1. Miracle, Vickie A. EdD, RN, CCRN, CCNS, CCRC

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For a few years now, we have been hearing the phrase "healthy work environment." At first glance, a healthy work environment is one in which everyone is healthy. This does not necessarily bring to mind a critical care unit. There is much illness in intensive care units.


However, we all know that that is not the definition of a healthy work environment. A healthy work environment is that which is conducive to healing as well as to the safety and well-being of the patients. But a healthy work environment is necessary for nurses as well. In 2006, Shirey1(p258) defined healthy work environments as "supportive of the whole human being, are patient-focused, and are joyful workplaces." I do not know about you, but I can think of a few workplaces that are not that joyful. Nevertheless, in this environment, nurses are able to meet the needs of their patients and their families as well as the goals of the unit and the organization. And then somewhere along the way, nurses should gain personal satisfaction from their work.1 A healthy work environment leads to improved patient outcomes and increased nursing satisfaction.2 In a healthy work environment, the healthcare team works together to deliver quality patient care and create an atmosphere conducive to healing for patients and increased well-being for nurses.3


There are negative impacts to an unhealthy work environment. These include, but are not limited to, (1) medication errors, (2) high staff turnover, (3) burnout, (4) ineffective delivery of patient care, (5) high stress levels, and (6) unsafe working conditions.4 These environments are not conducive to healing for patients and are detrimental to the staff.


So what are the necessary components for a healthy work environment? There are several. First, effective leadership must be present.1,3 All nurses have the capacity to be leaders. A healthy work environment fosters leadership growth in its staff and recognizes the importance and expertise of the nursing staff. In a healthy work environment, nurses are a valued resource.


Second, communication is critical to a healthy work environment. This includes communication among nurses, physicians, allied health professionals, patients, families, and management. The healthcare team must work together to foster good communication skills.1,2,5


In a healthy work environment, nurses participate in the decision-making process concerning patient care and their work environment.2,5 Their thoughts and opinions are sought and valued. Nurses are treated with respect.1


The fourth component of a healthy work environment is adequate staffing.2,5 We are all aware of the dangers of understaffing: increase in medication errors, high stress levels, low morale, burnout, and ineffective delivery of patient care. A healthy work environment is well staffed and plans are made accordingly to ensure adequate staffing to provide the utmost quality care to our critically ill patients.


Another component of a healthy work environment is recognition of the efforts and achievements of the staff.2,5 Many units recognize nurses who have earned certification or advanced degrees. Many celebrate when a staff member presents a poster or paper or a local, state, or national meeting. A healthy work environment promotes lifelong learning and scholarship.


Collaboration is another key ingredient for a healthy work environment.2 Nurses must work together and with other members of the healthcare team to meet the goals for the patients and their units. Collaboration requires good communication skills and the ability to work with others. The ability to compromise is a good skill. In a healthy work environment, nurses are not fearful or intimidated to voice their opinions. In fact, just the opposite occurs. Nurses are encouraged to actively participate in the decision-making process and in patient care.


Maintaining a healthy work environment is a challenge-but it is a challenge that critical care nurses can face. It is not something that is achieved quickly. Once you have established a healthy work environment, there is still an ongoing process. Effective leadership is necessary, as well as the commitment of the nursing staff. Critical care nurses must be active participants in this process and not onlookers. As part of our nature, critical care nurses are always up to a challenge.


Every critical care nurse and critically ill patient deserves a healthy work environment. As nurses, we must take the necessary steps to develop and maintain a healthy work environment for ourselves and our patients. It takes work and is not always easy, but it is something we all deserve.


Vickie A. Miracle, EdD, RN, CCRN, CCNS, CCRC


Editor, DCCN


Lecturer, Bellarmine University


Louisville, Ky




1. Shirey MR. Authentic leaders creating healthy work environments for nursing practice. Am J Crit Care. 2006;15:256-267. [Context Link]


2. Gilmore J. Healthy work environments. Nephrol Nurs J. 2007;34:11. [Context Link]


3. Anonymous. Effective leadership is essential in creating health work environments. Can Nurse. 2007;103:8. [Context Link]


4. Barden C, Distrito C. Toward a healthy work environment. Health Prog. 2005;86:16-20. [Context Link]


5. Ulrich B. Healthy work environment standards: is your unit up to par? Nephrol Nurs J. 2007;34:8. [Context Link]