New AACN Study Shows Benefits of Healthy Work Environments

New AACN Study Shows Benefits of Healthy Work Environments

New research from the American Association of Critical-Care Nurses (AACN) underscores the ongoing impact of the COVID-19 pandemic on nurses and the benefits of creating and sustaining healthy work environments (HWEs) to support nurse staffing, retention and optimal patient care.

Results from AACN’s fifth national survey of nurses are now published online ahead of the October 2022 print issue of Critical Care Nurse (CCN). “National Nurse Work Environments – October 2021: A Status Report” includes key findings from AACN’s survey of more than 9,000 nurses, compares the results with previous studies and recommends areas for improvement.

The 2021 survey was conducted two years earlier than regularly scheduled in an effort to assess the pandemic’s impact on nurses and their work environments. Key findings from the AACN survey include the following:

  • The nurse staffing crisis has become significantly worse. Only 24% of the respondents said they have appropriate staffing more than 75% of the time, compared with 39% of respondents in 2018.
  • Nurses’ intent to leave their current nursing position increased. More than two-thirds (67%) of respondents stated they intend to leave their nursing position within three years, compared with 54% in 2018.
    • Among those who intend to leave, 36% plan to leave within the next year.
    • Among those who intend to leave, respondents said top items that could very likely influence them to reconsider include higher salary and benefits (63%, up from 46% in 2018) and better staffing (57%, up from 50% in 2018).
  • Satisfaction with being a nurse declined since the last survey. Only 40% of all respondents indicated they were very satisfied with being a registered nurse, compared with 62% in 2018.
  • Nurses aren’t feeling safe and valued. Only 47% of the respondents agreed with the statement “My organization values my health and safety,” compared with 68% in 2018. This item had the highest correlation to job satisfaction.

Study co-author and AACN Chief Clinical Officer Connie Barden, MSN, RN, CCRN-K, FAAN, said, “Not surprisingly, the 2021 survey showed a decline in the health of nurses’ work environments. Unchecked, this decline can cause permanent damage to nurse retention and the entire healthcare system.”

Barden said, “A bright spot is that the study indicated implementation of the six AACN Standards for Establishing and Sustaining Healthy Work Environments (HWE standards) can be a game changer. Focusing on these standards is crucial to support nurse well-being, staffing and retention, which are necessary for optimal patient care.” After examining several key nursing challenges, AACN notes that workplaces that had actively implemented any of the six HWE standards showed better results than those that had not. The following includes some insights from the 2021 survey:

  • In units that had implemented or were “well on their way” to implementing any of the six HWE standards, nurses’ perceptions of appropriate staffing were higher (44%) than in those that had not implemented the standards or had just begun (16%).
  • Respondents working in units that had implemented HWE standards were half as likely to say they intend to leave their position in the next 12 months (26%), compared with those in units without implementation (52%).
  • Fifty-five percent of nurses working in units that had implemented any of the HWE standards reported being very satisfied with being a nurse, compared with 34% of those working in units that had not.
  • Regarding satisfaction with their current position, 33% of nurses working in units that had implemented the HWE standards reported being very satisfied, compared with 6% of those working in units that had not.

“Our findings indicate that unit or institutional implementation of the AACN HWE standards may mitigate the pandemic’s negative impact on nurses, which may help ease the current staffing crisis,” said principal investigator Beth Ulrich, EdD, RN, FACHE, FAONL, FAAN. She added, “Creating and sustaining healthy work environments is everyone’s responsibility, and this requires changing longstanding cultures, traditions and hierarchies. The benefits of doing so are increasingly clear, as are the consequences of inaction.”

Access the full-text article by visiting the CCN website at http://ccn.aacnjournals.org

Study: Cognitive Assessment Helps Identify Post-ICU Needs

Study: Cognitive Assessment Helps Identify Post-ICU Needs

Assessing patients for cognitive impairment at hospital discharge can help identify those who are at higher risk of developing new severe physical disabilities, according to new research in American Journal of Critical Care (AJCC).

Researchers at Montefiore Medical Center, the university hospital for Albert Einstein College of Medicine, Bronx, New York, found that about 30% of critically ill patients could not complete a simple screening assessment for cognitive impairment at the time of their discharge from the hospital, mostly due to physical or cognitive impairment at the time. They also found that about 47% of the surviving patients who were able to complete the assessment at this early point in their recovery scored at a level consistent with severe cognitive impairment.

Utility of Screening for Cognitive Impairment at Hospital Discharge in Adult Survivors of Critical Illness” looked at disability and mortality outcomes for patients following their stay in an intensive care unit (ICU), with a focus on whether screening for cognitive impairment when they left the hospital could inform strategies for post-hospital interventions.

“Leaving the hospital after surviving critical illness is only the beginning of a patient’s recovery. Months later, we found that ICU survivors often had cognitive impairment and new physical challenges,” said co-author Gerardo Eman, MD, an internal medicine resident in critical care at Montefiore. “Early and ongoing assessments of ICU survivors are crucial to developing post-ICU treatment plans and improving long-term outcomes.”

The researchers conducted post hoc analyses with data from two observational cohort studies. The FRAIL-STOOP study involved adult patients ages 50 years or older who were admitted to medical or surgical ICUs between January 2016 and July 2017. The second study, called CAMINANDO, involved adults ages 18 years or older with acute respiratory failure who were admitted between July 2018 and December 2019.

Patients in each cohort completed various cognitive and physical assessments during their hospital stay, and hospital treatment variables were collected via medical record review.

Within a few days of the patients’ discharge from the hospital, trained research coordinators administered a simplified version of the Montreal Cognitive Assessment (MoCA-Blind). Before administering the tool, they assessed whether the patient could follow at least three of five simple commands, including looking at them, nodding their head and opening or closing their eyes.

For patients unable to complete the assessment, the research coordinators classified the reason as due to cognitive impairment, physical impairment, refusal, leaving the hospital before the MoCA-Blind could be completed or another reason that didn’t fit one of the more specific categories. They also collected information on the patients’ disability status at that time.

Follow-up telephone interviews with hospital survivors and/or their surrogates were completed about six months after patients left the hospital, to assess vital and physical disability status.

The study population consisted of 423 adults across the two observational cohort studies, 320 of whom survived to hospital discharge.

Among the survivors, 213 completed the MoCA-Blind about the time of their hospital discharge. Six months later, 37 (17.4%) had died, and 41 (23.3%) survivors had new severe disability based on their baseline in-hospital assessments.

Of the 107 hospital survivors who could not complete a MoCA-Blind assessment at discharge, cognitive impairment was the primary reason for 47 (43.9%) of them. Six months later, 28 (26.2%) had died, and 30 (38%) had new severe disability.

Importantly, cognitive impairment at hospital discharge was not associated with an increased risk of death within six months, but it was associated with a higher risk of new severe physical disability.

The inability to complete a screening test may provide important prognostic data. The fact that a significant percentage of adults in this study could not complete the cognitive assessment at hospital discharge suggests there may still be a role for developing and validating a cognitive assessment tool specific to ICU survivors to gain a fuller picture of post-ICU needs.

To access the article and full-text PDF, visit the AJCC website at www.ajcconline.org.

Nurse Bioethicist Receives Kinney Distinguished Career Award from AACN

Nurse Bioethicist Receives Kinney Distinguished Career Award from AACN

The American Association of Critical-Care Nurses (AACN) has honored nurse and bioethicist Cynda Hylton Rushton, PhD, RN, FAAN, with its 2022 Marguerite Rodgers Kinney Award for a Distinguished Career.

Rushton receives the award for her exceptional contributions that enhance the care of critically ill patients and their families and the nurses who care for them, and further AACN’s mission and vision. The presentation will occur during the 2022 National Teaching Institute & Critical Care Exposition in Houston, May 16-18. Cynda Hylton Rushton, PhD, RN, FAAN.

An international leader in bioethics and nursing, Rushton is the Anne and George L. Bunting Professor of Clinical Ethics at the Johns Hopkins University Berman Institute of Bioethics and the JHU School of Nursing. She co-chairs Johns Hopkins Hospital’s Ethics Committee and Consultation Service. A founding member of the Berman Institute, she co-led the first National Nursing Ethics Summit that produced a Blueprint for 21st Century Nursing Ethics.

In 2016, she co-led a national collaborative, State of the Science Initiative: Transforming Moral Distress into Moral Resilience in Nursing and co-chaired the American Nurses Association’s professional issues panel that created “A Call to Action: Exploring Moral Resilience Toward a Culture of Ethical Practice.” She was a member of the National Academies of Medicine, Science and Engineering Committee that produced the report “Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being.”

“Dr. Rushton is an internationally recognized leader in nursing ethics, moral resilience and workforce issues and a longtime contributor to groundbreaking work on these topics,” said AACN President Beth Wathen. “Her work has influenced nursing practice, health policy and patient care.”

A member of AACN since 1979, Rushton is a frequent presenter at NTI and regularly contributes to AACN’s clinical journals.

She is a member of the American Nurses Association’s Center for Ethics and Human Rights Ethics Advisory Board and the American Nurses Foundation’s Well-Being Initiative Advisory Board.

Rushton is the chief synergy strategist for Maryland’s R3 Resilient Nurses Initiative, a statewide initiative to build resilience and ethical practice in nursing students and novice nurses.

She is a fellow of the Hastings Center bioethics research institute, chair of the Hastings Center Fellows Council and a fellow of the American Academy of Nursing.

She is the editor and author of “Moral Resilience: Transforming Moral Suffering in Healthcare,” the first book to explore the emerging concept of moral resilience from a variety of perspectives including nursing, bioethics, philosophy, psychology, neuroscience and contemplative practice.

She earned her bachelor’s degree in nursing at the University of Kentucky, followed by a master’s degree in nursing at the Medical University of South Carolina and a PhD from Catholic University of America in Washington, D.C.

About the Marguerite Rodgers Kinney Award: Established in 1997 and named for an AACN past president, the Marguerite Rodgers Kinney Award for a Distinguished Career recognizes extraordinary and distinguished professional contributions that further AACN’s mission and vision of a healthcare system driven by the needs of patients and their families where acute and critical care nurses make their optimal contribution. Recipients of this Visionary Leadership Award receive a $1,000 gift to the charity of their choice and a crystal replica of the presidential “Vision” icon. Other Visionary Leadership awards, AACN’s highest honor, include the Lifetime Membership Award and the AACN Pioneering Spirit Award.

AACN Taps 188 Hospital Units for 2021 Beacon Awards

AACN Taps 188 Hospital Units for 2021 Beacon Awards

ALISO VIEJO, Calif. — Feb. 16, 2022 — The American Association of Critical-Care Nurses (AACN) recognized 188 units from 126 hospitals that earned the Beacon Award for Excellence between Jan. 1, 2021, and Dec. 31, 2021. (View recipient list.)

The Beacon Award for Excellence lauds hospital units that employ evidence-based practices to improve patient and family outcomes. The award provides gold, silver and bronze levels of recognition to hospital units that exemplify excellence in professional practice, patient care and outcomes. Recognition is for a three-year term.

AACN President Beth Wathen, MSN, RN, CCRN-K, praises the exemplary efforts of the unit teams who achieved the Beacon Award for Excellence.

“Meaningful recognition takes on even greater relevance and importance as we continue to meet the challenges of the COVID-19 pandemic,” she said. “Being recognized as a Beacon unit underscores these teams’ ongoing commitment to providing safe, patient-centered and evidence-based care to patients and families. This achievement is a tremendous honor to those who have worked so hard to achieve excellence in patient care and positive patient outcomes.”

Beacon-designated units meet the criteria in five categories, all of which are consistent with other national awards, including the ANCC Magnet Recognition Program®, the Malcolm Baldridge National Quality Award and National Quality Forum’s Eisenberg Patient Safety and Quality awards. Units that receive the Beacon Award demonstrate practices that align with AACN’s Healthy Work Environment standards.

Recipients of a gold-level Beacon Award demonstrate staff-driven excellence in sustained unit performance and improved patient outcomes that exceed national benchmarks. Silver-level recipients demonstrate continual learning and effective systems to achieve optimal patient care. Bronze-level awardees demonstrate success in developing, deploying and integrating unit-based performance criteria for optimal outcomes.

In all, 58 units received gold-level Beacon awards, the program’s highest distinction. Among the 2021 recipients, University of California Davis Health System in Sacramento and University of North Carolina (UNC) Medical Center each had four units recognized with gold-level awards, with a fifth unit at UNC earning a silver-level award. St. Elizabeth Healthcare in Edgewood, Kentucky, had three units earn gold-level awards.

Children’s Hospital Los Angeles had four units recognized with Beacon awards in 2021, with two gold-level awards and two silver-level awards. VCU Health System in Virginia, Rush University Medical Center in Chicago and MetroHealth Medical Center in Cleveland, each had two units receive gold-level awards and a third unit was recognized with a silver-level award.

The medical intensive care unit (MICU) at ChristianaCare, Newark, Delaware, becomes the first unit in the United States to renew its Beacon Award for the fifth consecutive three-year cycle, earning gold-level recognition in 2021. In addition, two other units at ChristianaCare were recognized with silver-level awards.

“Through their relentless and uncompromising pursuit to deliver care that is nonpareil, the nurses of ChristianaCare’s MICU have become the paragon of what our profession can accomplish,” said Ric Cuming, EdD, MSN, RN, NEA-BC, FAAN, ChristianaCare’s chief nurse executive and ChristianaCare HomeHealth’s president. “The success that our ChristianaCare MICU has trailblazed, even in the face of this pandemic and continuously elevating benchmarks, also has catalyzed our health system’s other intensive care units to achieve unprecedented gains in safety and quality that have been recognized with the AACN’s Beacon award, the touchstone by which all critical care nursing excellence and quality are measured.”

A total of 34 hospitals had multiple units honored with an award in 2021, demonstrating excellence in caring for acutely and critically ill patients and their families. Memorial Hermann Hospital in Houston had the most units earn Beacon awards, with six units recognized with silver-level awards.

In all, 25 units at 13 New York hospitals attained Beacon status in 2021, the most for any state. Northwell Health had three units at North Shore University Hospital in Manhasset, New York, and two at its nearby Syosset Hospital receive Beacon awards. In Rochester, Highland Hospital, Rochester General Hospital an Unity Hospital Rochester Regional Health earned six Beacon awards, bringing the total for these area hospitals to 34 units currently recognized through the Beacon award program. Last year, University of Rochester Medical Center described its journey toward multiple Beacon awards in “The Beacon Collaborative: A Journey to Excellence,” published in the peer-reviewed journal Critical Care Nurse.

Learn more about the Beacon Award for Excellence, and read about one unit’s Beacon journey in Your Stories on the AACN website.

About the Beacon Award for Excellence: Established in 2003, AACN’s award recognizes top hospital units that meet standards of excellence in recruitment and retention; education, training and mentoring; research and evidence-based practice; patient outcomes; leadership and organizational ethics; and creation of a healthy work environment. Award criteria — which measure systems, outcomes and environments against evidence-based national criteria for excellence — provide a mechanism to initiate patient safety efforts. To learn more about the award, visit www.aacn.org/beacon or call 800-899-2226.

About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with more than 130,000 members and over 200 chapters in the United States.

Can a Better Nurse Work Environment Keep Patients Out of ICU?

Can a Better Nurse Work Environment Keep Patients Out of ICU?

Short answer: yes, improving nurses’ work environment can even save lives. Surgical patients in hospitals with better nurse work environments were less likely to be admitted to an intensive care unit (ICU) and less likely to die, according to an analysis of nearly 270,000 patient records.

Intensive Care Unit Utilization Following Major Surgery and the Nurse Work Environment” is the first study to directly link the nurse work environment to ICU use. Its findings suggest that efforts to improve the work environment for nurses may reduce ICU utilization and avoid risks associated with ICU admissions. The article is published in AACN Advanced Critical Care.

The researchers examined a large sample of Medicare beneficiaries undergoing general, orthopedic or vascular surgical procedures between January 2006 and October 2007. The cross-sectional study included 269,764 adult surgical patients in 453 hospitals.

They found that surgical patients in hospitals with good nurse work environments had 16% lower odds of ICU admission, 12% lower odds of in-hospital mortality, and 11% lower odds of dying within 30 days of hospital admission than patients in hospitals with mixed or poor nurse work environments. When they examined the joint outcome of either ICU admission or death within 30 days of hospital admission, they found 15% lower odds for either event for patients in hospitals with good nurse work environments.


Patients in the best nurse work environments had the lowest occurrence of ICU admission or 30-day mortality.

Co-author Anna Krupp, PhD, MSHP, RN, is an assistant professor, the University of Iowa College of Nursing. The research was conducted during her post-doctoral fellowship in health services and outcomes research at the University of Pennsylvania School of Nursing in the Center for Health Outcomes and Policy Research (CHOPR), where she was a National Clinician Scholar. Other co-authors are Karen Lasater, PhD, RN, FAAN, and Matthew McHugh, PhD, MPH, JD, RN, CRNP, from CHOPR and Penn’s Leonard Davis Institute of Health Economics.

Anna Krupp, PhD, RN.“A key difference between ICUs and lower acuity units is the staffing ratio of patients to nurses.”

“Hospitals with better nurse work environments may be better equipped to provide complex patient care in a lower acuity setting without compromising a patient’s odds of mortality,” Krupp said. “A key difference between ICUs and lower acuity units is the staffing ratio of patients to nurses. In the context of the COVID-19 pandemic, our findings suggest that a limiting factor in a hospital’s capacity to respond to the COVID-19 surges of critically ill patients is likely related to the quality of the nurse work environments prior to the pandemic. Fewer additional ICU beds may have been needed if hospitals had good nurse work environments prior to the pandemic, with enough nurses to safely care for patients in lower acuity settings.”

The research team used data from three sources: the Medicare Provider Analysis and Review, hospital characteristics from an American Hospital Association annual survey, and the RN4CAST survey of approximately 34,000 registered nurses at hospitals in California, Florida, New Jersey, and Pennsylvania. Hospitals were assigned unique individual identifiers to link them across the sources.

The nurse work environment was measured using the 31-item Practice Environment Scale of the Nursing Work Index, which is endorsed by the National Quality Forum. Hospitals were then categorized as good (top 25%), poor (bottom 25%) or mixed, which were the 50% between the high and low scales.

Patients in the best nurse work environments had the lowest occurrence of ICU admission or 30-day mortality. Patients in hospitals with poor nurse work environments had the highest occurrence.

Surgical patients in hospitals with good versus poor nurse work environments had 29% lower odds of being admitted to an ICU, 23% lower odds of in-hospital mortality, 21% lower odds of 30-day mortality, and 28% lower odds of being admitted to an ICU or experience 30-day mortality.

Admission to an ICU varied significantly by surgical group, with vascular surgical patients having the highest use of ICUs (47.4%), followed by general (18.2%) and orthopedic (5.9%).

Hospital characteristics, such as number of beds, teaching status, and technology capabilities, varied significantly. The analysis revealed that those with the best nurse work environments were nonteaching hospitals with more than 250 beds.

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