Chapter 13: Creating & Sustaining a Healthy Work Environment

Safe Patient Handling & Mobility Program outlines the roles of nurse leaders & managers & the staff. What are the 8 standards?

1. A culture of safety 2. A formal & sustainable SPHM Program throughout the organization 3. An ergonomic specific approach 4. Inclusion of SPHM technology 5. An effective system of education, training, & maintaining competence 6. Patient centered assessments & plans of care adapted to meet individual patient needs 7. Reasonable accommodations & post injury return to work for staff members who have been injured 8. A comprehensive evaluation system to evaluate SPHM program status

What are the 3 organizations that promote healthy work environments?

1. American Nurses Association (ANA) 2. American Association of College of Nursing (AACN) 3. American Organization of Nurse Executives (AONE)

The Healthy Nurse, Healthy Nation Grand Challenge (HNHN GC) will:

1. Engage nurses on 3 levels: Individual, Organizational, Interpersonal 2. Improve their health in key areas: Physical activity, rest, quality of life, safety 3. Create a healthy nurse population & in turn: a healthier workforce, effective; safe, sustainable healthcare; role models of health; educators & advocates for health

What are strategies nurse leaders & managers must use to prevent workplace violence?

1. Examine the workplace for the presence of an unhealthy environment 2. Increase awareness of workplace violence by providing information at staff meetings 3. Model & promote positive & professional behaviors to foster a healthy environment 4. Support the development of organizational zero tolerance of workplace violence programs & policies 5. Ensure communication is open, non biased, & respectful at all times 6. Deal directly with all reported incidents of workplace violence

What are the 8 hallmarks of the American Association Colleges of Nursing?

1. Manifest a philosophy of clinical care emphasizing quality, safety, interdisciplinary collaboration, continuity of care, & professional accountability 2. Recognize the contributions of nurses expertise on clinical care quality & patient outcomes 3. Promote executive level of nursing leadership 4. Empower nurses participation in clinical decision making & organization of clinical care systems 5. Maintain clinical advancement programs based on education, certification, & advanced preparation 6. Demonstrate professional development support for nurses 7. Create collaborative relationships among members of the healthcare team 8. Use technological advances in clinical care & information systems

What are the 7 premises of the Bill of Rights?

1. Nurses have the right to practice in a manner that fulfills their obligations to society & to those who receive nursing care 2. Nurses have the right to practice in environments that allow them to act in accordance with professional standards & legally authorized scopes of practice 3. Nurses have the right to a work environment that supports & facilitates ethical practice in accordance with the Code of Ethics for Nurses with Interpretive Statements 4. Nurses have the right to advocate for themselves & their patients freely & openly without fear of retribution 5. Nurses have the right to fair compensation for their work, consistent with their knowledge, experience, & professional responsibilities 6. Nurses have the right to a work environment that is safe for themselves & for their patients 7. Nurses have the right to negotiate the conditions of their employment, either as individuals or collectively, all practice settings

What are the 3 types of Nurse Fatigue?

1. Physiological, or reduced physical capacity 2. Objective, or reduced productivity 3. Subjective, a weary or unmotivated feeling

What are the 6 essential standards of AACCN for sustaining a healthy work environment?

1. Skilled Communication 2. True Collaboration 3. Effective Decision Making 4. Appropriate Staffing 5. Meaningful Recognition 6. Authentic Leadership

What are the 8 principles of Guiding Principles: Mitigating Violence in the Workplace published by the American Organization of Nurse Executives (AONE)?

1. Violence can & does happen anywhere is recognized 2. Healthy work environments promote positive outcomes 3. All aspects of violence (family, patient, & lateral) must be addressed 4. A multidisciplinary team, including patients & families, is required to address workplace violence 5. Everyone in the organization is accountable for upholding behavior standards, regardless of position or discipline 6. When members of the healthcare team identify an issue that contributes to violence in the workplace, they have an obligation to address it 7. Intention, commitment, & collaboration of nurses with other healthcare professionals at all levels are needed to create a culture shift 8. Addressing workplace violence may increase the effectiveness of nursing practice & patient care

What is the ART model?

Acknowledging a problem Recognizing choices & choosing purposeful actions to take Turning toward self & others to reconnect with self & the environment

identified 8 hallmarks of a work environment that fosters professional nursing practice

American Association of Colleges of Nursing (AACN)

promote the creation of healthy work environments that support excellence in patient care whenever nurses practice

American Association of Critical Care Nurses (AACCN) standards for establishing & sustaining healthy work environments

developed numerous initiatives, position statements & brochures focusing on what is part of a healthy work environment & what is not

American Nurses Association (ANA)

staffing must ensure the effective match between patient needs & nurse competencies

Appropriate staffing

process of self discovery by understanding one's purpose, holding, & practicing professional values, practicing with heart, establishing enduring relationships, & practicing self discipline

Authentic

nurse leaders must fully embrace the imperative of a healthy work environment, live in it, & engage others in its achievement

Authentic Leadership

process of acknowledging a misconception that is favorable to the person who holds the misperception or failure to see that one has a problem

Aware of self deception

Why do nurses frequently not report their injuries?

Believe that they would be letting their patients down, they consider injuries to be part of the profession, & they think that making a report would be pointless

process of purposefully speaking with frankness that is free from bias & risking speaking & hearing the truth

Candid

Organization consequences of workplace violence?

Creates a culture of fear & diminishes staff morale Impacts patient safety & job dissatisfaction Results in disrupted work relationships, miscommunication, & an unhealthy work environment Results in negative patient & nurse outcomes

What does an unhealthy work environment look like?

Creates stress among nurses Contributes to adverse events Lacks civility, respect, & courtesy Breeds ineffective interpersonal relationships

Where is the highest patient to nurse violence occurrence?

ER & psychiatric care environments

nurses must be valued & committed partners in making policy, directing, & evaluating clinical care, & leading organizational operations

Effective Decision Making

What do the safe patient handling laws require?

Established Policy Guidelines for securing appropriate equipment & training Collection of data Evaluation

perpetrated by outside persons entering the workplace or when nurses are going to or from the workplace; usually random

External violence

perpetrators typically have criminal intent, such as rape, assault, armed robbery for drugs, or gang reprisals in EDs

External violence

a social movement designed to transform the health of the nation by improving the health of the nation's 4 million RNs

Healthy Nurse, Healthy Nation Grand Challenge (HNHN GC)

one that is safe, empowering, & satisfying not merely the absence of real & perceived physical or emotional threats to health but a place of physical, mental, & social well-being, supporting optimal health & safety

Healthy work environment

disrespect, rudeness, & general disdain for others that often results in psychological & physiological distress for those involved

Incivility

What are the systematic factors of workplace violence?

Increased productivity demands Cost containment (while trying to provide safe care) Stress (from fear or litigation) Inadequate information between organization leadership & staff Lack of staff involvement in decisions

What does a healthy work environment do?

Increases work satisfaction & retention Improves organizational performance Improves patient outcomes Supports meaningful work with joy & safe patient care delivery Enhances recruitment & retention Sustains an organizations financial viability

What are barriers to safe patient handling & mobility?

Lack of a no lift policy Lack of adequate lifting equipment Lack of adequate space on unit Decreased staffing levels Architecture of the environment Nurses do not report their injuries

Reasons for under reporting workplace violence?

Lack of knowledge, time, & administrative support Fear of repercussion Lack of hospital administrators to follow up on reports Unhealthy work environment that breeds frequency & character of workplace violence

bullying or incivility between 2 or more nurses at the same level

Lateral/Horizontal Violence

What are the 2 types of nurse to nurse violence?

Lateral/Horizontal violence Vertical violence

nurses must be recognized & must recognize others for the value each brings to the work of the organization

Meaningful Recognition

process of developing a heightened awareness of & alertness to verbal & nonverbal communication, developing present centered awareness, & acknowledging & accepting each thought & feeling as it is

Mindful

this type of violence results in a negative community, emotional & physical aftermath, undesirable effects on patient care, & injured associations among coworkers

Nurse to nurse violence

helps nurses improve their work environment & ensure their ability to provide safe, quality patient care

Nurses Bill of Rights of 2001

affects the entire healthcare organization & occurs as a result of changing work environment

Organizational violence

this type of violence tarnishes the reputation of the organization as well as negatively impacts the employees

Organizational violence

Individual consequences of workplace violence?

Physical effects: frequent headaches, GI upset, weight loss/gain, sleep disturbances, HTN, & decreased energy Psychological effects: stress, anxiety, nervousness, depression, frustration, mistrust, loss of self esteem, burnout, emotional exhaustion, & fear

What are the dangers of nurse fatigue?

Physical injuries to safe & patients, irritability, reduced motivation, inability to stay focused, diminished reaction time, increased risk for errors, decreased memory, increased risk taking behaviors, impaired mood, ineffective communication skills, high levels of worker fatigue, reduced productivity, & increased risk of personal safety

____ is more prevalent among healthcare workers

Physiological & Psychological harm

What are the nurses obligation of fatigue?

Practice in a manner that maintains patient & personal safety Alert & take appropriate action Seek balance between personal & professional lives Responsibility to arrive at work well rested, alert, & prepared to deliver safe, quality nursing care

What are the causes of nurse fatigue?

Prolonged hours: slow reaction times, decrease attention to detail, errors of commission, compromised problem solving strategies, increased risk of errors, decreased memory, increased risk taking behavior, impaired mood, & ineffective communication skills Lack of rest breaks during working hours Lack of self care

What are the benefits of the Safe Patient Handling & Mobility Programs?

Reduction of workplace injuries Improvement in patient safety & quality of care Reduction of work related healthcare costs Increase in worker satisfaction & healthcare savings Reduction in worker's compensation, employee turnover, patient falls, & pressure ulcers

process of pondering the meaning of an experience carefully & persistently, creating meaning from past or current events that guide future behavior, & self questioning so situations become more clear & coherent

Reflective

inappropriately friendly behavior, sexually based verbal comments, vulgar, sexual language or inappropriate jokes/stories; unwelcome advances or requests for sexual favors; unwanted physical contact of a sexual nature; & sexual innuendo

Sexual harassment

nurses must be proficient in communication skills as they are in clinical skills

Skilled Communication

promotes skilled communication & encourages nurses to become aware of self deception, reflective, authentic, mindful, & candid

Skilled Communication Model

What are 2 models for creating a safe work environment?

Skilled Communication Model & ART Model

What are strategies nurses can reduce the risk of fatigue?

Sleeping the recommended 7-9 hours within a 24 hour period, taking brief rest periods before work shifts, improving overall health, adopting stress management strategies, & taking schedule meal & rest breaks when working

What are the resources for creating a safe work environment?

The Joint Commission, OSHA, & ANA

nurses must be relentless in pursuing & fostering this

True Collaboration

What are the 2 principal methods for patient lifting?

Two person lift & the hook & toss method

perpetrator has criminal intent & no legitimate relationship with the organization or its employees

Type 1 Workplace Violence

perpetrator is the customer/client, patient, family member, or visitor & has a relationship with the organization & becomes violent while receiving services; very common in healthcare

Type 2 Workplace Violence

perpetrator is another coworker or commits worker on worker violence; includes incivility & bullying & is very common in healthcare

Type 3 Workplace Violence

perpetrator has a relationship with a worker but no relationship with the organization; involves personal relationships (e.g., an employee is followed to work by his/her spouse with the intent to threaten or harm the employee)

Type 4 Workplace Violence

bullying or incivility between a nurse subordinate & someone at a higher level (e.g., a manager to staff nurse or charge nurse to staff nurse)

Vertical violence

Sexual harassment can occur between?

between nurses, between nurses & their supervisors, & between nurses & patients or family members

Harms, undermines, & degrades others Can include hostile remarks, verbal attacks, threats, taunts, intimidation, & withholding of support

bullying

repeated, unwanted actions intended to humiliate, offend, & cause distress in recipients

bullying

What is the ER risk factors of workplace violence?

degree of accessibility (24 hour access), amplified noise level, diminished security, elevated stress, & extended wait times

What are examples of organizational violence?

excessive workloads & unsafe working conditions

Sexual harassment can be addressed through?

federal & state legislation & by policies & procedures in place to protect staff from sexual harassment

What is the gender risk factor of workplace violence?

females

What are examples of Nurse to Patient Violence?

hitting a patient, using restraints without an order, & refusing to administer pain medication in a timely manner

Nurses are at high risk for musculoskeletal disorders due to:

inadequate lifting, transferring patients, & repositioning patients

includes gossiping, spreading rumors about others, & refusing to assist a coworker

incivility

What are individual factors of workplace violence?

lack of interpersonal coping & conflict management skills expectation for nurses to remain silent about workplace violence

includes biochemical attacks or terrorist attacks, & natural disasters

mass trauma or natural disasters

includes emotional abuse, intimidation, putdowns, harassment, humiliation, & human at the expense of a colleague

nonphysical workplace violence

impaired function resulting from physical labor or mental exertion

nurse fatigue

physical or nonphysical violence between or among nurses who have a workplace relationship

nurse to nurse violence

occurs when nurses are violent toward those in their professional care, with a resulting violation of the nurses code of ethics; violating professional boundaries

nurse to patient violence

Where are Patient to Nurse Violence likely to happen to females?

other speciality areas

What are the negative impacts of lifting without adequate techniques or equipment?

patient comfort, safety, & quality of care

What are examples of Patient to Nurse Violence?

patient hitting or biting a nurse or a family member yelling at a nurse

involves a patient or family member being violent toward a nurse

patient to nurse violence

Where are Patient to Nurse Violence likely to happen to males?

psychiatric setting

this type of violence jeopardizes the confidence & security of the individual witness, so the perpetrator is actually inflicting harm on secondary victims

third party violence

violence that is witnessed directly or indirectly by others

third party violence

witness can have the same physiological &/or psychological effects as to the victim of the actual violence

third party violence

considered a workplace free of risks of both physical & psychological harm

workplace safety

What is the age & experience risk factor of workplace violence?

younger & less experienced nurses