Issue link: https://beckershealthcare.uberflip.com/i/1495475
26 NURSING SPOTLIGHT How to get nurses to stay? Less talk, more action, says AACN president By Bari Faye Dean T he widespread shortage of nurses is the result of a foundational crack in hospital systems across the country, Amanda Bettencourt, PhD, APRN, president of the American Association of Critical-Care Nurses, told Becker's. It's not about money and it's not about burnout, Dr. Bettencourt said. "Hospitals are failing to provide safe, healthy work environments, and the result is an absolute feeling among critical care nurses that hospitals don't have our backs." In the AACN's most recent survey, published in the October 2022 issue of Critical Care Nurse, less than half of the participating nurses said their hospitals value their health and safety. Not an unlikely statistic considering a Press Ganey report said more than two nurses were assaulted every hour in the second quarter of 2022. "How can you provide excellent care when you feel like the place that you work for doesn't care about your health and safety? We had our patients' backs during the worst part of the pandemic — when we didn't know what to do. We raised our game and met the patients' needs," Dr. Bettencourt said. "And then nurses looked at our hospitals and said, 'What about us?'" As far back as 2004, the Institute of Medicine called on hospitals to create healthy work environments for nurses and pointed out the connection to patient safety and positive outcomes. "at was almost 20 years ago, so we know this problem has existed for a long time, and I think the pandemic just poured gasoline on that fire," she said. But the solution, she added, is also not a secret. e AACN issued a strategy — with six distinct standards of care — for improving healthcare work environments almost 10 years ago. ese include: skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition and authentic leadership. In addition to conducting research at the Children's Hospital of Philadelphia, Dr. Bettencourt is an assistant professor at the University of Pennsylvania School of Nursing, teaching clinical courses to undergraduate nurses in pediatrics. She said there's been a lot of talk about changing the work environment for nurses, but not enough action, adding the nursing exodus is the result of hospitals failing to put strategies in place to ensure healthy environments — places where nurses want to work because they feel valued. Question: The most recent AACN national nurse work environment survey reiterates your point. Only 40 percent of all respondents indicated they were very satisfied with being a registered nurse, compared with 62 percent in 2018. Can you explain why you think a failure to focus on creating healthy work environments is directly tied to the nursing shortage? Dr. Amanda Bettencourt: Nurses aren't going to stay in a work environment that is not good for them. And we know the best patient outcomes occur when our work environments are healthy. Creating a healthy work environment is an investment that pays dividends. A hospital can try many ways to attract nurses, but if any of those solutions are laid on top of an unhealthy work environment, they are going to fail. New nurses will not stay in a profession when they feel their health and safety is being threatened. And that's what we are seeing — more and more new graduate nurses leaving the acute care environment or the profession entirely aer one or two years of practice. at's not a sustainable pipeline. Yes, we need more people to enter the nursing profession. But if we don't fix the problems, new nurses are coming into the same environment that's making today's nurses leave. So we can bring them in, but we'll lose them eventually, and we'll be back in the same place that we're in today. Q: What can hospitals start doing now to keep nurses from leaving the profession? AB: We absolutely think that the work environment for nurses should be a critical point of attention for hospitals right now. Of the AACN's six standards for care, the ones that tend to make the biggest difference are things like respect from administration, having nurses at the tables for decision-making, having true collaboration and communication, and then making sure that leadership in those hospitals is authentic and collaborative. ese are things that matter to nurses; everything in the work environment has to be healthy. Just adding more nurses is not enough if nurses are entering work environments that are not healthy. e AACN's six standards can be directly attributed to higher quality patient care, lower nurse turnover and lower incidence of violence against nurses. Hospitals should have implemented these standards a long time ago. And now we are seeing the consequences of unhealthy work environments. Nurses are leaving. If you are a leader at a hospital and you've thought about implementing these six standards, now's the time to actually do it. ey can make a huge difference in outcomes that matter to patients and outcomes that matter to hospitals. And they will go a long way to retaining extremely talented and valuable acute and critical care nurses. Q: Why haven't these six standards of care been implemented in all hospitals already? AB: I know hospital leadership absolutely recognizes that these things are important as we are saying they are. Each one of these things is difficult to change; they're not easy fixes. We need hospital leadership to be talking about these things, because that will mean they understand the need for the changes. But it's going to take more than talking. Hospitals have to put effort and energy and resources into changing these things in a real and authentic way. It's time for them to put their money where their mouth is and put resources and effort into really making changes the nurses will feel. A nurse knows if they're working in a place that's healthy, that has appropriate staffing, that has authentic leadership. We can feel it. Whatever effort needs to be put in so that hospital culture changes and work environments for nurses are transformed — now is the time to do it. Q: In the AACN survey, only 47 percent of respondents said they agreed with the statement, "My organization values my health and safety," compared with 68 percent in 2018. What has to change? AB: Violence against healthcare workers, in general, has been a problem for decades — again, protecting nurses is a core part of a healthy work environment. But it's clearly getting worse. Is it the pandemic or are there societal changes that have made nurses feel the retaliation from patients and families more oen than before?