Elsevier

Nurse Leader

Volume 18, Issue 1, February 2020, Pages 30-34
Nurse Leader

Feature
Good for Nurses, Good for Patients:: Creating a Healthy Work Environment in a Pediatric Acute Care Setting

https://doi.org/10.1016/j.mnl.2019.11.005Get rights and content

Disruptive behaviors are widespread in nursing, and have significant potential to negatively impact patient and nurse outcomes. Nursing leaders at Nicklaus Children’s Hospital, a Magnet®-recognized, free-standing pediatric hospital received feedback from their nursing staff regarding an increase in bullying and incivility. To address negative behaviors and create a foundation for professionalism, a strategic plan was developed to assess and improve issues in the nursing work environment. By employing a structured approach to addressing disruptive behavior in the pediatric acute care setting, the organization has been able to achieve meaningful improvements in self-reports of nurse experience, satisfaction, and patient experience.

Section snippets

Frontline Leader Development

The first HWI key strategy that was employed to address cultural change was training for nursing leaders. This training was aimed at preparing frontline leaders with the essential skills required to set behavioral expectations and hold employees accountable for professional behavior. Three pilot units were selected to participate in this intervention: a critical care, medical-surgical, and specialty unit. Often, nurses will express the idea that it is uncomfortable or difficult to have

Outcomes

After the initial efforts to heighten awareness, create an intervention, and sustain the momentum forward, the nursing team analyzed the outcomes of this work in 5 Tower. Prior to the start of the initiative, nurses most frequently reporting witnessing the behaviors of “seeing nurses treated nicely to their faces but mocked or insulted behind their backs,” “being mocked or having a nurse roll his/her eyes,” and “being made to feel stupid or incompetent.” Upon reassessment, 5 Tower experienced a

Lessons Learned

After completing this work, the implementation team learned several important lessons. It was discovered that although the team considered itself an open and honest nursing team, it still took substantial effort to ensure that nursing staff felt comfortable and protected in sharing their experiences around bullying and incivility. Additionally, it become very apparent that simply educating and discussing concerns would not be sufficient to create a healthy work environment and sustain that

Conclusion

Disruptive behaviors such as bullying and incivility cannot thrive without favorable environmental conditions,1 and this health workforce initiative addressed those qualities. By employing a structured approach to addressing disruptive behavior in the pediatric acute care setting, we have been able to achieve meaningful improvements in nurse self-reports of experience, nurse satisfaction, and patient experience scores. Although incivility and bullying may be widespread in nursing, there are

Danielle Altares Sarik, PhD, APRN, CPNP-PC, is Research Nurse Scientist at Nicklaus Children’s Hospital in Miami, Florida. She can be reached at [email protected].

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There are more references available in the full text version of this article.

Cited by (2)

Danielle Altares Sarik, PhD, APRN, CPNP-PC, is Research Nurse Scientist at Nicklaus Children’s Hospital in Miami, Florida. She can be reached at [email protected].

Renee Thompson, DNP, RN, CSP, is CEO & Founder, The Healthy Workforce Institute.

Jennifer Cordo, MSN, APRN, NE-BC, is Nursing Excellence Manager and Magnet Program Director at Nicklaus Children’s Hospital.

Ivette Nieves Roldan, MSN, RN, CPN, is Nurse Manager, Neurology and Neurosurgery Unit at Nicklaus Children's Hospital.

Jackie L. Gonzalez, DNP, APRN, MBA, NEA-BC, FAAN, is Senior Vice President and CNO at Nicklaus Children’s Hospital.

Note: Renee Thompson is the chief executive officer and founder of The Healthy Workforce Institute. Nicklaus Children’s Hospital contracted with the Healthy Workforce Institute to assess and address disruptive behaviors. This research did not receive any specific grant funding from agencies in the public, commercial, or not-for-profit sectors. The authors acknowledge the work of the entire nursing staff at Nicklaus that made this improvement possible. Thank you to our nursing leadership and CNO, Jackie Gonzalez, for her support for this initiative. Additionally, we acknowledge receipt of the 2019 Sigma Theta Tau international Healthy Work Environment Award, based on the improvements that came from this work, and thank them for the honor.

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