Which of the following are elements of a healthy work environment:
A. BSN as an entry level requirement for all registered nursing staff, achievement of
... [Show More] specialty certification within 2 years of practice in an acute or critical care unit, established educational requirements for maintaining licensure as a registered nurse in the organization, required participation on a unit based or organizational based quality improvement committee.
B. Skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition, authentic leadership.
C. Healthy food choices in the cafeteria; non-smoking policies for patients, staff and visitors; provision of exercise programs for staff.
D. Certification requirements for nurses working in acute and critical care areas, advanced educational requirements for nurses caring for acutely ill patients, annual peer review as part of the evaluation process. - correct answer B. The American Association of Critical Care Nurses (AACN) has established a healthy work environment initiative to support and foster excellence in patient care
wherever acute and critical care nurses practice. This initiative recognizes that negative, demoralizing and unsafe conditions in the workplace contribute to medical errors, ineffective delivery of care, and conflict and stress among health professionals. In addition, an unhealthy work environment has negative effects on recruitment and retention, and patient outcomes. The 6 elements of a healthy work environment include:
Skilled Communication: Nurses must be as proficient in communication skills as they are in clinical skills.
True Collaboration: Nurses must be relentless in pursuing and fostering true collaboration.
Effective Decision Making: Nurses must be valued and committed partners in making policy, directing and evaluating clinical care and leading organizational operations.
Appropriate Staffing: Staffing must ensure the effective match between patient needs and nurse competencies.
Meaningful Recognition: Nurses must be recognized and must recognize others for the value each brings to the work of the organization.
Authentic Leadership: Nurse leaders must fully embrace the imperative of a healthy work environment, authentically live it and engage others in its achievement.
Detailed information on the Healthy Work Environment initiative is available at http://www.aacn.org/wd/hwe/docs/hwestandards.pdf
You are approached by a staff nurse who is new on the night shift (has been there for 3 months) after successfully completing a critical care course and residency program with a preceptor on day shift. He tells you that he is having problems with two long time night shift coworkers who constantly belittle him, tell him he is not doing things right, and talk about him to other staff behind his back. He is very uncomfortable working with these two individuals and dreads coming to work when he knows they will be working that night. He tells you that another new nurse on that shift is being treated the same way. You are aware that these two nurses have a reputation for this type of behavior and that other nurses have quit because of it. He asks you if you have any suggestions regarding how to deal with this situation. What would be your best response to him:
A.Encourage him and the other new nurse to confront these nurses the next time it happens and tell them they will be reported to human resources if their behavior doesn't change. Suggest that he enlist the rest of the night shift to join them in confronting this destructive behavior.
B. Acknowledge his discomfort and encourage him to document and keep a log of specific incidences when they occur. Refer him to literature on workplace bullying and healthy work environments. Encourage him to discuss his concerns with the manager and offer to accompany him if he would be more comfortable doing that with a support person. Ask if he would be interested in joining you in a discussion with the manager and clinical nurse specialist about education for the unit regarding healthy work environments and establishing a healthy workplace initiative on your unit.
C. Tell him that this behavior has been going on for years and it is allowed to continue because it is too hard to find night nurses. Tell him he either needs to transfer to another unit or put up with it.
D. Tell him you will talk to the manager about this behavior and report these nurses to human resources. Acknowledge that this has happened before but nothing was done about it and he just might have to ride it out until these nurses retire. - correct answer B. This type of behavior is a form of workplace bullying and occurs often in hospital settings. Disruptive behavior such as this will not go away on its own and should be dealt with as soon as it is identified. Literature on workplace bullying suggests that employees who are being bullied should report the behavior to their supervisor and document specific incidents as they occur. Organizations should have a Code of Conduct and zero tolerance policies regarding workplace bullying and violence in the workplace. Managers and supervisors have a responsibility to enforce those policies and to implement educational programs and initiatives to create a healthy workplace. The American Association of Critical Care Nurses (AACN) has a Healthy Work Environments Initiative that can serve as a resource for developing and maintaining a healthy environment at work.
This behavior may eventually have to be reported to Human Resources if it does not stop after appropriate education and intervention from management, but that should not be the first step in dealing with it. Literature on workplace bullying suggests that it is often a result of insecurity and a feeling of being threatened by new situations or people. If that is the case, threats from peers, supervisors, or human resources will not deal with the underlying causes. Staff who are participating in bullying should be given education and an opportunity to improve their performance before being disciplined.
Enlisting other staff to confront the behavior as it occurs might be needed in the case of violence, but with disruptive behavior such as what is described here, that would most likely increase conflict and make things worse. The appropriate course of action would be to report the behavior to a supervisor or manager and allow them time to deal with it appropriately.
The following is true regarding family presence during resuscitation efforts:
A. Literature supports no adverse psychological effects among family members who participated at the bedside.
B. Family presence during resuscitation is a nursing priority for pediatric critical care but not for adult critical care.
C. Units should have policies to prohibit family presence in order to avoid disruptions in care and improve patient outcomes.
D. Caring practice would not allow family members to be present during resuscitation efforts because of the increase in anxiety and fear that it creates for families. - correct answer A. According to the American Association of Critical Care Nurses (AACN): 'Evidence is mounting that family presence during resuscitation and invasive procedures is beneficial to patients, families and staff. Meeting psychosocial needs in a time of crisis exemplifies care driven by the needs of patients and families.' The AACN has two practice expectations regarding family presence: 1) Family members of patients undergoing bedside invasive procedures or resuscitation should be given the option of being present, and 2) All patient care units should have an approved written practice document addressing this issue.
Research has found that family presence benefits both patients and families. Families express decreased anxiety and fear and a sense of closure after being present. Studies also find that there are no patient care disruptions and no negative patient outcomes during family presence.
Caring practice involves decisions based on the needs of patients and families including advocating for unit policies and standards that support patient and family centered care.
You are caring for a 37 year old female patient admitted for acute pancreatitis. She is not married and does not have children. She has a sister, brother, two parents who visit frequently. She tells you her best friend has not been in to visit yet because the sign on the ICU door says two members of immediate family only at a time. Your best response is:
A. Immediate family is while you are here in the ICU. We need to have that policy to control the number of visitors. When you are transferred to another floor she can come to visit.
B. I want you to know that family is defined by you the patient. I apologize that our signage does not make that clear. I will contact your best friend and let her know that she is welcome to visit. I will also discuss our signage at our next unit based meeting.
C. If she really wants to come to see you she can tell the front desk she is your sister and they will probably let her in. Just make sure your real sister is not here at the same time.
D. We have this visiting rule in place because research has shown that visits of immediate blood relatives help patients get better, while other visitors cause too much stress on the patient. - correct answer B. The American Association of Critical Care Nurses supports 'unrestricted access of hospitalized patients to a chosen support person (e.g., family
member, friend, or trusted individual) who is integral to the provision of emotional and social support 24 hours a day, according to patient preference, unless the support person infringes on the rights of others and their safety, or it is medically or therapeutically contraindicated.' It is important for nurses to recognize that the patient [Show Less]