Changing the Work Environment in ICUs to Achieve Patient-Focused Care: Response to a Flawed Health System

The decision of the AACN to establish standards for healthy work environments grew from a strategic planning process in which the association identified the three most important issues facing its members and critical care nurses at large on which the voice and actions of the AACN would have the greatest effect. A healthy work environment was one of those issues and was judged to be so influential that the failure to address it would result in deleterious effects for every aspect of critical care practice. A task force and national review panel led by past AACN president Connie Barden developed the standards that were launched at a Washington, DC, press conference in January 2005. More than 30,000 copies of the standards were downloaded from the AACN Web site in the first month after their release; the number of copies downloaded now exceeds 120,000. These standards are guiding the transformation of the care environment in many institutions across the United States. comments
The standards have been presented in several AACN publications. The six standards (addressing skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition, and authentic leadership) were derived from a strong base of research evidence. Each standard is considered essential, and the standards are designed to be used together, not as stand-alone less pleased with the quality of collaboration than physicians are in the same setting. A disturbing finding from a 2004 survey of safety attitudes revealed that more than one third of nurses reported finding it difficult to speak up when they detected a problem with a patient. Pronovost and col-leagues14(p 1028) have called this “interdependence without integration,” which is an apt phrase that describes the critical nature of nurse-physician work, a relationship that must be improved if both nurses and physicians are to be effective.
Perhaps these different views of collaboration are related to the quality of the interaction. True collaboration, as directed by the standards, builds over time, leading to joint decision making that embraces the worldview of each discipline. True collaboration is normal, respectful, and ongoing. With true collaboration, each professional is a full partner in the dialogue; loud voices or lofty titles will not dominate the discussion or the decision.

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