There is growing evidence in the nursing literature regarding the positive impact of healthy work environments on staff satisfaction, retention, improved patient outcomes, and organizational performance.
Although much work has been done to identify what needs to happen in practice environments to maximize the health and well being of nurses, the achievement of these key elements has proved challenging for many organizations in today’s turbulent healthcare environment (Laschinger, 2007; Ulrich et al, 2009).
If a healthy work environment is to be achieved at the unit level, current and future nurses in these unit-level roles and the nurse manager role will need development and mentoring to develop the leadership skills needed to support the development of healthy work places.
Leaders can help create a deeply satisfying organizational culture at the unit level by engaging staff in the development of shared values in their work. A failure to take steps to build cultures of engagement can lead staff to feel that they are not supported in their work. Research with Magnet-designated hospitals continues to identify important aspects of healthy practice environments (Drenkard, 2009).
Another innovative leadership approach to promote healthy work environments at the unit level has been the utilization of the Clinical Nurse LeaderSM (CNL)® role. Interest in the CNL role continues to build nationwide as nurse leaders face a healthcare environment where retention of the workforce is critical, reimbursement is based on indicators sensitive to nursing care, and patient safety is a growing concern. Unfortunately, many organizations are not investing resources in the development of both current and future nurse leaders, helping them to build the skills needed to promote healthy work environments (Sherman, Bishop, Eggenberger, & Karden, 2007). It is challenging for today’s leaders to predict what knowledge, skills, and abilities will be needed to lead in the future healthcare delivery system. Kate will read Marshall Goldman’s (2007) best selling book “What Got You Here Won’t Get You There.” Goldman pinpoints 20 bad habits that stifle successful careers and what leaders need to do to change them. Emerging leaders must be taught that relationships live within the context of conversations that individuals have, or don’t have, with one another.
Often with novice leaders, structured techniques can help to promote better team relations by providing them with a shared simple set of words that describes critical communication behaviors.
The Two-Challenge Rule requires communicators to voice their concern at least twice to receive acknowledgment by the receiver.
Call-Outs are a strategy that emerging leaders can be encouraged to use to inform all team members of crucial information during emergencies. Check-Backs require the sender of the communication to verify the information that is being received by the other team member.
Leaders are also encouraged to use briefings, debriefings, and huddles to keep communication lines open throughout a shift. Agree to ground rules for discussion that are acceptable to all parties, (examples of these rules might include one person talking at a time and length of meeting times).
Highlight an overall goal that all team members value, such as providing the best care possible to our patients.
Keep the lines of communication open and respect differences in attitudes, values, and behaviors. Acknowledging the work and contributions of other staff members is a key leadership responsibility.
Although healthcare is built around relationships, it is also a business that needs to be managed. A self-rating on the Science of Leadership competencies in the Nurse Manager Inventory (NMLC, 2004) is a good place for emerging leaders to begin to identify their strengths and weaknesses. Dr Elizabeth (Beth) Pross is an Assistant Professor in the Christine E Lynn College of Nursing at the FAU. Related ArticlesGrowing Nurse Leaders: Their Perspectives on Nursing Leadership and Today’s Practice EnvironmentSusan M.
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Discussions about a culture of patient safety abound, yet nurse leaders continue to struggle to achieve such a culture in today’s complex and fast-paced healthcare environment.
It has been more than 10 years since the Institute of Medicine (IOM) released its report, To Err is Human: Building a Safer Health System.
The IOM report (Kohn, Corrigan, & Donaldson, 2000) quickly elevated awareness of patient safety. An organizational culture consists of the values, beliefs, and norms that are important in the organization. The Joint Commission holds hospital leaders responsible and accountable for regularly assessing the safety culture within their organizations (TJC, 2011).
Regular, front-line cultural measurements related to safety, followed by action, allow healthcare organizations to compare their safety record with other organizations, promote safety-focused attitudes, initiate interventions, and measure intervention effectiveness (Sexton, 2006). The following scenario, gleaned from a study of patient safety and the experiences of nursing unit leaders, describes a fictional hospital (Hospital Hope) and the hospital experience of a fictional patient (Mrs. Hospital Hope’s mission was to be the community pace setter for providing patient-centered care with the highest safety and quality standards. The hospital’s senior executive leadership believed that safety culture measurement and improvement processes could act as the tipping point for superior patient safety. Hospital Hope leadership determined to advance the hospital’s mission by becoming an evidence-based organization.
While searching the nursing and healthcare literature, the nurse manager learned about the Comprehensive Unit-Based Patient Safety Program (CUSP), a structured framework for safety improvement developed by Johns Hopkins Hospital (Pronovost et al., 2006).
The staff began embracing the driving factors of a safety culture, such as teamwork and evidence-based care. Situation-Background-Assessment-Recommendation (SBAR) communication became the standard reporting practice. The SICU nurse manager wanted to assure that the patient was always the center of care even in the face of all the culture changes that were being made.
In this article, a hypothetical scenario has illustrated how nursing leaders can translate theory into practice at the bedside. The establishment of a healthy work environment requires strong nursing leadership at all levels of the organization, but especially at the point of care or unit level where most front line staff work and patient care is delivered. It can be challenging for today’s leaders to predict what knowledge, skills, and abilities will be needed to lead in the future. 31, 2010) "Growing Future Nurse Leaders to Build and Sustain Healthy Work Environments at the Unit Level" OJIN: The Online Journal of Issues in Nursing Vol. Many organizations, including the American Association of Critical Care Nurses (2005), the American Nurses Credentialing Center (2008), the Institute of Medicine (2004), the International Council of Nurses (2007), and the American Association of Colleges of Nursing (2002), have outlined criteria that characterize a healthy work environment. The establishment of a healthy work environment requires strong nursing leadership at all levels of the organization, but especially at the point of care or unit level where most front line staff work and where patient care is delivered. In this article the authors will present a review of the literature addressing the importance of healthy work environments in healthcare organizations and the significant role of nurse leaders in building and sustaining these healthy environments. A healthy work environment cannot occur without nurse leaders who support its importance, authentically live it, and engage others in its achievement (AACN, 2005). O’Neil, Morjikian, Cherner, Hirschkorn, & West (2008) found in their research that the greatest single barrier to nurses accessing leadership and professional development opportunities was the inability to get time off the unit to invest in the acquisition of new skills. A competency model that is now widely used for nursing leadership development at the unit level is the Nurse Manager Leadership Collaborative (NMLC) Learning Domain Framework (NMLC, 2006) presented in the Figure.
Ideally, this development would take place as part of an emerging leaders program that could include self-assessment tools, presentations, group discussions, reading assignments, journal reflections, experiential activities, and application exercises. She and her manager will have a short session each week to discuss her progress in being more inclusive. TeamSTEPPS TM is an evidence-based teamwork system aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals. Emerging leaders can be encouraged to assertively practice this technique when they observe a deviation from standards of practice or witness unprofessional behavior. Emerging leaders can be encouraged to use check-backs to follow up on responsibilities that they delegate to others.
These tools and other information in the TeamSTEPPS program can be used to help emerging leaders improve their communication skills (Sherman & Eggenberger, 2009). Even in the most ideal of environments, communication breakdowns and conflict are inevitable on teams.
Real-time conflict situations offer excellent coaching opportunities for experienced leaders to work with novices. Managing conflict well in an environment helps to create a culture where staff feel valued.
It is difficult to build healthy work environments in healthcare settings that are not financially stable. Nurse managers are in a unique position to involve emerging leaders in the development and monitoring of a unit budget. The Healthcare Financial Management Association (HFMA) and the American Organization of Nurse Executives (AONE) co-publish a nursing-business newsletter, The Business of Caring.
It is important to ensure that they develop the skills and competencies that will be needed for them to be successful. Beth has had 28 years of experience as a registered nurse, the last 11 years of which were in nursing education and administration. In this article the authors discuss the concept of a patient safety culture, present a fictional scenario describing what happened in a hospital that lacked a culture of patient safety, and explain what should have happened in the above scenario.
This report, edited by Kohn, Corrigan, and Donaldson (2000) laid out a four-tiered approach for improving patient safety: (a) establish a national focus to create leadership, research, tools, and protocols around patient safety, (b) identify and learn from errors, (c) raise performance standards for improvements through the action of oversight organizations, purchasers of healthcare, and professional groups, and (d) create safety systems at the delivery level. A safety culture survey, specifically a unit-based survey, can assess conditions in a work setting that may lead to adverse events and patient harm. Jackson, a 73 year old widow, mother of two adult daughters, grandmother of four, and great-grandma to three children, was admitted to Hospital Hope, a typical suburban hospital viewed by the community as a good hospital. Jackson was active in her community, volunteered at the local library, and enjoyed sharing blooms from her showcase flower garden. Jackson did have a well-documented, Grade 6, systolic heart murmur stemming from a childhood illness.
Jackson survived hospitalization without permanent injury despite experiencing three preventable conditions during her hospital stay, namely pneumonia, a central line infection, and episodes of hypoglycemia, all of which could have been prevented if established, evidence-based care had been practiced. To that end, the hospital leadership administered a patient safety survey, the SAQ, to the front-line staff to assess the existing culture.
She found the CUSP principles, described in an on-line tool kit, to be a helpful resource for training her entire multidisciplinary team, including physicians.
Handoffs, whether shift-to-shift, unit-to-unit, or between multidisciplinary team members, became clear and transparent. She began to collect, analyze, and report quality data to drive performance improvement and to share lessons learned with nurse manager colleagues throughout the hospital.
The SICU nurse manager and the staff were pleased with the safety changes that were occurring. The entire SICU multidisciplinary team designed a Safety and Quality Bulletin Board which they placed in a central location that was easily visible to care providers and visitors alike. At a staff meeting she reminded the SICU nurses of the final phrase of the Nightingale pledge. Just as the nurse manager had empowered her nurses to lead in patient care, the staff nurses committed to empowering their patients, and families, to be partners in their own care. Yet, the success of providing patients with the safest and highest quality of care is becoming recognized as being dependent upon a strong cultural foundation at the unit level (Smits, Wagner, Spreeuwenberg, van der Wal, & Groenewegen, 2009). It has used a patient safety culture framework that defines safety culture driving factors as leadership, evidence-based practice, teamwork, communication, and a learning, just, and patient-centered culture. Sammer has had a leadership role in the quality and safety arena since 2002, first in a community hospital and currently as Director for Quality and Patient Safety at Adventist Health System, a forty three-campus, healthcare system covering 10 states.

James is an experienced nurse educator, having served as an undergraduate faculty member, as a clinical coordinator, and as a graduate faculty member focusing on nursing education until her appointment as Dean of the School of Nursing at Southern Adventist University in 2005. This article presents a review of the literature regarding the importance of healthy work environments in healthcare organizations and the significant role of nurse leaders in building and sustaining these healthy environments.
They will  also discusses the development of leadership skills, presenting a widely used competency model for nursing leadership development, namely, the Nurse Manager Leadership Collaborative Learning Domain Framework, a useful resource in the development of unit leaders. Kramer and Schmalenberg (2008) observed that only staff nurses can confirm whether initiatives planned and designed to improve the health of a work environment are successful. There is evidence in the literature that work environments are evaluated as being more healthy and staff retention is better when staff feel supported by their nurse manager (Kramer et al.
Achievement of Magnet recognition through the American Nurses Credentialing Center (ANCC) Magnet Recognition Program® is considered in nursing to be the gold standard for hospitals seeking to build professional practice environments that are healthy and support the work of nurses. The effects of the Magnet professional practice environments on patient care were reported in several studies. This role evolved in 2004 as an outcome of meetings that the American Association of Colleges of Nursing had held with stakeholders to discuss what changes were needed in nursing education for the future. They help to reduce the contentious relationships and communication problems that AACN (2005) described in the healthy work environment standards document. In many organizations, very little attention is being paid to succession planning and the development of emerging nurse leaders at the point of care (Stichler, 2008). Many current leaders in healthcare today were selected for their roles because of their clinical and technical proficiency (Sherman, Bishop, Eggenberger, & Karden, 2007).
Nurse-manager leadership is necessary to support the development of healthy work environments. Strong coaching from an experienced and respected nursing leader who helps an emerging leader with self-development plans can be equally powerful when formal programs are not in place. She acknowledges that she is not inclusive in her decision making and is often judgmental about the viewpoints and contributions of others. The art of leadership involves managing relationships with others and influencing their behaviors. It was developed for use in clinical practice with funding from the Agency for Healthcare Research and Quality. If managed effectively by emerging leaders, these breakdowns can be viewed as an opportunity for team growth. It can be helpful to present a structured approach to resolving conflict among team members. AACN (2005) noted that recognition of the value and meaningfulness of one’s contribution to an organization’s work is a fundamental need and important for both professional and personal development.
This newsletter can be downloaded for free and serves as an excellent resource to educate emerging leaders about business and finance. The development of healthy work places that are responsive to the ever-changing healthcare environment will be in their hands. Lynn College of Nursing at the Florida Atlantic University (FAU) where she is also an Associate Professor and Program Director of the Nursing Administration and new Clinical Nurse Leader tracks in the graduate nursing program.
She currently serves as an appraiser for the American Nurses’ Credentialing Center Magnet Recognition Program® which she has done for the past 6 years. The magnet nursing services recognition program: A comparison of two groups of magnet hospitals. AACN standards for establishing and sustaining healthy work environments: A journey to excellence. Workplace empowerment and magnet hospital characteristics as predictors of patient safety climate. Connecting the dots: Responding to the challenges of budget and finance education for nurse leaders.
Context matters: The impact of unit leadership and empowerment on nurses' organizational commitment. Healthy workplaces for health workers in Canada: Knowledge transfer and uptake in policy and practice. This discussion is offered within a framework consisting of seven driving factors of patient safety.
Because creating safety systems at the point-of-care delivery was the ultimate target of all the IOM recommendations, the IOM committee continued to emphasize that healthcare organizations should create an environment in which safety was a top priority. This type of cultural assessment can raise awareness about patient safety issues, assess the current status of the culture related to safety, prompt interventions, and track the effectiveness of improvements over time.
Because culture is often viewed as somewhat nebulous in nature, a patient safety culture tool, such as a framework, may help the nursing unit leader enhance the unit’s patient safety culture by making more tangible the specific driving factors of a culture of safety. As the story unfolds, the reader is permitted multiple opportunities to witness both individual actions and system-wide occurrences that led to negative outcomes. She was proactive in maintaining her health through regular activity, such as walking and water aerobics, and by healthy eating. Her recovery was slow and her two daughters, one a nurse educator and the other a lawyer, were at her bedside as often as SICU visiting hours allowed. The Board members understood that their role included not only responsibility for the financial health of the hospital, but equally as important, for assuring patient safety and the provision of quality care (Conway, 2008). The survey results were clear: fewer than 50% of SICU care providers believed there was a strong culture of safety and teamwork within their unit.
Mutual respect among all the team members allowed for structured information exchange opportunities, such as a quick debriefing following a near miss adverse event (Leonard, Graham, & Bonacum, 2004). The SICU nurses agreed to hold each other accountable for improved outcomes on their unit through teamwork and good communication.
The nurse manager became even more determined to continue building a safety culture within her unit. The nurse manager was responsible for keeping the data reports current and for including national and state benchmarks. As a unit, the nurses chose to implement one process they believed would demonstrate a compassionate, caring approach to patient-centered care.
Jackson’s hospital admission, Hospital Hope leadership re-administered the cultural assessment survey. This article has provided a model of the driving factors that are important in creating a culture of patient safety. Choosing a validated and widely used safety culture assessment instrument offers nursing leaders the opportunity to not only learn about the safety culture within their units, but also to address specific behaviors and values that need to be strengthened and to work with their staff in developing action an plan for improvement. It is recognized that this scenario may well be unrealistic in terms of the nurses’ immediate willingness to change their behavior.
This story exemplifies the importance of the nursing unit leader and validates the notion that nurses are leaders whether in the board room or at the bedside—they lead from wherever they stand.
Her responsibilities include supporting the system hospitals in the areas of healthcare quality and patient safety agendas. Her current responsibilities as Dean include oversight of AS, BS completion, and MSN degree programs. Vital Signs: Central line-associated blood stream infections --- United States, 2001, 2008, and 2009. Measuring patient safety culture: An assessment of the clustering of responses at unit level and hospital level. It also discusses the development of leadership skills by presenting the Nurse Manager Leadership Collaborative Learning Domain Framework, a widely used competency model for nursing leadership development that can serve as a useful resource in the development of leaders at the unit level.
Accessible nursing leaders play a key role in helping to give nurses a voice in the improvement of patient care environments (AACN, 2005). Participating nursing leaders were urged to think completely out of the box as they looked at the issues and challenges of today’s healthcare delivery system. These problems can occur between nurses and administrators when nurse managers have responsibilities and spans of control that make it difficult both to track and monitor patient outcomes as well as to assume responsibilities for coaching the staff. The attributes and behaviors that leaders need to support the development of healthy work environments are often identified as the “soft skills” (Shirey, 2006). To address this need for leadership development, the American Organization of Nurse Executives, the Association of periOperative Registered Nurses, and the American Association of Critical Care Nurses worked collaboratively to develop a model that would identify competency domains needed by current and future nurse leaders.
Emerging leaders can be asked to do a self-rating using the competencies in the Nurse Manager Inventory (NMLC,2004).
Kate’s nurse manager views Kate as having high potential for a more significant leadership role.
Casey Stengel, the beloved manager of many major league baseball teams, noted, from his own leadership career, that “Finding good players is easy. Left unresolved, conflict can cause a loss of productive work time, medical errors, decreased patient satisfaction, staff turnover, and the development of an unhealthy work culture (Manion, 2005). Kouzes and Posner (2006), two well known leadership experts in the field of business, have noted that the most significant contribution today’s leaders can make for the future is develop their successors so that they will adapt, prosper, and grow. Prior to joining the faculty at FAU, Rose had a 25-year nursing leadership career with the Department of Veterans Affairs. Her research interests include transforming health organizations through caring values and transformational leadership. These factors include leadership, evidence-based practice, teamwork, communication, and a learning, just, and patient-centered culture. It described a safety culture as one that focused on preventing, detecting, and minimizing hazards and error without attaching blame to individuals (Kohn, Corrigan, & Donaldson).
One framework available to nursing leaders offers seven driving factors related to a patient safety culture.
In the subsequent section (Leadership Response) the actions of a nursing leader, as demonstrated by the fictional SICU nurse manager, illustrate how performance within the framework of a safety culture could have yielded different results. Jackson had no reason to suspect either that nearly one in every 20 hospitalized patients in the US each year develops a hospital-acquired infection or that central-line-associated blood-stream infections (CLABSIs) are among the most deadly types of hospital-acquired infections with a mortality rate of 12-25% as reported by the Centers for Disease Control and Prevention (CDC) (2011c).
She had not been a hospitalized patient since an abdominal hysterectomy 20 years previously. She was admitted to Hospital Hope for diagnosis and treatment and soon scheduled for an aortic valve replacement. They were eager to help in their mother’s recovery by assisting her with bathing, feeding, and ambulation. The Board was also aware of The Joint Commission (2011) leadership standard that specified the Board’s role in quality and safety oversight.
The SICU team embraced the evidence and incorporated the central line insertion standards, consisting of good hand hygiene, full barrier precautions, skin preparation using chlorhexidine for disinfection, avoidance of the femoral artery, and a daily evaluation for line necessity (CDC, 2011b), into their daily routine.
They collaborated with the unit respiratory therapists to standardize care with the goal of preventing hospital-acquired pneumonia. Techniques included showing mutual respect for comments or queries from any and all team members, from the young nursing students to the chief of staff. She wanted her staff to feel safe to report not only patient safety issues, but also errors and patient harms. At first, the staff was hesitant to post outcomes that could reflect poorly on the care they were providing.
They chose to review daily, with the patient, his or her plan of care for the day and to encourage family participation in the care as appropriate. This time, 87% (well within the goal range of 80% or greater) of the SICU staff responded positively to the teamwork and safety culture, hand-off communication, and non-punitive reporting items on the assessment.
The scenario was presented in this manner, however, to serve as a useful model to guide nursing leaders as they lead their patient care units toward increased nursing satisfaction, improved patient experiences, and safe and excellent quality outcomes.

Specifically this role includes: (a) leading and managing innovative quality and safety redesign initiatives, including measurement, analysis, and outcomes reporting, (b) sharing best practices and outcomes through publication and presentations, and (c) providing education and training for hospital executives, medical executive committees, and governing boards. She serves on major decision-making bodies within the university, teaches a core class at the MSN level, and serves as a mentor for graduate student research.
The human factor: The critical importance of effective teamwork and communication in providing safe care. The American Association of Critical Care Nurses has worked collaboratively with the Gannett Healthcare Group and the Bernard Hodes group to conduct national surveys of critical care nurses to assess the progress and impact of their healthy work environment standards.
These components or forces of magnetism have evolved since the early 1980s when the American Academy of Nurses (AAN) first commissioned a study to determine why, during a competitive time, certain hospitals did not experience a shortage of nurses.
Ulrich’s study further concluded that even hospitals “in the process” of Magnet designation showed significant improvements in their nurse and patient outcomes because of the improved practice environments.
Their discussions led to the design of the CNL role and the initiation of the CNL pilot project (American Association of Colleges of Nursing, 2007). In addition to the model, a Nurse Manager Inventory (NMLC,2004) was developed which outlines key skills needed by nurse managers in each competency domain area. They know how their communication and actions impact others and are sensitive to watching the cues in an environment when things are not going well.
She is concerned, however, about Kate’s lack of tolerance of others and agrees that it could negatively impact Kate’s career if she does not commit to personal transformation. Getting them to play as a team is another story.” The same could be said of teams in healthcare settings. Emerging leaders can be coached to develop intentional behaviors that help to recognize the staff in their environments.
Golden (2008) noted that despite the need to become more financially savvy, current and emerging nurse leaders often gravitate to what they do best; and rarely does that include fiscal responsibilities. They can be given assignments to review staffing variances and create staffing alternatives. The Business of Caring features a Business School for Nurses as a regular educational section of the newsletter. She is widely published and speaks nationally on the topic of nursing leadership development. The report emphasized the need for leaders at the clinical, the executive, and the governing board levels to take ownership for patient safety. These groups, along with many other federal, state, and professional organizations, recognized that a patient safety culture was integral to improved safety outcomes and became the drivers for new policies and standards. It is important that nursing leaders adequately assess the safety culture in their workplace and clearly articulate a framework to guide personnel as they work to increase safety within their work settings. These factors include: (a) leadership, (b) evidence-based practice, (c) teamwork, (d) communication, (e) a learning culture, (f) a just culture, and (g) a patient-centered culture (See Figure). However, the doctors and nurses appeared to be reluctant to involve them in their mother’s daily plan of care. In a unit meeting the SICU nurse manager asked the front-line staff to identify their patient safety concerns. They asked the nurse manager to arrange an inservice with the diabetes educator so they could learn more about preventing hypoglycemia. For example, a new graduate nurse, upon observation of a doctor who was not following best practice for infection prevention while inserting a central line, felt safe speaking up and asking the doctor to follow safety standards. However, as they continued to embrace a culture of safety, they learned that transparency leads to awareness and awareness leads to change.
Their findings from the 2006 and 2008 studies indicate that issues still remain in the work environment that can impede the quality of care, safety of patients, and RN job satisfaction.
What was found were elements of healthy practice environments, environments where nurses were respected, valued, and had a “voice.” Forty-one of the hospitals studied were identified as Magnet organizations. The evidence clearly supports that Magnet practice environments are exemplars of healthy care environments that support professional nurse practice and quality patient care.
In her role as a CNL project consultant, Tornabeni (2006) noted that the context of how nurses practice has changed and the work of nursing and patient care environments needed to be realigned to reflect this. CNLs are expected to guide the clinical team by encouraging professional development, providing continuing education, and promoting clinical excellence and collegiality. Jack Welch (2001), the former Chairman of General Electric, noted that he spent a great deal of resources on leadership development because “Giving people self-confidence is by far the most important thing that I can do.
The inventory can be used to develop charge nurses, unit facilitators, and emerging leaders.
A gap analysis on a particular skill could lead to the development of an action plan to develop that needed competency. Both she and Kate are also aware that such behaviors do not support the development of a healthy work environment. Guiding team members to get past their day-to-day problems, conflicts, and communication issues and more toward a goal of working as a high performance work team is a significant leadership challenge for emerging leaders. This recognition could be as simple as a thank you at the end of a shift, or it might involve having the emerging leader nominate staff for organizational awards.
Novice leaders often fail to understand the impact of nursing activities and staffing on the revenue of a healthcare agency.
They can also be assigned to projects to elevate staff awareness about the costs of supplies and equipment. Examples of recent topics include the following: reducing hospital readmissions, evaluating staffing costs, determining return on investment, business writing tips, medical variation, and the cost of care. These emerging leaders will ultimately replace them and continue the very important work that is being done to improve nursing work environments and most importantly patient outcomes. Nurse managers will find practical examples illustrating how leaders can help their teams establish a culture that offers the patient quality care in a safe environment. In this article the authors will discuss the concept of a patient safety culture, present a fictional scenario describing what happened in a hospital that lacked a culture of patient safety, and explain what should have happened in this scenario. Jackson was admitted to the Surgical Intensive Care Unit (SICU) for recovery and post-operative care. Jackson and her family, and the discomfort and inconvenience of her preventable morbidity, were unnecessarily high. She discovered that some of the nurses had attended a continuing education program on the prevention of CLABSIs and that these nurses had become increasingly concerned about the incidence of CLABSIs on the unit. The nurse was confident she would be respected and supported by the unit manager and by executive leadership. She received her BS in Nursing from Southern Adventist University, Collegedale, TN, her MSN degree from the University of Texas at Arlington, and her DSN in Nursing Education and Occupational Health from the University of Alabama at Birmingham.
The safety organizing scale: Development and validation of a behavioral measure of safety culture in hospital nursing units.
This entails a paradigm shift from a more traditional command-and-control style of staff supervision toward a transformational style of leadership in which leaders enhance the motivation, morale, and performance of their follower groups.
They cite a need for improved leadership to improve staff perceptions of leadership support and reduce turnover in critical care units (Ulrich et al. Currently there are 340 ANCC-designated Magnet hospitals and another 199 hospitals in the application process (C. CNLs are in a unique position to promote a healthy work environment at the unit level because their practice is at the point of care. It is available at no cost and allows nurses to use Benner’s novice-to-expert scale to rate themselves on a variety of key leadership skills (Shirey, 2007). Yet the need to do this is critical in healthcare environments where team synergy and interdependence are required for high quality patient care. If nurses are unable to see the financial ramifications and costs of decisions, they will be less successful in advocating for the resources needed to successfully staff and operate units. With the trend toward hospital reimbursement for performance measures that are nursing sensitive, emerging leaders need to understand how nursing care outcomes impact the financial bottom line of their institutions.
This newsletter is a very rich source of business information and practical strategies that can be easily used by nursing leaders. This discussion will be offered within a framework consisting of seven driving factors of patient safety culture. Jackson was discharged to an extended care facility for continued recovery and rehabilitation and eventually returned to her home. The nurse manager asked these nurses to give a report at the next SICU staff meeting on what they had learned. In this ideal culture of safety, the physician deferred to the evidence-based expertise presented by the new graduate. The staff nurse was pleased to be asked and prepared an informative presentation for her colleagues. The Safety Attitudes Questionnaire: Psychometric properties, benchmarking data, and emerging research. Managing their health related program… Public health insurance thats perfect for purchase of these arches included materials.
The positive relationship between this type of transformational leadership and satisfaction of staff is supported by research (Faila & Stichler, 2008). They also have a strong academic preparation designed to build key leadership skills to support staff.
The three domains in the framework (see Figure below) also provide a useful structure to plan leadership development activities targeted to growing current and future nurse leaders at the unit level.
This authenticity in nursing leadership is often described as the glue needed to hold together a healthy work environment. Equally important in this turbulent healthcare environment is understanding the science of leadership as described below. The overall goal of all the activities described above should be to help emerging leaders develop confidence in their ability to build a business case to support their decisions. These seven factors are presented in the Figure, originally published by Sammer, Lykens, Singh, Mains, & Lackan (2010).
In this way the entire team learned that CLABSIs are now considered mostly preventable and that each CLABSI carries excess healthcare costs of $16,550 and a mortality rate of up to 25% (CDC, 2011a).
Self assessment instruments and 360 degree evaluations can be very powerful tools to help current and emerging nurse leaders assess their current strengths and weaknesses in the different dimensions of leadership. Shirey (2006) has proposed that becoming an authentic leader requires self-discovery, self improvement, reflection, and renewal. That meant that one of every four patients who developed a central line infection was at risk of dying! Following the presentation, the SICU nurse manager encouraged the staff to share ideas for safe reporting of errors and to describe what it would feel like to work in a non-punitive environment. The staff acknowledged that using a non-arbitrary and transparent model to guide in decisions related to human fallibility would help to build trust. When developing emerging leaders, a self-rating on the Art of Leadership competencies in the Nurse Manager Inventory (NMLC,2004) is a good place to begin to identify strengths and weaknesses. They asked the nurse manager to provide them with additional information on evidence-based best practices for preventing CLABSIs.

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