1. Donnelly, Gloria F. PhD, RN, FAAN, Editor-in-Chief

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Raising the Bar for Healing Environments

Ten years ago I got a frantic phone call from the staff development director of a large tertiary care hospital. "We need you to do a workshop for our nurses to help them manage stress more effectively." I asked why the interest in offering stress management strategies to nurses, and her reply was telling. "We aren't offering this workshop as a choice, it'll be mandatory for all nurses so they can learn to better manage work-related stress." Thinking that mandatory stress management was contradictory, I continued my assessment by asking what was going on in the hospital. "We've had a lot of changes lately-new management, one unit closed and several have merged, and all position descriptions were revised. Add to this higher-than-ever acuity and increased cost- containment pressures, and our nurses are stressed to their limits."


After careful consideration, I declined her invitation. One or 2 days of stress management techniques could send the wrong message that nurses' stress is self-induced instead of a reasonable reaction to an environment that's undergoing rapid change and organizational stress. Further, mandated stress management creates yet another stressor for nurses who might not be ready to change. Instead I recommended that the hospital better invest their staff development monies on first giving nurses the tools to manage and understand change: education in leadership and delegation training, change management, and financial management and planning. When we expect nurses to quickly adapt to change, it's best to clarify direction and expectations rather than shift the focus to self-care.


Fortunately we're seeing tangible signs that health care administrators are taking note of our environmental conditions and collective healing power. In September 2003, for example, the Association of Academic Health Centers published an instrument called The Organization Therapeutic Index (OTI). 1 Focusing on 11 elements, the OTI uses already existing instruments "to assess an entire culture of healing" including patient outcomes and staff satisfaction with their practice environments. The elements are grouped into 4 broad areas: technical competence of the staff; compassion and commitment to patients and families; commitment to community; and collaboration among the staff and with the patient. A scoring system for each of the elements allows administrators to benchmark their own facilities' areas for improvement. The OTI also can be customized by a collaborative group of staff and consumers to reflect the uniqueness of the facility and its mission.


The OTI puts heavy emphasis on collaboration and teamwork as a significant marker of a facility's therapeutic effectiveness for both patients and staff. Additional items measure CEO leadership, nurse turnover rates and satisfaction, cultural sensitivity, and the quality and type of staff education and interaction. Imagine the benefits we could achieve when staff, administrators, and consumers of care collaboratively design a measure of therapeutic effectiveness for their facility. We'd raise the bar with explicit benchmarks. Fewer consultants would get calls to do band-aid stress management workshops for harried staff. And organizations would heal themselves.




1. Bulger RJ. The Quest for Therapeutic Institutions. Washington, DC: Association of Academic Health Centers. Available at: [Context Link]