheduling are challenging, and these nursing shortages are driving up work hours, yet there is current literature that speaks to the risk when staff work too much.4–7 These studies address staff safety in driving home, the decrease in cognitive function the longer the nurse works in a day, and the number of shifts nurses work in a week. One error made by a nurse who is too tired can be potentially harmful to patients. In addition, making such an error that is serious can lead to nurses becoming a second victim and feelings of guilt that they allowed themselves to become so tired.Nurses need frequent breaks and time away from the bedside to rejuvenate. They should not be forgoing breaks and continuing to work. Most states have laws related to required breaks for workers, which can result in penalties if not followed. The American Nurses Association (ANA) released a position statement8 on nurse fatigue in 2014. In that statement, the ANA recommends that appropriately managing fatigue is a joint responsibility between the nurse and the employer.8 On one hand, nurses have an ethical responsibility to come to work rested. On the other hand, employers are responsible for sustaining a culture of safety, ensuring that staff are getting adequate sleep, and ensuring that staff are fit for duty when they come to work.8 The statement outlines numerous detailed recommendations for both the employees and employers to manage fatigue.Eleven states have implemented laws about safe handling of patients, and a movement is underway to write federal legislation. The laws all have specific statements that require hospitals to review each injury caused by handling a patient. It also requires an emphasis on ensuring that nurses have the appropriate equipment and training to move patients safely.9 Most of the laws also require that a policy and procedure on how to move patients be in place. Some hospitals have hired “lift teams,” and others have implemented these requirements in unit-level training. The goal of these programs is to decrease or eliminate, if possible, manual lifting of any patients.Violence in the workplace is on the rise. It is not unusual to turn on the news at night and hear about another violent or active shooter incident. The Joint Commission has required that hospitals have a policy on how the employer is addressing disruptive behaviors and violence in the workplace. The Occupational Safety and Health Administration defines workplace violence as, “Any act or threat of physical violence, harassment, intimidation or other threatening disruptive behavior that occurs at the work site. It ranges from threats and verbal abuse to physical assaults and even homicide. It can affect and involve employees, clients, customers, and visitors.”10 About 20% of workplace injuries happen to health care workers, but 50% of workplace assaults happen to health care workers.11Hospitals that have HWEs have strong programs in place to protect their workers. In addition to having abusive behavior policies required by The Joint Commission, there should be a strong sense of security for the staff. One hospital’s approach to workplace violence took their plan to a higher level. They did a questionnaire with the staff that identified 3 types of violence: family abuse and intimidation of staff; patients and families screaming and/or using inappropriate language directed at patients and staff; and intimidation tactics, such as standing too close when speaking to the nurse, threats of litigation, or silence when the nurse is addressing them. This hospital developed an algorithm and tool for the staff to use when involved in these situations. They encourage staff members to notify the security team immediately if they feel they are being threatened. If the problem continues and does not impede care, staff can create a behavioral contract with the family and track any problems. If the problems persist, staff can restrict the family’s right to visiting. This sends a strong message to staff that the organization is protecting them and that this behavior is not tolerated.All of these programs support and strengthen HWEs. The purpose is not only to support the staff, but rather to address safety for both staff and patients. True authentic leaders support these programs and are constantly looking for ways they can support their staff. Programs on fatigue management and safe handling of patients may appear to focus more on the safety of staff, but ensure safety for both patients and staff. The workplace violence program tends to focus more on staff safety. It is important for the staff to believe they work in a safe and secure environment. These programs are essential for creating and sustaining a HWE.