Appropriate Staffing After the Pandemic: A New Challenge for Healthy Work Environments

Abstract

When the American Association of Critical-Care Nurses (AACN) launched the Healthy Work Environment (HWE) Standards in 2005, nurses finally had guidance to help improve their work environment. The 6 HWE standards are appropriate staffing, skilled communication, true collaboration, authentic leadership, meaningful recognition, and effective decision-making.1 The HWE standards were introduced by Dorrie Fontaine, then president of AACN, and the president of the Joint Commission, which demonstrated the commitment these bodies had to improving health care work environments. The HWE standards were released shortly after the VitalSmarts “Silence Kills” study,2 which focused on the importance of the communication and collaboration of the team for patient safety.3Through the years, Ulrich et al have studied work environments to monitor changes over time. The baseline report was done in 2006,4 and at that time, 50% of the research participants knew healthy work environments existed and about 50% of them felt that communication and staffing were the lowest scoring standards.4 The follow-up survey was done in 2008. At that time, most of the nurses were satisfied with nursing as a career, and they felt that (1) their unit’s work environments were better than the organization’s, (2) improved leadership could decrease turnover, and (3) for the most part things had not changed significantly from the baseline study.5 The 2013 study reported that the quality of work environments had declined, with the largest declines in the area of effective decision-making.6 In this study, nurses reported that they were aware of appropriate staffing for patient safety, but they also stated that their staffing had also declined. In 2018, there was some good news. Some of the HWE standard areas had improved and were higher than all previous studies, especially in the areas of communication, collaboration, decision-making, and meaningful recognition.7 Staffing had increased since the 2013 study but was still lower than the previous 2 studies. Many nurses reported in the 2018 study that they were planning on leaving their organization in the next 12 months.7 The last study was completed in the fall of 2021. These results should be published soon; it is anticipated that the findings will reflect the fall 2021 pandemic challenges being faced in health care environments.New challenges surfaced in late 2021 and continue in 2022. Staffing was poor overall during the pandemic, and the many COVID-19 surges caused additional demand for care for large numbers of critically ill patients at a national level.8 In 2022, many millennials are leaving their current positions for higher paying jobs through travel agencies or to pursue sign-on bonuses. Even those nurses who like their jobs and have positive comments about their managers are taking new higher paying positions in the hopes of buying new homes, paying off school loans, or being in a better financial position. This year is being labeled the year of the “Great Resignation.”8 This nursing shortage and the related variables are unlike anything we have previously seen. Hospitals are closing beds because of nursing shortages and are reporting millions of dollars lost as a result of the pandemic and having to decrease volumes in operating rooms and procedural areas to shift staffing to the high-acuity critically ill patients.9AACN has been leading the way to improve staffing. In September 2018, the Guiding Principles of Staffing were published on the AACN website.10 The focus of the Guiding Principles is to address not only the numbers of staff but the needs of the patients and the competencies of the nurse. Staffing needs to be viewed as a “dynamic process.” AACN’s call to action on staffing states that “Meaningful and sustainable change to traditional staffing models is a moral imperative that requires urgent collaborative action.”10 The 8 guiding principles are10AACN has collaborated with the American Nurses Association (ANA), the American Organization of Nurse Leaders (AONL), the Healthcare Financial Management Association (HFMA), and the Institute for Healthcare Improvement (IHI) to recommend solutions to the staffing crisis. This Think Tank met early in 2022 and put forth a set of priorities and recommendations to provide strategies that can be implemented in 12 to 18 months. The group developed an action plan to change the culture in health care delivery with the goal of improved nurse retention, better patient outcomes, and healthier work environments.11 The priority topics addressed in the recommendations are11The Think Tank recommendations focus on not only what health care system leaders need to do the address the issues but also what policy makers and professional organizations should do. A detailed list of recommendations can be found on the Staffing Think Tank page (www.nursingworld.org/practice-policy/nurse-staffing/nurse-staffing-task-force).It is time that we address our pressing issues to support a healthy work environment, particularly in ensuring adequate staffing to provide safe and effective care. To quote our AACN 2022-2023 president’s theme Starting Now, we have an opportunity to do things differently and reimagine our profession. We cannot continue to do things the same way and expect different results. Our staff and our patients need us to act now.