AACN Advanced Critical Care

Volume 33, Number 3, pp. 280-282

© 2022 AACN

Creating a Healthy

Workplace
Nancy Blake, PhD, RN, CCRN-K,
NEA-BC, NHDP-BC, FACHE, FAONL,
FAAN
Department Editor

Appropriate Staffing After the Pandemic: A

New Challenge for Healthy Work Environments
Nancy Blake, PhD, RN, CCRN-K, NEA-BC, NHDP-BC, FACHE, FAONL, FAAN

W hen 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 stan-
dards 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.3
Through 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 scor-
ing 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 pub-
lished 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

Nancy Blake is Chief Nursing Officer, LAC+USC Medical Center, 24719 Garland Drive, Valencia, CA
91355 (ntblake@aol.com).

The author declares no conflicts of interest.

DOI: https://doi.org/10.4037/aacnacc2022746

280
VO L U M E 3 3 • N U MB E R 3 • FALL 2022
national level.8 In 2022, many millennials are
leaving their current positions for higher pay-
ing 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.9
AACN and Staffing
AACN has been leading the way to improve
staffing. In September 2018, the Guiding Prin-
ciples 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 are10
• Nurses are essential to the successful deliv-
ery of health care.
• Appropriate nurse staffing is crucial for
optimal patient care.
• Appropriate staffing is inextricably linked
to healthy work environments.
• Higher nurse job satisfaction, which leads
to lower staff turnover, is closely tied to
appropriate staffing.
• The creation of appropriate staffing
plans requires a nimble, comprehensive
approach.  Environments: A Journey to Excellence. 2nd ed. Ameri-
• Progress on appropriate staffing advances
national patient safety and quality goals.
• The complex challenge of appropriate
staffing will require bold and innova-
tive solutions.
• A new paradigm is needed that reflects
the full value nurses bring to patient
care and recognizes nurse staffing as
an investment.  Crit Care Nurse. 2009;29(2):93-102.
AACN has collaborated with the Ameri-
can Nurses Association (ANA), the American
CREATING A HEALTHY WORKPLACE
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 recom-
mendations are11
• Healthy work environment
• Diversity, equity, and inclusion
• Work schedule flexibility
• Stress injury continuum
• Innovative care delivery models
• Total compensation
The 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 organi-
zations should do. A detailed list of recom-
mendations can be found on the Staffing Think
Tank page (www.nursingworld.org/practice-
policy/nurse-staffing/nurse-staffing-task-force).
Conclusion
It is time that we address our pressing issues
to support a healthy work environment, partic-
ularly 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 differ-
ent results. Our staff and our patients need
us to act now.
REFERENCES
1. American Association of Critical-Care Nurses. AACN
Standards for Establishing and Sustaining Healthy Work
can Association of Critical-Care Nurses; 2016.
2. Maxfield D, Grenny J, McMillan R, Patterson K, Switzler
A. Silence Kills: The Seven Crucial Conversations for
Healthcare. VitalSmarts, L.C; 2005.
3. Fontaine DK, Gerardi D. Healthier hospitals? Nurs
Manage. 2005;36(10):34-44.
4. Ulrich BT, Lavandero R, Hart KA, Woods D, Leggett J,
Taylor D. Critical care nurses’ work environments: a base-
line status report. Crit Care Nurse. 2006;26(5):46-57.
5. Ulrich BT, Lavandero R, Hart KA, et al. Critical care
nurses’ work environments 2008: a follow-up report.
6. Ulrich BT, Lavandero R, Woods D, Early S. Critical care
nurse work environments 2013: a status report. Crit Care
Nurse. 2014;34(4):64-79.
281
CREATING A HEALTHY WORKPLACE
7. Ulrich B, Barden C, Cassidy L, Varn-Davis N. Critical care
nurse work environments 2018: findings and implications.
Crit Care Nurse. 2019;39(2):67-84.
8. Hansen A, Tuttas C. Professional choice 2020-2021: travel
nursing turns the tide. Nurse Lead. 2022;20(2):145-151.
9. Martin BI, Brodke DS, Wilson FA, Chaiyakunapruk N,
Nelson RE. The impact of halting elective admissions
in anticipation of a demand surge due to the coronavi-
rus pandemic (COVID-19). Med Care. 2021;59(3):213-219.
10. American Association of Critical-Care Nurses.
AACN guiding principles for appropriate staffing.
282
W W W .AACN ACCON LIN E .ORG
https://www.aacn.org/policy-and-advocacy/guiding-
principles-for-staffing
11. American Association of Critical-Care Nurses, American
Nurses Association, American Association for Nurs-
ing Leadership, Healthcare Financial Management
Association, Institute for Healthcare Improvements.
Nursing staffing think tank recommendations: priority
topics and recommendations. 2022. https://www.
nursingworld.org/~49940b/globalassets/practiceand-
policy/nurse-staffing/nurse-staffing-think-tank-
recommendation.pdf
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