“When people go to work, they shouldn’t have to leave their hearts at home.”
The CENTER for American Nurses (The Center), founded in 2003, was established to help nurses create healthy work environments through education and research. While other national nursing associations focus on national and state policy, the Center partners with organizations, state nurses associations, and individual registered nurses to develop resources, strategies, and tools to help nurses manage and influence evolving workplace issues.
Policy in the health care workplace establishes standards, identifies boundaries, and provides protections for employees, employers, and patients. Mutually determined, defined, and documented policy assists health care organizations to more efficiently and effectively provide quality patient outcomes. While much workplace policy is mandated from federal and state levels, helpful and meaningful policies shaping workplace culture, employee satisfaction, and positive patient outcomes are initiated and developed by passionate and expert health care professionals within the workplace itself.
The Center for American Nurses
The CENTER for American Nurses offers evidence-based solutions and powerful tools to equip nurses to navigate workplace challenges, optimize patient outcomes, and maximize career benefits. These tools, services, and strategies support nurses at all levels of experience who are striving to improve their practice environments, meet their personal and professional goals, and promote excellence in patient care (Scott, 2008). Nurses face many challenges in the work environment such as increased workloads, fatigue, musculoskeletal injuries, difficult coworkers, and so on. The Center serves as a resource for nurses seeking to overcome these challenges and create work environments that support health care professionals as well as patients. For example, the Center offers an extensive program for nurses seeking to develop effective conflict engagement skills (CENTER for American Nurses, 2010). In addition, the Center provides resources to address lateral violence and bullying.
The Center monitors internal and external factors affecting the work environment through environmental scans and national surveys; provides leadership and vision in response to changing work environments; and develops and disseminates strategies to address personal and professional concerns that can initiate and shape workplace policy. For example, the Center hosts monthly webinars to explore issues such as becoming an exceptional charge nurse, defining respect, and surviving shift work. Recently, the Center partnered with the Women’s Institute for a Secure Retirement (WISER) to create tools to help nurses increase their financial literacy.
Finally, the Center creates and disseminates position statements to guide the profession in specific areas that affect health care work environments. The Center’s Zero Tolerance Policy addressing disruptive behaviors has been broadly recognized and used by facilities seeking to curb workplace violence.
To identify evolving workplace issues, the Center surveys the national nursing community and reviews the latest evidence-based research to develop fact sheets to educate nurses and provide solutions to identified concerns. Nurses may access the Center’s information and services through individual memberships or through their state nurses association. Nursing associations and organizations whose primary purpose does not involve representation of its members for collective bargaining purposes are eligible for membership in the Center.
Current Workplace Advocacy Policy Issues
When overtime hours, particularly mandatory overtime, are required by organizations to provide adequate registered nurse staffing, nurses can be pushed beyond their capacity to work safely and to provide appropriate, quality care to patients. Extended work hours contribute to nurses’ job dissatisfaction (Institute of Medicine, 2004; United States General Accounting Office, 2001). Additional shifts and hours are also reported to cause work-related illness and injuries (Christo & Pienaar, 2006; Cohen & Single, 2001) as well as health care errors (Institute of Medicine, 2004). The Center recommends that nurses develop workplace policies in collaboration with employers requiring no employee be forced to work overtime. In 2006, The Center adopted a position statement opposing mandatory overtime and outlining recommendations to decrease the physical and mental burdens such practices place on health care professionals (CENTER for American Nurses, 2006).
It has been noted that fatigue impairs nurses’ performance and increases the chance of making errors that affect health outcomes. It is not uncommon for nurses to work past the end of a scheduled shift. Those who work shifts lasting 12.5 hours or more have a 3 times greater risk for making errors (Rogers, Hwang, Scott, Aiken, & Dinges, 2004). To improve the work environment, the Center agrees with the recommendation made by the Institute of Medicine to prohibit mandatory or voluntary overtime in excess of 12 hours per 24-hour period and in excess of 60 hours per 7-day period (Institute of Medicine, 2004). Nurse fatigue is a controversial issue. Some support imposed limitations on work hours and shifts; others, particularly those who work overtime or have more than one job, believe they can self-regulate their work behaviors. The Center has provided a number of publications on shifts, work hours, and nurse fatigue to inform nurses about personal safety and quality care. Examples include Nurses and Fatigue fact sheets and articles focusing on shifts and work hours posted on the Web and provided directly to state nurses association members for reprinting in their statewide publications. Future nurse fatigue workplace policies will need to balance the work interests of nurses and employers with the safety interests of patients.
Musculoskeletal injuries are common because of the need to lift, turn, and assist patients. Back, neck, and shoulder pain are the most common type and cost the industry an estimated 6 absentee days per nurse per year (Trinkoff, Lipscomb, Geiger-Brown, & Brady, 2002). The Center supports the American Nurses Association’s (ANA) “Safe Patient Handling” campaign to encourage hospitals to provide lifting devices and lifting teams when transporting, lifting, and repositioning clients.
The current nurse shortage is compounded by the large number of aging nurses. The average age of a nurse in the U.S. is estimated to be 47 years (HRSA Health Professions, 2010). Mature nurses work in environments that are often stressful, demanding, and lack retention incentives devised especially for older nurses. They are expected to mentor novice nurses and build healthy intergenerational collaborative work relationships. In addition, a majority lack the financial skills necessary to plan for retirement. The Center highlights workplace strategies designed to retain mature nurses, increase nurses’ financial planning skills, and explore flexible staffing strategies that support the mature nurse.
Workplace design profoundly affects nurses and patients in the health care environment. A well-planned facility design can improve the quality of care for patients, promote recruiting and retention of staff, and enhance operational efficiency and productivity (CENTER for American Nurses, 2007). The Center provides education about ergonomics, technology, and workplace design to promote the well-being and safety of health care workers and patients. Nurses are encouraged to participate as full partners in workplace design and redesign decisions (CENTER for American Nurses, 2007).
Lateral Violence and Bullying in the Workplace
Evidence validates that disruptive behaviors such as lateral violence and bullying negatively impact the health care work environment, the recruitment and retention of nurses, and the quality and safety of patient care (see Chapter 56). The Center has worked with other organizations to decrease such behavior.
Initiating Workplace Policy
How can nurses influence workplace policy? First, nurses can stay informed by reading the literature in their area of practice and participating in webinars and discussion groups hosted by nursing organizations, such as the Center. It is important to respond quickly to federal or state policies that affect the workplace. The recent national impact of the H1N1 virus stimulated rapid revisions of workplace infection-control policies. If a policy is not supported by administration, build a strong, evidence-based case. Build support among colleagues. Seek information from the state nurses association or the Center. The Center’s extensive resources in conflict engagement may be helpful. Involve other members of the health care team in developing workplace policy that provides a healthy work environment for quality patient care.
For a list of related websites, please refer to your Evolve Resources at http://evolve.elsevier.com/Mason/policypolitics/