Tackling Issues in the Work Environment: The role of Healthy Work Environments Best Practice Guidelines

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Tackling Issues in the Work Environment: The role of Healthy Work Environments Best Practice Guidelines. Irmajean Bajnok, RN, PhD – Director, International Affairs and Best Practice Guidelines Program & Centre for Professional Nursing Excellence Registered Nurses’ Association of Ontario
Tackling Issues in the Work Environment:The role of Healthy Work Environments Best Practice GuidelinesIrmajean Bajnok, RN, PhD – Director, International Affairs and Best Practice Guidelines Program& Centre for Professional Nursing ExcellenceRegistered Nurses’ Association of OntarioJune 4, 2009Nurses’ Association of New BrunswickPresentation OverviewTo describe the background to the HWE BPG Program, including a conceptual framework for healthy work environmentsTo briefly discuss the HWE guidelines with a focus on teamwork and staffingTo discuss background and results from the HWE BPG Pilot EvaluationTo Share specific HWE BPG implementation successes What is a healthy work environment for nurses?“A healthy work environment for nurses is a practice setting that maximizes the health and well-being of nurses, quality patient outcomes and organizational and system performance”.Why Develop HWE BPGs?Recruitment and retention Nurses’ environments and patient and system outcomesEvidence based management practicePrinciples for Guideline DevelopmentStrongest evidence available Systematic reviews by JBILevel of evidence identifiedSemi-annual literature review & semi-annual internet search Overall review at least every five yearsMeaningful to practicing nurses Relevant to all nurses Commonly defined terms & definitionsProject ObjectivesIncrease awareness of HWE elements Assist nurses in creating HWEsProvide stakeholders with HWE strategiesAchieve sustainable outcomes Target Audience for HWE GuidelinesNurses in all roles Interdisciplinary Team MembersNon-nursing Administrators, Policy makers and GovernmentsProfessional Organizations and Labour GroupsPublicGUIDING FRAMEWORKSClinical BPG MethodologyConceptual Model for Healthy Work EnvironmentPlanningGuideline ChoiceDevelopmentExpert panelSystematic ReviewBest Practice Guidelines MethodologyDraft GuidelineStakeholder ReviewRevision & FinalizeDisseminationImplementationHWE BPG Guideline RecommendationsIndividualRecommendationsSystemRecommendations Organization/TeamRecommendationsOffice of Nursing PolicyUnderlying Assumptions of ModelHWEs basic to quality, safe patient careModel applies to all settings & roles in nursing Outcomes affected by individual factors or combinations of factorsProfessional/occupational components unique to each profession; other components generic for all professions/occupationsPhysical/Structural Policy ComponentsExternal Policy FactorsLegislative, trade, economic & political influences external to the organizationOrganizational/Physical FactorsPhysical characteristics & environment of organization Organizational structures & processes created to respond to physical work characteristics & demandsPhysical Work Demand FactorsRequire physical capabilities & effortExternal Policy FactorsOrganization/PhysicalFactorsPhysical Work DemandFactorsNursePatientOrganizationalSocietalOutcomesCognitive/Psycho/Socio Cultural ComponentsIndividual Cognitive/Psycho/Social Work Demand FactorsRequire cognitive, psychological and social capabilities & effort (e.g. problem solving, effective coping skills, communication skills)Organizational Social FactorsOrganizational climate, culture & valuesExternal Socio-cultural FactorsConsumer trends, care preferences, family roles, diversity of the population & providers, changing demographicsIndividualCognitive/Psycho/SocialWork DemandFactorsNursePatientOrganizationalSocietalOutcomesOrganizationalSocialFactorsExternalSocio-CulturalFactorsProfessional/Occupational ComponentsIndividual Nurse FactorsPersonal skills, knowledge & attributes which determine response to work demandsOrganizational Professional/Occupational Factors Nature & role of the profession/ occupation (e.g. level of autonomy scope of practice)External Professional/Occupational FactorsPolicies and regulations (e.g. standards of practice, certification, ethical recruitment) Nurse PatientOrganizationalSocietal OutcomesIndividualNurseFactorsOrganizationalProfessionalOccupationalFactorsExternal Professional Occupational FactorsEvaluation of GuidelinesDraft Guideline – Stakeholder ReviewProcess Evaluation for PanelPilot Evaluation: ImplementationBroad System UptakeImplementation StrategiesIndividual (Champions, conference, Institutes)Organizational (BPSOs, ACPFs)SystemProvincialNationalInternational Goal is to support nurses as Knowledge Professionals. Six Foundational HWE BPG GuidelinesDeveloping & Sustaining Nursing Leadership Chair: Dr. Heather LaschingerDeveloping & Sustaining Effective Staffing and Workload Practices Chair: Dr. Linda O’Brien-PallasEmbracing Cultural Diversity in Health CareChair: Rani SrivastavaProfessionalism in NursingChair: Dr. Andrea BaumannCollaborative Practice Among Nursing TeamsCo-chairs: Dr. Diane Doran & Leslie VincentWorkplace Health, Safety and Well-being of the NurseChair: Dr. Mary Ferguson-ParéGuidelines Nearing CompletionPreventing and Managing Violence in the WorkplacePractice Education in NursingGuidelines In Progress
  • Preventing Nurse Fatigue in Health Care
  • Interprofessional Collaboration in Health-Care
  • Future Guidelines
  • Managing Conflict in Health-Care Teams
  • THE HWE GUIDELINESCONCEPTUAL MODEL FOR DEVELOPING & SUSTAINING NURSING LEADERSHIPBroad External Factors Sociocultural Context Professional/Occupational Context
  • Organizational Supports
  • Valuing of
  • Professional Nursing
  • Human Resources
  • Information/Decision
  • Support
  • Transformational Leadership PracticesBuilding relationships and trustCreating an empowering work environment
  • Healthy Outcomes
  • Nurse
  • Patient/Client
  • Organization
  • System
  • influenceinfluenceCreating an environment that supports knowledge development and integration
  • Personal Resources
  • Professional Identity
  • Individual Attributes
  • Leadership Expertise
  • Social Supports
  • Leading and sustaining changeBalancing competing values and prioritiesEmbracing Cultural Diversity in Health Care: Developing Cultural CompetenceDiversity is MORE than: An immigrant issue A color issue A language / religion issueIt is about differences in values, beliefs, worldviews, and access to resources Professionalism in Nursing
  • Consists of …..
  • eight evidence-informed attributes of professionalism
  • organizational characteristics that support effective professional practices
  • successful strategies for enabling professional behaviours
  • Purpose:Provides organizational systems and supports requiredPromotes the importance of fostering a climate and culture which supports the promotion of health, well-being and safety of nurses Describes impacts→ patient safety and satisfactionWorkplace Health, Safety and Well-being of the Nurse24Collaborative Practice Among Nursing TeamsNurses within the Context of the Inter-Professional Team
  • Nurses practice in and contribute to the context of an inter-professional work environment involving many professionals. Although we recognize the interprofessional nature of our work, the focus of this guideline is to help you on the journey to excellence in teamwork within nursing, embedded in the larger context of the interprofessional environment. 
  • Where Does Collaboration Occur Among Nursing Teams?
  • Collaboration occurs:
  • communicating patient information
  • planning care
  • intervening
  • assistance with procedures
  • unit/ team management
  • monitoring team activity
  • ….and much more
  • Recommendations
  • Individual
  • Team
  • Organization
  • System
  • Model of The Patient Care Delivery Systems Factors that Affect Staffing and WorkloadHEALTHYWORKINGENVIRONMENTINPUTSTHROUGHPUTSOUTPUTS
  • Patient/Client Characteristics
  • Provider Characteristics
  • Nursing
  • System Characteristics
  • System Behaviors
  • Patient/Client Characteristics
  • Provider Characteristics
  • Nursing
  • System Characteristics
  • System Behaviors
  • Nursing Care ProcessesEnvironmental Complexity Factors
  • Patient/Client Outcomes
  • Provider Outcomes
  • Nursing
  • System Outcomes
  • Source: Evidence Based Standards for Measuring Nurse Staffing and Performance (O’Brien-Pallas et al, 2004)Staffing levels and schedules support the delivery of safe, effective and ethical nursing care including:Providing sufficient levels of appropriately skilled nurses to meet client care requirementsMaximizing continuity of care and caregiverEnhancing the stability of the nursing profession by maximizing the number of permanent (full-time and part-time) positionsDeveloping schedules and rotations to meet the baseline workload requirementsWorkload & Staffing PrinciplesStaffing levels and schedules support the delivery of safe, effective and ethical nursing care, including:Providing mechanisms and staffing to meet fluctuating patient/client acuity and workload, as well as replacementBeing responsive to staff work-life considerations and the impact on recruitment and retentionBeing efficient from a cost perspective, including minimizing the use of overtime and agency staffingBeing perceived as fair and equitable by all categories of nursing staffComplying with relevant collective agreements, organizational policies, scopes of practiceWorkload & Staffing Principles30Recommendations FrameworkOverall Commitment of Organization to Workload and Staffing & Involvement of Nursing at the Senior LevelOrganizational LevelWorkload Considerations as Part of all Strategic & Contingency PlanningUsing Input from Nursing in All RolesStrategic StaffingDecisionsTactical StaffingDecisionsLogistical StaffingDecisionsOperational LevelGovernmentsStandards, Research, EthicalSystem Level31HGHLIGHTS OF PILOT EVALUATION AND RESULTSPilot Implementation EvaluationEight (8) Pilot sites in Ontario Centre for Addiction & Mental Health Headwaters Health Centre Kingston General Hospital & Hotel Dieu Hospital Queensway Carleton Hospital Saint Elizabeth Health Care Sunnybrook Health Sciences Centre William Osler Health Centre York Central HospitalEvaluation of Implementation of guidelinesEvaluation of effectiveness of recommendationsNurse Survey FindingsPre-Implementation3 Months Post-Implementation: Overview of results6 Months Post-ImplementationOverview of ResultsImplementation Makes a DifferenceOf the Total 101 Individual Nurse Recommendations Across HWE BPGs:80% increased in presence in nursing work environments and nursing practice from pre-implementation to 6 months post-implementationNurses Reported….Using the HWE BPGsContinue to Apply and WorthKey TrendsNurses value all elements of healthy work environmentsA focus on implementing the recommendations makes a difference for nursesNurses also perceive patients receive better care Recommendations were a fit with the workplace contextNurses indicate they will continue to focus on the elements of a healthy work environmentHow the Guidelines Can be UsedStart with what fits the cultureAssessment of current practices & policiesCompetency/performance assessmentDesign of organizational development programsAssess system gaps & discuss evidenced based strategiesCollaborative Practice Success StoryTaking Ownership of Team Challenges Affecting WorkloadWE DID ITandIT WORKED!!Workload and Staffing Success StoryCollaborative Practice Success StoryOpening Up a “Closed” UnitCollaborative Practice Success StoryTACKLING A TOXIC TEAMNON NURSING WORK EASES THE WORKLOAD PRESSUREWorkload and Staffing Success StoryKey Points for Success
  • Engage Staff
  • Create a vision & communicate to all
  • standing agenda item on committees
  • Link to strategic planning
  • Support of senior admin
  • Ensure strong leadership
  • designated coordinator
  • Engage the Nurse Managers
  • ensure adequate staffing/replacement
  • Share and celebrate successes!
  • What have we learned?This is a very important area to nurses and to our patientsWe made this area important to governments and other policy makersWe have different types of evidence for these guidelines, and there are gaps in the researchThis work is possible and critical if we want to achieve nursing excellenceHealthy Work Environment Best Practice Guidelines:Enable Evidence Based Management Decision Making for Quality of Care and Quality Of Work LifeThey Do Make the Difference!Questions and Discussion
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