Other Titles
Creating a Healthy Work Environment in the ED: An Evidence-Based Practice Initiative [Title Slide]
Abstract
Background/Significance: Following the COVID-19 pandemic, a community emergency department (ED) faced a critical staffing shortage with nursing turnover rates as high as 46.2%. Strategies to mitigate the staffing shortage were primarily focused on recruitment methods without an intentional focus on evaluating why the nurses were leaving. Understanding the interdependent relationship between nurse attrition and the work environment, the ED Clinical Nurse Specialist (CNS) led an evidence-based practice project to improve the work environment. The purpose of the project was to create an environment in which nurses feel valued, respected, and fulfilled in their work; ultimately leading to decreased nurse turnover.
Interventions: The ED CNS utilized the first 4 steps of the EBP process (inquiry, literature search, appraisal, and synthesis) which demonstrated that a healthy work environment leads to improved nurse satisfaction, improved intent to stay, improved clinical outcomes, and improved patient satisfaction (Alilyyani et al., 2018; Al Yahyaei et al., 2022; Monroe et al., 2021; Kester et al., 2022; Park & Song, 2022; Ulrich et al., 2019; Wei et al., 2018). Interventions described in the literature to cultivate a healthy work environment (HWE) were consistent with The American Association of Critical Care Nurses’ (AACN) Healthy Work Environment Standards (HWES), including adequate staffing; effective communication; authentic leadership; engagement and collaboration; and meaningful recognition (AACN, 2020). AACN’s HWE assessment tool was utilized to assess the baseline work environment scores. The lowest scoring standards were chosen as priority areas of focus, which included skilled communication; appropriate staffing; and meaningful recognition. Collaborating with frontline staff as key stakeholders, in addition to using evidence-based interventions; an implementation plan was developed and carried out over several months. The interventions included improved transparency with unit data, improved methods of communication, educational opportunities, an intentional focus on formal and informal recognition, addition of clinical support positions, redesign of staffing assignments, and creation of new processes to improve unit efficiency.
Outcomes/Evaluation: Post-implementation data, again utilizing AACN’s HWE assessment tool, demonstrated a significant improvement in the scores for each of the six HWES. Following the implementation of AACN’s HWES, RN turnover decreased from 46.2% to 3.6%; as a result of the improved work environment, the Press Ganey Likelihood to Recommend scores increased from 56.2% pre-implementation to 62.9% post-implementation. Additionally, improvements in patient outcomes were also seen, including decreased average door to needles times for patients receiving thrombolytic therapy (70 mins to 47 mins); decreased blood culture contamination rates (11% to 4%); and decreased left-without-being-seen rates (3.7% to 1.7%). Based on the improved outcomes in the community ED, implementation of the HWES across the system’s four EDs is now in progress.
Implications for Practice: Implementation of the HWES resulted in improved staff retention, improved patient satisfaction, and improved patient outcomes. As nurse retention continues to be an area of priority focus, nurse leaders must strive to create an environment where nurse feel valued and respected. Through authentic leadership, nurse leaders play an integral role in improving the work environment; ultimately improving nurse, patient, and system outcomes.
Notes
References:
AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence. (2020). American Journal of Critical Care, 14(3), 187-197. https://doi.org/10.4037/ajcc2005.14.3.187
Alilyyani, B., Wong, C. A., & Cummings, G. (2018). Antecedents, mediators, and outcomes of authentic leadership in healthcare: A systematic review. International Journal of Nursing Studies, 83(1), 34–64. https://doi.org/10.1016/j.ijnurstu.2018.04.001
Al Yahyaei, A., Hewison, A., Efstathiou, N., & Carrick-Sen, D. (2022). Nurses’ intention to stay in the work environment in acute healthcare: a systematic review. Journal of Research in Nursing, 27(4), 374–397. https://doi.org/10.1177/17449871221080731
Kester, K., Pena, H., Shuford, C., Hansen, C., Stokes, J., Brooks, K., Bolton, T., Ornell, A., Parker, P., Febre, J., Andrews, K., Flynn, G., Ruiz, R., Evans, T., Kettle, M., Minter, J., & Granger, B. (2021). Implementing AACN’s Healthy Work Environment Framework in an Intensive Care Unit. American Journal of Critical Care, 30(6), 426–433. https://doi.org/10.4037/ajcc2021108
Monroe, C., Loresto, F., Horton-Deutsch, S., Kleiner, C., Eron, K., Varney, R., & Grimm, S. (2021). The value of intentional self-care practices: The effects of mindfulness on improving job satisfaction, teamwork, and workplace environments. Archives of psychiatric nursing, 35(2), 189–194. https://doi-org.proxy.library.kent.edu/10.1016/j.apnu.2020.10.003
Park, J. E., & Song, M. R. (2022). Effects of emergency nurses’ experiences of violence, resilience, and nursing work environment on turnover intention: A cross-sectional survey. Journal of Emergency Nursing. https://doi.org/10.1016/j.jen.2022.10.001
Ulrich, B., Barden, C., Cassidy, L., & Varn-Davis, N. (2019). Critical care nurse work environments 2018: Findings and implications. Critical Care Nurse, 39(2), 67–84. https://doi.org/10.4037/ccn2019605
Wei, H., Sewell, K. A., Woody, G., & Rose, M. A. (2018). The state of the science of nurse work environments in the United States: A systematic review. International Journal of Nursing Sciences, 5(3), 287–300. https://doi.org/10.1016/j.ijnss.2018.04.010
Sigma Membership
Non-member
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Translational Research/Evidence-based Practice
Keywords:
Work Environment, Personnel Retention, Emergency Service, Nursing Shortage, Emergency Department
Recommended Citation
Hignight, Megan, "Creating a Healthy Work Environment to Improve Nurse Retention: An Evidence-Based Practice Project" (2026). Creating Healthy Work Environments (CHWE). 115.
https://www.sigmarepository.org/chwe/2024/presentations_2024/115
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Washington, DC, USA
Conference Year
2024
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-03-04
Creating a Healthy Work Environment to Improve Nurse Retention: An Evidence-Based Practice Project
Washington, DC, USA
Background/Significance: Following the COVID-19 pandemic, a community emergency department (ED) faced a critical staffing shortage with nursing turnover rates as high as 46.2%. Strategies to mitigate the staffing shortage were primarily focused on recruitment methods without an intentional focus on evaluating why the nurses were leaving. Understanding the interdependent relationship between nurse attrition and the work environment, the ED Clinical Nurse Specialist (CNS) led an evidence-based practice project to improve the work environment. The purpose of the project was to create an environment in which nurses feel valued, respected, and fulfilled in their work; ultimately leading to decreased nurse turnover.
Interventions: The ED CNS utilized the first 4 steps of the EBP process (inquiry, literature search, appraisal, and synthesis) which demonstrated that a healthy work environment leads to improved nurse satisfaction, improved intent to stay, improved clinical outcomes, and improved patient satisfaction (Alilyyani et al., 2018; Al Yahyaei et al., 2022; Monroe et al., 2021; Kester et al., 2022; Park & Song, 2022; Ulrich et al., 2019; Wei et al., 2018). Interventions described in the literature to cultivate a healthy work environment (HWE) were consistent with The American Association of Critical Care Nurses’ (AACN) Healthy Work Environment Standards (HWES), including adequate staffing; effective communication; authentic leadership; engagement and collaboration; and meaningful recognition (AACN, 2020). AACN’s HWE assessment tool was utilized to assess the baseline work environment scores. The lowest scoring standards were chosen as priority areas of focus, which included skilled communication; appropriate staffing; and meaningful recognition. Collaborating with frontline staff as key stakeholders, in addition to using evidence-based interventions; an implementation plan was developed and carried out over several months. The interventions included improved transparency with unit data, improved methods of communication, educational opportunities, an intentional focus on formal and informal recognition, addition of clinical support positions, redesign of staffing assignments, and creation of new processes to improve unit efficiency.
Outcomes/Evaluation: Post-implementation data, again utilizing AACN’s HWE assessment tool, demonstrated a significant improvement in the scores for each of the six HWES. Following the implementation of AACN’s HWES, RN turnover decreased from 46.2% to 3.6%; as a result of the improved work environment, the Press Ganey Likelihood to Recommend scores increased from 56.2% pre-implementation to 62.9% post-implementation. Additionally, improvements in patient outcomes were also seen, including decreased average door to needles times for patients receiving thrombolytic therapy (70 mins to 47 mins); decreased blood culture contamination rates (11% to 4%); and decreased left-without-being-seen rates (3.7% to 1.7%). Based on the improved outcomes in the community ED, implementation of the HWES across the system’s four EDs is now in progress.
Implications for Practice: Implementation of the HWES resulted in improved staff retention, improved patient satisfaction, and improved patient outcomes. As nurse retention continues to be an area of priority focus, nurse leaders must strive to create an environment where nurse feel valued and respected. Through authentic leadership, nurse leaders play an integral role in improving the work environment; ultimately improving nurse, patient, and system outcomes.
Description
Following the COVID-19 pandemic, a community emergency department (ED) faced a critical staffing shortage. A literature review demonstrated an interdependent relationship between nurse attrition and the work environment. Based on this, the ED leadership team implemented AACN’s Healthy Work Environment Standards, resulting in improved retention, patient satisfaction, and clinical outcomes