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FigureAs we seek to reframe our professional lives in the wake of the COVID-19 public health emergency, concern about healthcare work environments has escalated. The National Academy of Medicine, for instance, prioritized actions that address the work environment in their National Plan for Health Workforce Well-being, and the National Institute for Occupational Safety and Health (NIOSH) recently launched the Impact Wellbeing campaign with a primary goal of influencing system level change.1,2 The American Association of Critical-Care Nurses (AACN) similarly recognizes the importance of the healthcare work environment in their Standards for Establishing and Sustaining Healthy Work Environments.3 This column is the first in a series that will focus on creating positive changes in the context in which healthcare is delivered, so that our workforce can thrive and optimize patients' experiences. Background First published in 2005 and updated in 2016, AACN's Standards for Establishing and Sustaining Healthy Work Environments offer a framework for considering the relational and contextual elements that influence job satisfaction and care delivery (see Table 1). In fact, AACN's central advocacy priority is to improve the health of nurses' work environments. Resources to realize this goal include offering an open access, validated work environment assessment tool; conducting a series of national surveys to assess the state of acute and critical care work environments; and co-leading a partnership to address nurse staffing, consistently the lowest rated of the six standards. Table 1: - AACN's Standards for Establishing and Sustaining Healthy Work Environments Standard Definition Example Skilled Communication Be as proficient in communication skills as you are in clinical skills. A nurse is angry after a comment by another nurse and, rather than reacting, responds by asking for more information about the comment's meaning. True Collaboration Be relentless in pursuing and fostering true collaboration. When a nurse and another team member don't agree about the plan of care, they each take time to hear the other person's perspective. Effective Decision-Making Be committed partners in making policy, directing and evaluating clinical care, and leading organizational operations. Nurses serve on a hospital-wide committee with other members of the healthcare team to develop a plan to reduce the rate of hospital-associated infections. Appropriate Staffing Staffing must ensure the effective match between patient needs and nurse competencies. Patient assignments are adjusted to address a change in patient condition. Meaningful Recognition Be recognized and recognize others for the value each brings to the work of the organization. Nurses receive paid time to engage in professional development activities such as conference attendance. Authentic Leadership Fully embrace the imperative of a healthy work environment, authentically live it, and engage others in its achievement. Leaders routinely reach out to newly oriented nurses to hear their concerns and offer support. Source: American Association of Critical-Care Nurses. Standards for establishing and sustaining healthy work environments. 2016. www.aacn.org/nursing-excellence/standards/aacn-standards-for-establishing-and-sustaining-healthy-work-environments. Analysis of AACN's national survey data demonstrates an implementation gap. Nurses who report working in units that are actively engaged in implementing AACN's standards are less likely to report moral distress and intent to leave and are more likely to report a higher percentage of shifts with appropriate staffing.4 In the most recent study, conducted in 2021, nurses reported significantly lower ratings on all six standards than in the 2018 study.4 These findings support AACN's new approach, which is to connect with health systems, hospitals, and individual units to support implementation of these standards. Future Healthy Work Environments columns will describe the resulting projects and their outcomes. Why are our work environments unhealthy? The mission of healthcare prioritizes human connection and carefully considered interventions. This mission coexists with the business of healthcare, which prioritizes efficiency and productivity. These priorities aren't mutually exclusive, but the effort to align them magnifies the collective emotional stress in the work environment. Other sources of distress include: Increases in workplace violence. Many patients who seek healthcare do so not because they trust the healthcare system but rather because they have no other recourse. That desperation contributes to discordant communication, verbal abuse, and physical violence. Global increases in the incidence of healthcare workplace violence are both an outcome and a symptom of unhealthy work environments.5 Unclear goals of care. Patients who present with life-limiting illness face prognostic uncertainty and decisions that are ethically fraught. In a fast-paced environment, there's seldom time to sort through the ethical elements of care delivery, resulting in moral uncertainty and moral distress. Division among the team. Hospitals merging with larger systems creates efficiency through centralized resources but also less opportunity for those who make decisions to connect with the workforce affected by those decisions. In addition, AACN surveys show significant differences in the way managers and direct care nurses rate their work environments.4 These differing perceptions demonstrate a divide between leaders and staff. Because healthcare delivery is inherently a complex endeavor, environments that lack time and space for connection among team members feel hostile. It's frightening that nearly a quarter of nurses plan to leave the profession.6 At the same time, it's not surprising when considering that contextual barriers to care delivery compound the emotional toll of being with patients and witnessing their suffering. How can we move forward? The first step is conceptualizing the work environment as a changeable feature of our lives. The word "environment" sounds like a fixed entity, as stable and permanent as the physical structure of a healthcare facility. That perception casts changes in the work environment as unattainable. An alternative perspective is to apply the paradigm of risk factors for health problems, which are modifiable (such as tobacco use and dietary choices) and nonmodifiable (such as genetics and other preexisting conditions). For example, discordant views on appropriate goals of care for a critically ill patient may be unavoidable. What is modifiable, however, is the way we frame those differences and the responses we provide. If much of the work environment is composed of its occupants' behaviors, attitudes, and relationships, then each member has some power to contribute to its improvement. The illnesses and injuries we see in our patients are a constant reminder that profound and life-changing events aren't always in our control. Our day-to-day interactions, which may seem mundane by comparison, have an immense impact on the environment in which we work, and in that space, we have the opportunity for influence. What should be easy is terribly hard Another key step is recognizing that change is hard. AACN's six standards may seem straightforward but implementing them requires deliberate effort. They're not discrete but interrelated, and all are evidence-based. In addition to survey data demonstrating the implementation gap, seminal work shows that the impact of higher staffing levels on patient outcomes varies based on the health of the work environment. In settings with unhealthy work environments, higher staffing levels weren't associated with a decrease in 30-day patient mortality but in settings with higher staffing and a healthy work environment, mortality was significantly lower.7 Because implementing all six standards in an environment that's currently unhealthy is both unrealistic and overwhelming, nurses who seek to implement the standards can use the free Healthy Work Environment Assessment Tool and then select one standard, perhaps one with a lower score, and work only on that standard. Often, addressing one standard leads to improvements in the others. For instance, creating a program that demonstrates meaningful recognition means understanding what's meaningful to your colleagues. To determine that, teams use skilled communication and then, to develop an intervention, they rely on effective decision-making. The implementation of the process or program they develop will require authentic leadership and true collaboration. Recognizing how these actions and conversations connect to specific Healthy Work Environment standards reinforces each participant's contribution and begins the journey toward a healthier work environment. Creating change The care of acute and critically ill patients is emotionally fraught, and unhealthy work environments are a modifiable source of stress for our healthcare workforce. The AACN Healthy Work Environment standards provide a framework for creating change in the relationships we make and the context we experience in our professional lives. In later columns, we'll dive deeper into the evidence base for the Healthy Work Environment standards and share strategies that units and organizations have used to implement them.
2Starting Now: Implementing the Healthy Work Environment Standards Is More Important Than Ever
Starting Now: Implementing the Healthy Work Environment Standards Is More Important Than Ever
3Transition to Practice: Onboarding Components for Establishing and Sustaining Healthy Work Environments.
Transition to Practice: Onboarding Components for Establishing and Sustaining Healthy Work Environments.
6Longitudinal Evaluation of Implementation of AACN's Healthy Work Environment Framework in an Intensive Care Unit.
Bedside nurse turnover in the United States is 22.5%, representing a national challenge that has been attributed to poor work environments. Poor work environments result in decreased nurse satisfaction and retention as well as poor patient outcomes. Healthy work environments have the opposite effects. To evaluate the impact of implementation of the American Association of Critical-Care Nurses (AACN) healthy work environment framework in an intensive care unit on work environment scores, turnover, and tenure during a 6-year period. A prospective, longitudinal design was used to evaluate implementation of the healthy work environment framework in an intensive care unit in a large academic medical facility. Interventions for each of the 6 healthy work environment standards were carried out. The AACN Healthy Work Environment Assessment Tool was used to measure each standard in 2017, 2019, 2021, and 2023. No statistically significant differences were found between cohorts. The score for each healthy work environment standard and the overall score increased significantly from 2017 to 2023. Nurse turnover increased during the COVID-19 pandemic but restabilized within 2 years. Findings from this study suggest that targeted interventions addressing the healthy work environment standards are associated with improved staff satisfaction and reduced turnover. Furthermore, the findings highlight the value of the healthy work environment framework in improving nurse retention.
Read more41Perceptions of US nurses and nurse leaders on authentic nurse leadership, healthy work environment, intent to leave and nurse well-being during a second pandemic year: A cross sectional study.
The main aim of this study was to determine the perceptions of clinical nurses and nurse leaders about authentic nurse leadership, work environment, pandemic impact, well-being and intent to leave their position and profession during the second year of the pandemic. This research team studied the variables pre-pandemic and in year one of the pandemic. As the pandemic continued, subsequent reports of workforce instability, deteriorating work environment and vulnerable well-being called for an understanding of the current state to inform needed actions by leadership. This study is a cross-sectional, descriptive, correlational analysis using national survey data from 1795 US clinical nurses and nurse leaders in the fall of 2021. Pandemic impact was high, authentic nurse leadership was present, healthy work environment was not present and nurse well-being was at-risk and negatively correlated to both healthy work environment and authentic nurse leadership. Within our sample, 61.8% of nurses had no intention to leave their positions, and 82.5% had no intention to leave the profession. Compared with clinical nurses, nurse managers had significantly higher scores on all instruments. The findings of this study support leadership as positively related to a healthy work environment. Authentic nurse leadership, a healthy work environment and nurse well-being are all critical components of efforts to stabilize the nursing workforce as we recover and rebuild post-pandemic. This is a call to action for leadership that will serve the goals of retaining nurses, rebuilding work environments and improving well-being.
Read moreGender Differences in Work Stress and Bullying Victims
Introduction. Oil and gas refinery industry often face unique challenges in creating a healthy and productive work environment. This difference gender composition in an industry dominated by male workers provides its own dynamics in interpersonal relationships in the workplace. Work stress and bullying have potential to create an unhealthy work environment and harm an individual's psychological well-being. The aim of this research is to determine relationship between work stress and bullying, work stress and gender, and relationship between bullying and gender in oil and gas refinery industry Methods. This study used correlative analysis with sample of 218 workers. Instrument used is PSS-10 questionnaire (work stress) and the relationship dimension in HSE MS-IT (bullying) Results. Statistical test show there is a relationship between work stress and bullying (p value=0.0001), there is no relationship between gender and work stress (p value= 0.287), there is a relationship between gender and bullying (p value= 0.001). Discussion. Our findings show workers who report being bullied are more likely to experience work stress. Gender differences do not influence a person to experience work stress, this suggests other factors beyond gender may be more dominant in influencing work stress. Male workers more often report experiences of bullying, these findings highlight the importance of understanding gender dynamics in the context of workplace bullying. Conclusion. It is important to overcome bullying in the workplace, so work stress decreases and a healthy work environment is created. Anti-bullying policies, training for management and employees, and psychosocial support can be necessary solutions.
Read more1Healthy Work Environment Standards in Tele-Critical Care Nursing.
The COVID-19 pandemic exacerbated staffing challenges in intensive care units, with increased burnout and moral distress cited as major problems. A healthy work environment is critical to nurses' success and wellbeing. During the pandemic, a survey by the American Association of Critical-Care Nurses revealed decreased composite scores in each of the 6 critical elements of a healthy work environment. Hospital units that improved even 1 critical element reported higher job satisfaction. The use of telehealth tools by expert nurses expanded care delivery during the pandemic by improving response to acutely and critically ill patients while supporting hospital-based nurses. All of the critical elements of a healthy work environment are relevant to the tele-critical care nurse's role and challenges. This article describes how tele-critical care nurses were affected by the pandemic and how healthy work environment strategies promoted successful nurse and patient outcomes.
Read moreCritical care nurses’ health and their description of a healthy and sustainable work environment in intensive care units in Sweden: A cross-sectional study
Intensive care units are stressful environments and can bring negative psychological outcomes among critical care nurses. The aim of the present study is to describe critical care nurses’ characteristics and perceptions of health in relation to sex, and also provide their description of a healthy and sustainable work environment in intensive care units using a person-centred practice framework. A cross-sectional design was employed with 136 participants who responded to a questionnaire. Descriptive statistics and qualitative content analysis were used. Regardless of sex, critical care nurses perceived their current health to be significantly lower than their health before the COVID-19 pandemic. They described effective staff relationships and a supportive organization as being essential for a healthy and sustainable work environment. Critical care nurses have recovered to their perceived pre-pandemic health to some degree. Well-functioning teams and a supportive organizational system might nurture a healthy and sustainable work environment.
Read morePENGARUH TOXIC LEADERSHIP, JOB STRESSDAN PERCEIVED ORGANIZATIONALSUPPORT TERHADAP TURNOVER INTENTION PADA KARYAWAN DI PT. KELAPA SAWIT GSB EMPAT LAWANG
This study aims to analyze the influence of toxic leadership, job stress, and perceived organizational support on turnover intention in case study employees at PT galempa Sejahtera Bersama Simpang Perigi Empat Lawang Branch. This research uses quantitative methods with a survey approach, where data is obtained through questionnaires distributed to 60 respondents. The results of this study confirm that psychological, social and support factors have a significant influence on individual exit intentions. This underscores the importance of positive leaders and a healthy work environment as well as support from the company in maintaining employee engagement. Therefore, organizations need to implement policies to improve leadership quality, effectively manage work stress, and increase the level of support perceived by employees to lower high exit intentions. A decrease in exit intention can be achieved through improving a healthy and supportive work environment. Keywords: Toxic Leadership, Job Stress, Perceived Organizational Support, Turnover Intention
Read more74Systematic review of evidence on the impact of nursing workload and staffing on establishing healthy work environments
Background This systematic review set out to examine the impact, if any, of nursing workload and staffing on creating and maintaining healthy work environments. For the purposes of this review, the term 'healthy work environment' was defined as '. . . a practice setting that maximizes the health and well-being of nurses, quality patient outcomes and organizational performance'. This definition identifies nurse, patient and organisational outcomes as indicators of the establishment and maintenance of a healthy work environment. Objectives The review sought to determine the impact of: • Patient characteristics, nurse characteristics, system characteristics and system processes on workload, scheduling and concepts of productivity and utilisation • Workload, scheduling and concepts of productivity and utilisation on the quality of outcomes for clients, nurses and the system/organisation Search strategy The search strategy sought to find both published and unpublished studies and papers written in the English language. A three-step search strategy approach was used. An initial limited search of MEDLINE and CINAHL databases was undertaken to identify optimal search terms followed by an analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. A second extensive search using all identified keywords and index terms was then undertaken. The third step consisted of a search of the reference lists of all identified reports and articles for additional studies. Selection criteria Types of studies: This review considered research papers that addressed the appropriateness and effectiveness of workload and staffing concepts in fostering a healthy work environment in healthcare. The types of papers to be considered included: meta-analysis, randomised controlled trials, quasi-randomised controlled trials, cohort studies, case-control studies, descriptive studies and correlational studies. The review considered all participants involved or affected by workload and staffing concepts within the nursing workforce in a healthcare environment, including staff and patients. System and policy issues were also considered. Types of interventions: All workload and staffing strategies that impact on the work environment, patient and nurse outcomes were considered in this review. Types of outcome measures: Outcomes of interest were categorised into four groups: nursing staff outcomes, patient outcomes, organisational outcomes and system outcomes. Data collection and analysis Following assessment of methodological quality, data were extracted using data extraction tools based on the work of the Cochrane Collaboration and the Centre for Reviews and Dissemination. Statistical pooling was not possible and findings were presented in narrative form. Results Of the 2162 papers identified in the search, 171 were selected for full paper retrieval and assessed independently by two reviewers for methodological quality. A total of 40 papers were included in the review: one systematic review; one cohort study; and 38 correlational descriptive studies. Results were summarised in narrative form. The evidence suggests strong correlations between patient characteristics and work environments; and workload and staffing and the quality of outcomes for clients, nurses and the system/organisation. This gave rise to a number of recommendations for practice and for further research, such as: • A greater proportion of regulated staffing (i.e. registered nurses, enrolled nurses, practical or vocational nurses) is associated with improved outcomes related to the Functional Independence Measure score, the Short Form Health Survey (SF-36) vitality score, patient satisfaction with nursing care, patient adverse events (including atelectasis, decubitus ulcers, falls, pneumonia, postsurgical and treatment infection and urinary tract infections) • An increase in the number of registered nurse hours available is associated with improved patient outcomes in relation to falls, pneumonia, pressure ulcers, urinary tract infection, length of stay and postoperative infection rates.
Read moreHealthy Work Environment, Occupational Burnout, and Psychological Wellbeing among Staff Nurses: A Comparative Study
Background: Healthcare organizations are social systems that established to maintain the patients’safety and their emotional, spiritual, and physical needs. Aim: to explore the relationship betweenthe healthy work environments, burn out, and psychological well-being among staff nurses atgovernmental and private hospital. Design: A Comparative- correlational research design wasutilized. Setting: the study was conducted in the governmental and private hospital. Sample: Aconvenience sample of staff nurses 85 out (117) in government & 73 out (80) at private hospital).Tools. Three tools were used: healthy work environment questionnaire, Maslach burnout inventory,and Psychological Well-Being Manifestation Measurement Scale. The results: the study resultsrevealed that 61.2% of the staff nurses in a governmental hospital had a moderate level of healthywork environment compared to 68.5% of the staff nurses in private hospital who had higher levelsof a healthy work environment. 89.4% & 93.2% of the staff nurses in governmental and privatehospital respectively experienced a moderate level of occupational burnout. There was a highlystatistically positive significant relationship between total score of healthy work environment andtotal score of psychological wellbeing among the staff nurses in governmental and private hospital.Recommendation: Both the governmental and the private hospital should step forward to draftpolicies for prevention, early detection and management of occupational burnout among staff nurses.Also, Developing and implementing continuous program for staff nurses to enhance, maintaininghealthy work environment, and enhancing psychological wellbeing is recommended
Read moreZNAČAJ PRIMJENE ZAŠTITNIH MJERA I PROCEDURA PRI RADU U VISOKONAPONSKIM POSTROJENJIMA
Work in high-voltage (HV) facilities is high-risk and falls into the category of jobs with special working conditions. In order to preserve the life and health of employees who service HV facilities, it is necessary to ensure the highest level of protection. In Elektroprivreda Crne Gore AD Nikšić, by fully implementing legal regulations and an integrated management system (IMS), within which the international standard ISO 45001:2018 - Management systems for health protection and safety at work was implemented, an integrated solution is provided that provides employees with a safe, healthy and sustainable working environment. The principle based on risk management has been adopted, with a focus on identifying and reducing risks, through continuous improvement, which has made a major qualitative shift in corporate governance, which is the basis for maintaining a safe and healthy working environment. In order to minimize risks in HV facilities, by organizing work through general, organizational and technical protection measures, procedures and rules are prescribed that must be consistently implemented and respected. Therefore, all categories of work performed in HV facilities: work in a de-energized state, work near voltage and work under voltage must be accompanied by work documents, without which work cannot begin. The culture of safety and health at work is precisely based on the daily respect of the rules and responsibilities of all of us, which is also a commitment to a common goal, which is a safe and healthy working environment.
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8Healthy and Entrepreneurial Work Environment for Older Employees and Its Impact on Work Engagement during the COVID-19 Pandemic
Managing older employees is a major challenge for companies, especially during COVID-19. Therefore, creating a healthy and entrepreneurial work environment as well as an inclusive culture within organizations is crucial for companies to maintain their sustainable advantage. The main objective of this paper is to develop a multidimensional model of a healthy and entrepreneurial work environment for older employees and determine its impact on their work engagement during COVID-19. Structural equation modeling was used for data analysis. The results show that workplace health promotion, entrepreneurial working conditions, and leadership lead to better well-being of older employees. In addition, entrepreneurial working conditions that promote intergenerational synergy lead to higher work engagement of older employees, especially during the COVID-19 pandemic. For the elderly, the entrepreneurial work environment is therefore particularly important, even though entrepreneurship is mostly attributed to younger men. In addition, older employees’ well-being and the promotion of intergenerational synergy have a positive impact on their work engagement. The results will help companies better manage their older employees, shape their workplace, and increase the sustainable benefits of their businesses during and after the COVID-19 crisis.
Read moreHealthy work environment from the perspective of Jordanian ICU nurses: a descriptive cross-sectional study using the AACN assessment tool
BackgroundPrevious research has emphasized the significant influence of workplace conditions in healthcare settings on nurses’ caregiving practices and patient outcomes. However, there remains a gap in understanding these dynamics, particularly within the context of intensive care units.PurposeTo assess the perception of Jordanian ICU nurses regarding their work environment using the American Association of Critical-Care Nurses-Healthy Work Environment Assessment Tool (AACN-HWET).MethodsEmploying a quantitative, descriptive, and correlational cross-sectional design, the study sampled 150 registered nurses from four Jordanian hospitals in Amman. Participants completed the Healthy Work Environment Assessment Tool (HWEAT), with statistical analyses including descriptive statistics, independent t-tests, Pearson’s correlation coefficient, and one-way ANOVA.ResultsOf the 190 questionnaires distributed, 150 were completed (79% response rate). Participants had a mean age of 30.9 years, were mostly male (56.7%), married (62%), and had an average of 6.1 years of ICU experience. Analysis revealed a mean healthy work environment score of 3.09, reflecting a positive perception of the work environment among Jordanian ICU nurses. However, overall HWEAT mean was 3.09, categorized as ‘good’; Skilled Communication was lowest (M = 3.29, SD = 0.74) and True Collaboration highest (M = 3.22, SD = 0.96). Group differences by marital status, perceived resource adequacy, and hospital type were observed in unadjusted tests.ConclusionThe findings highlight the need for targeted policies and ongoing training programs that strengthen leadership, communication, and resource management—practical strategies that hospital management can implement to enhance ICU nurse satisfaction and ultimately improve patient safety and care quality.
Read more9Safe and Healthy Work Environment: A Study of Artisans of Indian Metalware Handicraft Industry
Swami Vivekananda (2001 [1907]) said ‘with means alright, end must come’. To elaborate the saying of the great visionary, if the people working in an organization are happy and contented, it will have a positive bearing upon the output. The concept of quality of work life has drawn the interest of a number of scholars at various points of time in different kinds of environmental settings. The current study is based on one of the eight constructs proposed by Walton related to quality of work life ‘safe and healthy working conditions’ which include variables such as physical working conditions (cleanliness, lighting, temperature, ventilation), ergonomics, workplace safety and working hours. This construct indicates a safe and healthy work environment in the organization. The employers must ensure that the safety of the employees is reasonably taken care of. This can in turn reduce the costs related to employee injury such as medical care, sick leave and disability benefit costs. This construct of quality of work life consist of 15 measurable variables.
Read more6Appropriate Staffing for a Healthy Work Environment
Nurse staffing increasingly has become a topic of research studies. Data currently exist on the relationship between adverse events and nurse staffing.1,2 Data also exist on the relationship between fatigue and patient outcomes.3 Knowing the right number of nurses to have and how to optimally manage their schedules is a goal that all hospitals would like to achieve. The American Association of Critical-Care Nurses (AACN) has listed Appropriate Staffing as an essential standard for a healthy work environment (HWE).4 AACN states that “Staffing must ensure the effective match between patient needs and nurse competency.”4(p28) Many critical elements of this standard relate to the structures and processes necessary for staffing that matches the needs of patients with nurses’ competencies, which ultimately leads to an HWE.Appropriate staffing is necessary to keep patients safe. Numerous staffing bills have been introduced at the state level. Some have passed and become law, such as the Staffing Ratio Assembly Bill 394 in California. Opinions are mixed about whether this bill improved care by identifying a fixed ratio, but an improvement was observed in the overall skill mix, with an increase in the number of registered nurses hired to meet the ratios. Aiken et al2 presented a relationship between higher skill mix in registered nurses and better patient outcomes. Donaldson et al5 found that after reviewing nursing outcome data before and after implementing the ratios in California, a significant difference was not found in the prevalence of hospital-acquired pressure ulcers, restraint use, or reduction of falls at the unit level in medical-surgical units.So, what is the right mix for staffing? Is there a magic number? As mentioned previously, staffing must ensure an effective match between the needs of the patient and the competency of the nurse. To achieve this match, the nursing care delivery model in the hospital needs to address these issues; a method must be in place to determine staffing and patient acuity. The remainder of this article discusses some examples of structures and processes that some hospitals have implemented for determining staffing and acuity based on the AACN Synergy Model for Patient Care.6Many hospitals are searching for an acuity system that will give them the number of nurses needed for staffing on the basis of patient acuity, and that would help the charge nurses and managers know when to decrease staffing as a patient’s acuity becomes lower and the staffing needs are decreased. Acuity programs have improved over the past 10 years, and a few systems are available to help hospitals effectively manage their staffing needs and overall labor management, while also decreasing costs. Cerner Clarvia (Cerner Corporation, Kansas City, Missouri) is an acuity program that can electronically determine patient acuity by pulling data from the electronic health record and determining a nursing acuity score based on identified nursing outcomes. It is an acuity-based system used to move patients to the desired outcomes needed for discharge. As a patient’s condition improves, the number of nursing hours needed for patient care decreases. This system also has a scheduling component that is fully integrated, which assists in matching nursing scheduling needs with patient acuity. When linked electronically with a competency system, it can propose nursing assignments by matching nurse competencies to the needs of the patients. Nursing acuity and staffing systems are moving away from the traditional nursing task-based staffing to effectively match the patient’s needs with the nurse’s competencies, as deemed essential by the Appropriate Staffing standard. The Cerner Clarvia staffing and acuity system is one example that is consistent with the critical elements of the HWE Appropriate Staffing standard. We have come a long way from paper-and-pencil acuity tools that were in place years ago.The AACN Synergy Model was developed on the principle that patient characteristics drive patient acuities. Table 1 lists the 8 patient characteristics of the Synergy Model, and Table 2 lists the 8 nurse characteristics of the Synergy Model. The goal of this model is to match the nurse’s competencies with the patient’s needs/characteristics, resulting in synergy.6 This model was based on the work by Curley7 and created by the AACN Certification Corporation. Curley was the first to publish research on “patient-nurse synergy.” This model has been incorporated at various hospitals for staffing and as a model for professional nursing. Baylor Healthcare in Dallas, Texas, is a hospital that has incorporated the Synergy Model into patient care and has it as the foundation for the Baylor Healthcare System Professional Nursing Practice Model. John Dixon has lectured on this topic at several national conferences, including the AACN National Teaching Institute (NTI). As Dixon said in his 2008 presentation at the American Nurses Credentialing Center Magnet conference, “Professional nursing practice occurs in a healthy work environment where patient needs are assessed and matched to nursing competencies. This synergy results in Safe Passage for patients.”8With the changes occurring in health care and the increasing emphasis on wellness, a strong focus of hospital care is to move the patient through the care continuum as quickly as possible. Structures and processes are needed to achieve ideal patient outcomes. Appropriate staffing continues to be an essential standard to provide the best care while optimally using appropriate resources. Resources are available on the AACN Web site if you are interested in learning more; these resources include journal articles, posters presented at AACN conferences, and statements about what others have done to implement these standards in their work environment.
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