1. Pinkerton, SueEllen PhD, RN, FAAN, Editor-in-Chief

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"Healthy work environments" are a common topic in the health care literature, as well as in most business literature. Various studies on work environments show their relationship to employee satisfaction and productivity, and in health care, their relationship to patient outcomes.

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In late January, the American Association of Critical-Care Nurses (AACN) held a national briefing in Washington, DC, on health care work place communication, in which it released Standards for Establishing and Sustaining Healthy Work Environments.1 The standards were based on the analysis of dozens of focus groups, interviews, workplace observations, and a survey of more than 1700 nurses, physicians, clinical-care staff, and administrators during the latter half of 2004.


AACN and VitalSmarts(TM) (the company behind the New York Times best-selling books Crucial Conversations and Crucial Confrontations) joined together to complete the survey Silence Kills: The Seven Crucial Conversations forHealthcare.2 The purpose of the study was to describe the conversations that are crucial in hospital settings.


Some of the key findings of the AACN survey3 include the following:


* Eighty-four percent of physicians and 62 percent of nurses and other clinical-care providers have seen coworkers taking shortcuts that could be dangerous to patients.


* Eighty-eight percent of physicians and 48 percent of nurses and other providers work with people who show poor clinical judgment.


* The 10 percent of health care workers who raise these crucial concerns observe better patient outcomes, work harder, and are more satisfied and committed to staying in their jobs.



About half of the respondents to the survey said that the concerns they voiced had been going on for more than a year. "One in five physicians say they have seen harm come to patients as a result of these concerns, and 23 percent of nurses say they are considering leaving their units because of these concerns."4


An example from the data that were collected follows. "There is a cardiologist who everybody feels is incompetent. He makes himself very accessible to general practitioners, so he gets a lot of referrals, but those of us who have to work with him-the thoracic surgeons, anesthesiologists, and other cardiologists-would never put someone under his care."5


These examples indicate how deeply embedded some of the behaviors are in individuals who work in health care organizations. It is not a simple matter of teaching a new procedure or new way of doing things. It will take a concerted effort to change the culture and behaviors of these individuals. The main points identified by AACN in its release "AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence" provide a framework "to promote core competencies such as communication and collaboration, that will ensure patient safety, enhance staff recruitment and retention, and maintain an organization's financial viability."6


The AACN is to be applauded for taking this leap and identifying standards. It is doubtful that anyone will disagree with the need for such standards. The true test will be how many organizations adopt the standards and put mechanisms and processes in place to make them operational. It is not an easy task, but the challenge has been made by AACN. Let's see who steps forward to embrace this effort to improve the work environment.


SueEllen Pinkerton, RN, PhD, FAAN






1. American Association of Critical-Care Nurses. "New Study Finds U.S. Hospitals Must Improve Workplace Communication to Reduce Medical Errors, Enhance Quality of Care." News Release (2005, January 26). [Context Link]


2. Maxfield D., et al. Silence Kills: The Seven Crucial Conversations for Healthcare. VitalSmarts(TM) Industry Watch (2005). [Context Link]


3. American Association of Critical-Care Nurses (2005). [Context Link]


4. Maxfield D., et al., p. 3. [Context Link]


5. Maxfield D., et al., p. 5. [Context Link]


6. American Association of Critical-Care Nurses. "Communication in the Healthcare Workplace: A Prescription for Better Care." Frequently Asked Questions (2005, January 26). [Context Link]