Minutes matter when a patient may have had a stroke, but being far from a physician with advanced training in neurology no longer needs to be a barrier to rapid diagnosis and intervention thanks to telestroke programs designed to improve access to the limited number of specialists, regardless of the geographic isolation of patients who may have experienced a stroke.
Telestroke, or stroke telemedicine, is a form of telehealth in which physicians with advanced training in stroke care use technology to provide immediate consultation to a local healthcare professional to recommend diagnostic imaging and treatment for patients with stroke at an originating site. Patients who present within 4.5 hours of when they were last known to be well may be eligible for thrombolytic drug therapy or endovascular intervention, often measured as door-to-needle time.
After launching a telestroke consultation program, Essentia Health, an integrated health system serving patients in Minnesota, Wisconsin, and North Dakota, increased the percentage of patients receiving thrombolytics in less than 60 minutes and decreased the average door-to-needle time.
Essentia Health initiated the telestroke program in the fall of 2019, with coverage provided by four interventional neurologists, three of whom work in the system’s Comprehensive Stroke Center in Fargo, North Dakota. In addition to this center, telestroke services are provided to five other acute stroke-ready hospitals throughout rural areas in the upper Midwest.
Through the telestroke program, neurology consultations are available to all sites 24 hours a day, every day of the year. They can be used for inpatient and emergency department stroke activations at each facility.
The team developed a tiered stroke alert algorithm and telestroke workflow chart to help healthcare professionals at rural sites determine eligibility for telestroke consultation to decide the treatment plan.
The algorithm categorized strokes as levels I to III according to the symptoms and time when the patient was last known to be well. Telestroke consults were most often used for patients with level I stroke alerts since they were within the timeframe when they might be eligible for thrombolytic drug therapy or endovascular intervention.
Once staff members determine whether a telestroke consultation will be initiated, they refer to the step-by-step workflow chart, which specifies actions needed for each multidisciplinary team member.
“Regardless of the type of stroke, rapid diagnosis and intervention are critical for improving survival rates and reducing the long-term effects of stroke,” says Chelsey Kuznia, BSN, RN, SCRN, the stroke program manager for Essentia Health’s Comprehensive Stroke Center in Fargo, one of only two such facilities in North Dakota. “People living in rural areas not only have increased stroke risk factors, but they also face challenges to getting the advanced care they need in a timely way, which leads to higher rates of disability and death.”
In 2022, telestroke connections for 42 patients were completed, with a stroke diagnosis confirmed in 25 (61%). Fourteen patients with confirmed stroke received thrombolytic therapy. In contrast, others were not eligible, either because of patient-related contraindications or because more than 4.5 hours had elapsed since their last-known well time.
Of the 25 patients with confirmed stroke, 18 (72%) were discharged home, three were discharged to skilled nursing facilities, one to an inpatient rehabilitation unit, one to hospice, and two died.
The year before the implementation of the telestroke program, 11 of 15 eligible patients (73%) received thrombolytic therapy in less than 60 minutes, with a mean door-to-needle time of 61 minutes. During the year after implementation, the results improved: 11 of 12 eligible patients (92%) received thrombolytic therapy in less than 60 minutes, and the mean door-to-needle time decreased to 38 minutes.
Dr. Anne Dabrow Woods has incredible insight into nursing as a practicing critical care nurse practitioner and nursing educator with over 39 years of experience and counting.
Amidst a sea of temporary band-aid solutions for nursing, like gig apps and travel nurses, Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, the Chief Nurse of Health Learning, Research and Practice, Wolters Kluwerspoke with Daily Nurse to discussher practical, long-term solutions to address the nursing shortage and burnout. What follows is our interview, edited for length and clarity.
How long have you been in nursing, and what are some of your roles during that time?
I’ve been a nurse for 39 years and a nurse practitioner for 25 years. I’ve worked as a staff nurse, nurse educator, manager, and director of different critical care in hospitals, and then I went on and became a nurse practitioner. As a chief nursing officer, developing the right resources for nurses and other clinicians in education, practice, or research is imperative, so I’m out there doing it. As a critical care NP, I work weekends for Penn Medicine Chester County Hospital and teach undergraduate nursing. About ten years ago, I flipped over to working in graduate education at the master’s and doctoral levels for both Drexel University and Newman University as adjunct faculty. So, I wear different hats. I know what nurses need in practice. I’m a nurse practitioner, but I always work alongside nurses. I work in critical care, so I have my doctorate in nursing, a master’s degree, and a post-master’s certificate. And I’m a fellow in the American Academy of Nursing, so it’s just doing what I love.
You can talk about it because you’re living it.
What gives me street cred for people when they talk to me is that I know what’s happening out there and living it through what I do with nursing education, but also what’s going on in practice today. There are a lot of things in practice we have to change. There are going to be few nurses left at the bedside to care for patients. We’re on the precipice right now. We can change things for the better if we play our cards right.
There are several temporary solutions to address staffing shortages and burnout, like gig apps and traveling nursing. What insight can you share about practical, long-term solutions to the nursing crisis?
In travel nursing, you have an app to sign up for any shift you want, but they’re all band-aids. The more significant problem is we have a nursing shortage, and we knew it before we went into the pandemic. Then, post-pandemic, we’re seeing the effects that many more people either retired or decided to leave the bedside and go into other roles. Or some people left the profession together. So, what we anticipated with the nursing shortage coming in 2030 has hit us sooner than that. These quick, short solutions that people talk about, you hit the easy button, and they think it’s going to fix things, and it’s not.
The bottom line is we have to increase our pipeline, which is an issue right now. And we need to ensure that the nurses graduating are practice-ready because they are not. We need to understand most nurses in acute care and long-term care settings now are novice nurses or nurses who have only been in the profession for a few years. So, the fact that we have less experienced nurses at the bedside is problematic. The other big thing we’re seeing is that nurses in the age group from 25 to 35, which should be who we are relying on over the next 10 to 20 years, are starting to leave the profession because they are very burned out. They’re unhappy and need to see healthcare organizations addressing the pitfalls that we’re seeing with staffing. So they’re deciding to leave. We need to do some things, not only in academia, to make sure our nurses are practice-ready, but we also need to make sure in practice that these new graduate nurses coming in are supported and trained so they can become competent. We need to make sure that we support them through more extended orientation programs or nurse residency programs. Then, we always have people available to the newer nurses as their support system or resource. And a lot of healthcare systems still need to invest in that.
The good news is they are starting to understand the importance of a resource nurse position to help these newer nurses when they have questions. But we need to fix this right now. And this means different care models, too. So before the pandemic, we had this primary nurse model, which we’ve been practicing for 25 years, where one RN took care of four, five, maybe six patients. Then the pandemic hit, and you have many more patients and nurses. So we switched to this team model where you had a more experienced nurse who oversaw the care that less experienced nurses delivered. So we now know, post-pandemic, that we can’t stay in the primary nurse model anymore. We have to use the team model as an alternative care model because there are not enough experienced RNs.
Can you discuss how a team-based nursing model can help offset today’s nursing shortage?
We’re redefining the work of nursing. Before, in the primary nurse model, the nurse did much of the patient’s care. In a team model, the nurses oversee the care by unlicensed assistive personnel. So people like certified nursing assistants or patient care techs will do many hands-on activities of daily living like bathing, dressing, and other things. So that’s what the team model does. It allows you to have one very experienced RN overseeing several less experienced nurses and the work of your unlicensed assistive personnel. It means you can care for more patients, yet you still have one experienced nurse overseeing everything. They won’t be in there doing the baths as much and that type of thing. They’re going to delegate that to other people. But we have to do that to care for our patients appropriately. And it doesn’t mean that the care of patients will suffer. If you put the model in place correctly, it means that the work of nursing will be more defined as someone overseeing, directing, and delegating the care. Of course, the RNs only have things they can do in their scope of practice. And they will continue to do that. But it means that the team leader will do a lot more delegation. So we’ll still have quality care, but all RNs won’t do it. Other people will do it.
What problems must be overcome with the team model of nursing?
I’ve been a nurse for 39 years and was taught the team model of care. But if you graduated in the 80s into the mid-90s, you learned the team model of care because that’s what we did. And then we shifted over to primary. So anybody who’s graduated in the last 20 years needs to learn the team model of care. The graduate nurses need to understand what it is, too. So, when the pandemic came, we had to switch from the primary nurse model to the team nurse model. We had to re-educate people quickly on working within a team model of care and how to facilitate delegation.
But most importantly, we had to facilitate the correct communication so patient care doesn’t suffer. We can drive quality patient outcomes. So that’s part of it. We have to educate people. And academia has got to start educating people as well. And they are now aware of that. Many programs are starting to include alternative models of care.
During our recent nursing strikes, you’ve discussed the importance of revealing systemic issues healthcare must address. Can you talk about how nurse-specific billing data makes nurses literally and figuratively invisible in terms of political and financial decision-making capacity within the U.S. healthcare sector and what we can do to overcome these issues?
Physicians and nurse practitioners, like myself, can bill for our services. So, whatever we do, we document it and get reimbursed. I work in acute care, so I never see a reimbursement because the hospital sees the reimbursement. So, nurses are looped in with the room and board charge for the patient. So, there is nothing that financially defines the value of nursing because they don’t bill for their services. Now, we can look at outcomes data. And we do know that if you have fewer nurses, your patient outcomes will suffer. There’s an increased mortality rate and all of that. The best way for us to show the nurses’ value and give them a voice is to quantify their value and what nurses bring to the healthcare system. If we can get to the point where nurses are reimbursed for what they do with patients, we’ll see the value of nursing. We look at patient outcomes, and that type of thing, but the fact that nurses are looped in the room board charge is ridiculous to me. The chief financial officer will clearly understand nursing’s value once we’re moved over to the other side of the ledger. So that’s where we need to get to now. Nursing informaticists and healthcare organizations are analyzing the data to see what we can pull out of the EHRs to demonstrate the value of nurses and what they bring to the healthcare setting and show if you don’t stop at a certain level, based on the nurse competency and patient acuity, you’ve worsened patient outcomes. And it’s going to cost the healthcare organization X amount of dollars. But we need to go further than this. And that’s why we need to see if we can get nurses to bill for their services.
The nursing workforce is 50 percent of a healthcare institution’s expenditure, and when trying to balance the books, they will look at their biggest costs. Nursing is taking up the most significant amount. So they start to chip away at it, which gets us into trouble. We will only stop that once we can demonstrate and show the evidence that what we do as nurses does make a difference. And we can tell you how much of a difference that is financially if nurses were able to bill. That’s where we eventually get to, and I don’t know if I’ll see it in my lifetime, but that would solve many of the issues.
Change across healthcare in the last few years requires a new path forward for nurse staffing and care models. How should nursing be optimizing recruitment, retention, and care models post-pandemic?
People always look at how much we pay a department and then ask what they produce. What is their output? You’re not aligned. You’re just constantly roped in with room and board. Healthcare is a business, and every business has to show a return on investment. If you invest in a group or a product, you need to see what the organization gains from it. If nurses bill for their services or are recognized for everything they bring, you can see that it’s worth investing in nursing to get a higher return. You’ll get better patient outcomes. You’ll get better reimbursement from Medicare, the big blues, and everybody else in insurance. But we have to invest in our nurses. That’s the secret here.
Everybody is focusing on recruitment. We have to recruit more but then recruit these new nurses who need to be more competent, and many need to be practice-ready. But you got to train them. You can’t just leave them floundering after you finish training. So that’s where the nurse residency comes in. The latest stats show the turnover rate is 22.5 percent. And for new nurses, it’s 33 percent. New graduate nurses leave within one year because they do not feel valued. So healthcare organizations that invest in training invest in large residency programs, which means they’ll be in orientation for six months to a year, and their turnover rate is much lower. But it’s not just about recruitment. We must retain our talent within our healthcare organizations and make every nurse feel valued.
We need to pay nurses what they’re worth. When you look at all the reasons people leave and what they want, and even the striking nurses, which I’ve talked a lot about, and ask them why they leave, of course, they mention salary. But the real reason is staffing because there are not enough competent nurses at the bedside. And we still insist on staffing by numbers and ratios. And we can’t do that anymore. We have to look at what is the competency of the nurse. And if they have the skills to care for the patients in that specific unit. So it’s the competency of the nurse, but also the patient acuity. So, ten years ago, if you had a 20-bed unit, you could get away with having four RNs. It will take a lot of work with patient acuity and nurses being less experienced today. You’re going to need better quality care. You have to look at all that, and you’ll have to step higher. So we look at competency-based staffing, which looks at the nurse’s competency, the patient acuity, the numbers, and what people consider safe. But you can’t just look at numbers alone. And that’s where we need to get to. Healthcare organizations must start investing in the nurses there to help them with training and help them move up in an organization or laterally to different roles. People would stay, but they don’t feel like they’re being invested in and burned out because more nurses are needed to work beside them. They’re going to leave, and that’s just the reality of the situation.
Should we encourage nurse leaders to talk more with nurses to learn about their concerns?
Nurse leaders have to get out of their offices. They must be up on the units, talk to the people at the bedside, and talk to their managers. We’ve talked a lot about the staff. We also have to think about that middle management layer, the nurse managers. Those people are leaving as well. We need to ensure that they are adequately trained to assume the competencies of the nurse manager role. The organization’s CEO, CFO, and directors must be up on the units visible. I talked to the people working to see the real issues and asked them what would help them. The big thing is that we have to change culture right now. And the best way to change culture is to get out there if you’re a leader and see what’s happening within your organization. So it’s about improving that communication, getting out of the office, walking the walk, and talking the talk. Or talking the talk, walking the walk, you have to be able to do both.
I work for Penn Medicine, Chester County Hospital, and we see our leaders on the floors. And I work weekends, and they come in on the weekends. And that is great. I won’t say we don’t have issues because we do like everybody else. They struggle sometimes with staffing, but the fact that our leaders are present, they see what’s going on, they hear when people say, “Look, we can’t do this anymore.” They listen. And that’s what all organizations need to do. If leadership is listening and provides the staff with the right resources, like information tools, that type of thing they can use in their practice. But changing the correct number of competent nurses is vital because they’re investing in the workforce.
Will new staffing models, partnerships with academic institutions, and being more mindful of techniques help retain workers and solve the staffing crisis?
That’s good and going to help. One thing to remember is they can’t do it by themselves. Academia can’t do it alone, and we have to work together. We cannot be in our silos anymore. We need help. When you look at enrollments in nursing programs around the country from undergrad, bachelor’s, master’s, and doctoral levels, all enrollments are down over the last year. So people look at our profession and say, “Wow, I don’t want to be a nurse.” Because they’re talking to nurses who say, “I’m exhausted.” We’re going to change that, but we need to start. First, we should be working with high school students when they decide what they want to do with their life. So nursing is challenging and can be hard, but it’s also so rewarding. And if we work together, then we can make change happen. It’s about ensuring we fill the pipeline and educating people correctly. The NCLEX test just changed in April to focus on clinical judgment, which is what every nurse needs to be able to use in their everyday practice. I’m excited they decided to do this because it will make these graduate nurses more practice-ready. If they graduate, pass the NCLEX exam, and get into practice, we need to support them because they’re just starting to understand clinical judgment. We need to foster and facilitate that education, even when they’re in practice, by giving them the training and skills they need. So when they get to be three years out, five years out, they’re truly competent nurses who could then help with the next group of new nurses coming in.
We have to work together, get out of these silos, talk to each other. We have to pay faculty more. The age range is higher than a staff nurse’s, so many are retiring. We need to get people in nursing 10-20 years to think of becoming faculty. They want to stay in their staff position because they get paid much less, so we must address faculty salaries. We need to ensure they have adequate resources in schools, like more simulations, and invest in adjunct faculty. So, somebody like me, I don’t work full time as faculty because they can’t pay me enough. I know how to teach because I was trained how to teach. We need to train nurses who are hungry and excited to want to help and teach them how to facilitate learning. And we need to do more of that.
I’m just doing what I love. I’m a nurse, and I love this profession. When you’re in it for a while, it’s our responsibility to give back to the profession. So, I do all these things because it’s my professional responsibility to do that. But the truth is, I love everything I do.
We’re at the best time in our profession because people are listening to us. And we have the ability, if we speak with one voice, to get the things we need to improve with great opportunities ahead for all of us.
Improved organ donation practices and greater program visibility led to a sustained increase in referrals, donors, and transplanted organs at a Georgia hospital, thanks to a focus on enhanced staff education and family communication.
Co-author Jesse Gibson, MBA, BSN, RN, TCRN, is the trauma program director and chair of the Donation Advisory Committee at the trauma center, serving 18 counties in a predominantly rural area. Part of a five-hospital health system, the medical center serves more than 2,600 trauma patients annually, with 95% having blunt trauma. Since the initiative was conducted, the hospital has been nationally verified as a Level I trauma center by the American College of Surgeons Committee on Trauma.
“By investing in staff members and partnering with bedside providers, our facility improved the organ donation experience for nurses, physicians, donors, and families,” Gibson says. “The outcome of that investment has been a hospital culture that values and celebrates organ donation as a standard of care for patients and families and an important part of honoring end-of-life wishes.”
The performance improvement initiative began at the end of 2017 to address concerns about lower-than-expected metrics related to the medical center’s organ donation process. Initial reviews of patient care revealed deviations from best practice, including missed referrals, care team members initiating discussions about donation with families, and misconceptions about the donation process.
The Donation Advisory Committee helped clarify language and revise policies related to end-of-life care, partnering with the hospital liaison at its organ procurement organization to increase physician and staff education and provide visibility for the process. Beyond engaging staff to reinforce the expected practice, a transitional language guide was provided to physicians and advanced providers to assist them in any initial discussions that may arise with families. A series of organ donation presentations in 2018 and 2019 provided staff education. They encouraged a dialogue about the process and review of the most recent organ and tissue data, metrics, and expectations.
To improve the program’s visibility, the project team arranged for a “Donate Life” flag to be raised on the main campus each time a family authorized organ donation. The team also implemented an “honor walk” to recognize the donor and family as donors are transported from the inpatient area to the operating room for organ procurement, with staff members lining the hallway to show respect and support. In 2019, the hospital held its first donation remembrance celebration, attended by families of organ donors and the clinical staff members who cared for them.
Since the project began, the number of organ referrals, donors, and transplanted organs has increased yearly, except for a slight dip in 2020 during the early COVID-19 pandemic. The number of organ referrals doubled, from 169 in 2015 to 320 in 2021. The number of organ donors in 2021 was 31, with more than 22 donors in 2015, 2016, and 2017. Similarly, the total number of organs donated in 2021 was 102, up from 16 in 2015. The rate at which an appropriate requestor initiated the conversation about organ donation with the family increased from 52% in 2015 to 90% in 2021.
Patients with alterations in level of consciousness are among the most difficult to assess and may have subtle neurological changes that can occur suddenly and become life-threatening if they go unnoticed.
Nurses who care for these patients must have the knowledge, skill, and time to confidently perform comprehensive neurological assessments to identify changes that require quick diagnosis and intervention by the multidisciplinary team, according to a new article in Critical Care Nurse.
Co-author Melissa Moreda, MSN, APRN, ACCNS-AG, CDCES, CNRN, SCRN, is an inpatient diabetes clinical nurse specialist at Duke Raleigh Hospital in North Carolina.
“Neurologically impaired patients are among the most vulnerable, often unable to communicate, advocate for, or defend themselves,” she says. “Direct care nurses are at the forefront of care, and it’s imperative to understand key components of an assessment and be able to evaluate trends rather than isolated events.”
The article provides guidance for conducting a thorough neurological assessment, including:
General behavior and body position
Vital signs
Level of consciousness
Mental status
Motor control and sensory function
Cranial nerve function
Pupillary response
Language and speech
Reflexes
Cerebellar function
Many of the components of a neurological assessment are subjective, and changes in status may be subtle, requiring ongoing and astute monitoring. When minute changes are identified quickly, interventions critical for brain preservation can be implemented rapidly to prevent long-term complications and provide quality care for patients with altered levels of consciousness.
Older patients with Alzheimer’s disease and related dementia (ADRD) have almost twice the risk of dying soon after they are discharged from an intensive care unit (ICU) and within the 12 months afterward, according to research published in the American Journal of Critical Care (AJCC).
The study found that older adults with ADRD who were admitted to an ICU were much less likely to be discharged home and faced almost twice the risk of death in the same calendar month as discharge and the 12 months after discharge when compared with patients who did not have an ADRD diagnosis.
“Patients with ADRD often have a limited life expectancy, which can be further shortened after an ICU admission or other acute event,” she says. “Our findings raise questions about proactive strategies to diminish the likelihood of an ICU admission or early discussions with families and caregivers about palliative care.”
Deaths in the ADRD cohort were almost twice as common within the same calendar month after discharge and within the following 12-month period, compared with deaths in the non-ADRD cohort.
In addition to short-term and long-term mortality, the analysis revealed that more than one-third (37.6%) of patients with ADRD went home after hospital discharge, compared with more than two-thirds (68.6%) of non-ADRD patients.
Being dual-eligible for Medicare and Medicaid further raised patients’ risk of not being discharged home from the ICU and dying within the same calendar month after discharge and within 12 months following their discharge.
The observational study used Optum’s de-identified Clinformatics Data Mart Database version 8.1, which covers the period from 2016 to 2019. The analysis included adults age 67 or older with continuous MA coverage who were first admitted to an ICU in 2018. ADRD and comorbid conditions were identified from claims.
After applying exclusion criteria, the final study population included 145,342 patients with a first-time admission to the ICU in 2018 and who were discharged from the ICU. Among this group, 10.5% (15,289) were diagnosed with ADRD.
The analysis did not examine reasons for the initial ICU admission and causes of death or differentiate between types of ADRD or between mild and severe dementia and other elements that might influence outcomes.
It is well known that many U.S. healthcare organizations face a significant nurse staffing challenge, and as leaders and administrators seek solutions, we must emphasize an essential element of nurse recruitment and retention — establishing and sustaining healthy work environments (HWEs).
The most recent “National Nurse Work Environments” study, conducted in 2021 by the American Association of Critical-Care Nurses (AACN), shows that the health of nurse work environments across the country has declined dramatically. In that study, 67% of nurses reported plans to leave their current positions due to high levels of job dissatisfaction, moral distress, and inappropriate staffing. For this reason alone, it is well past time for organizations to address this HWE challenge.
Report improved staffing with an appropriate skill mix
Report higher quality of patient care
Score higher on every HWE standard
Why Is an HWE So Important?
In addition to AACN’s 2021 study findings, a significant body of research underlines the importance of healthy nurse work environments. A meta-analysis byLake, et al and a systematic review completed byWei and colleagues are just two examples of research that supports the correlation between HWEs and positive patient, nurse, and hospital outcomes. From the mounting research that now spans nearly two decades, we know the following:
Without immediate and bold action, work environments may worsen, which will further imperil our national healthcare system. Responses from the more than 9,000 nurses who answered AACN’s 2021 survey indicated significant declines in the health of the work environment compared with AACN’s previous 2018 survey:
Nurse Well-being Declined
Nearly 40% of RNs rate their emotional health poorly.
52.8% of RNs report that their organization does NOT value their health and safety.
48% of RNs report feeling moral distress either “frequently” or “very frequently.”
The number of RNs experiencing moral distress “very frequently” doubled from 11% in 2018 to 22% in 2021.
72% of RNs report having experienced at least one form of abuse (verbal, physical, discrimination, or sexual harassment).
Quality of Care Decreased
The perception of “good” or “excellent” quality of care has fallen 13 percentage points since 2018.
53% of RNs report that the overall quality of care has declined.
The number of RNs who report the quality of care has become “somewhat worse” or “much worse” grew by 16 percentage points.
Staffing is a Problem
Only 46% of RNs report their unit ensures an effective match between patient needs and nurse competencies.
Just 25% of RNs report being appropriately staffed on a regular basis.
Ratings on the Appropriate Staffing standard fell 15 percentage points since 2018.
Job Satisfaction Fell
Job satisfaction decreased by 18 percentage points since 2018.
Satisfaction with the nursing profession fell for the first time (only 76% of RNs reporting satisfaction with being an RN compared with 92% in 2018).
67% of RNs plan to leave their current positions in the next three years, compared with 54% in 2018.
Of those RNs planning to leave, 82% report adequate staffing would make them reconsider.
Take the First Step
The first step to remedy these issues is to assess the work environment using the AACN Healthy Work Environment Assessment Tool (HWEAT). Recently updated to provide a more informative analysis, the new assessment tool highlights unit and organizational influences on the work environment and dives deeply into each of the six standards. The free assessment features 24 web-based questions, takes less than 15 minutes, and comes with a department report with national benchmarking data and a comprehensive toolkit to guide the next steps. Gathering assessment baseline information in this way helps identify department strengths and opportunities while enabling the team to track progress over time.
Review the report as a team, and develop an implementation plan to ensure everyone’s voice is heard. This procedure is key to engaging team members and driving meaningful change.
A Call to Action
Establishing HWEs is everyone’s responsibility. The work is not easy, but the benefits of doing so are increasingly clear, as are the consequences of inaction. When nurses work in unhealthy environments, patient and family outcomes, nurse well-being, and staff retention decline. With a national nursing shortage projected to be from 200,000 to 450,000 nurses by 2025, the viability of our healthcare system is at stake. It’s time for everyone to begin this important work.
