Hi, I'm so happy to be here. I'm Teresa Davis, also known as Terry, and I'm the president of the American Association of Critical Care Nurses. Also I'm from Inova Health System in Falls Church, Virginia, and I'm the AVP of the High Reliability Center. So I'm going to be talking to you. So we're going to, we really want to recognize the signs of an unhealthy work environment. We kind of heard some in the violence talk. And really think about those intentional efforts to create and sustain a healthy work environment. And then also look at what are the opportunity for organizations, individuals, and medical societies to improve the workforce issues. Okay, so in the healthy work environment standards there are six standards. So skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition, and authentic leadership. And what we saw was, so what we did, we do surveys, AACN since 2006 has been doing a survey multiple years. And in 2021 they did a survey purposely during COVID to really look to see where nursing was and how they were feeling about things. And what we saw was, we really saw some changes in the survey and every element of the standards had dropped in their outcomes in the 2020-21 survey. So the largest being staffing. So in staffing levels they say that staffing still remains critical. We only saw 25% who said that they had appropriate staffing levels. And then as far as satisfaction goes, nurses' satisfaction with being with the profession, it's the first time that we saw such a significant decline. It went from 92% in 2018 to 76% in 2022. So that was a significant change that we had not seen before. We really felt it was a call to action to look and see what can we do. The other piece that was really strongly reflected in that survey was that 67% of nurses plan to leave the profession over the next three years, since 2022. So all of those things caused us to really say, we can't ignore this. This is really, really important. And so when you look at these ratings, this just shows the scores from 2006 through 2021, and we really saw the drops from 2018 to 2021. We know that we had issues in 2018 before COVID ever came, but they were really exacerbated during COVID. Another study that was out there looked at the quality of life and self-care. And this was done by Watson, and this was a mixed, multi-mixed study. And it looked, they wanted to test a pilot of intervention to address self-care and to look at the professional quality of life. So the nurses supported some satisfaction with intervention and improved work-life balance, but the scores and the quality did not improve. And so what we said was, the author said was that, you know, really addressing individual well-being and resilience is insufficient, that we have to look at the work environments. We have to make sure that organizational issues, such as violence, are addressed. So the things that we have done this year, I'm really excited about. I've been with AACN like my whole critical care career. They're really been an organization that has helped me really find my path during my critical care career. And healthy work environment is something that I have taught over the years for many, many years. And even in my own environment, I was a director of a tele-ICU nurse back in 2004. And we were outside of the hospital, so we had never done anything like this before. And I was like, oh my gosh, how am I going to lead this team in this environment that is not a hospital? And so I use the healthy work environment elements as the foundation for how to run my unit and how to move things forward. And our survey results in our patient or employee engagement and employee satisfaction went through the roof after we implemented the healthy work environment. And my HR person called me and said, what are you doing? Like what did you change? How did you increase these numbers so much? But it was really the attention to these six standards that made a difference. So what I'm really excited about is this year we've had a lot of action around this. And we're using our CSI and healthy work environment, we're using an implementation program to really look at implementing within cohorts. So we have seven cohorts across the country, and there's multiple units in those cohorts. And they are specifically looking at how to implement the healthy work environment standards. And then another really exciting element that's there is the healthy work environment national collaborative. So that's a 24-month program, and that will come out in 2024, in the spring of 2024. It is an interprofessional program, because if you implement the healthy work environment standards and you don't include your physicians, your respiratory therapists, your pharmacy, all of those that you work with, it won't be a successful program. It has to be everyone you interact with and across the board. And so it is an interprofessional program. And applications are coming in now, and we're really, really excited to see this work done. And this will really be around implementation science. So we all know that when you do research, you don't see it come out for several years. Implementation science teaches you how to bring the research to the bedside in a very rapid way. And so we're using those elements of implementation science to use in this implementation work that we're doing. So another big piece, of course, you heard about the 25% feeling that they had appropriate staffing. That's really important. And so a lot of national work has been done to address staffing. And we worked with ANA, AONL, and HFMC in the Partners for Nursing Staffing Think Tank. And that was like, what can we do right now? And the focus was on organization and policy. And the priorities that came out of that, number one, being healthy work environment, diversity, equity, and inclusion, the work schedule, flexibility, you know, nurses want to be flexible. It's a new generation of nurses. They're not interested always to be in those solid 12-hour shifts. Stress, injury, continuum, the innovative care delivery models. You know, you have virtual nursing out there. You have different ways of working. We're exploring all new ways to transform the work environment to make it a healthier place to work. And then total compensation. Compensation, of course, has played a part all through the nurse's career. And then after that work came the Nursing Staffing Task Force for long-term sustainable solutions. So we asked about, you know, how do we handle the ongoing challenges? And it mostly focuses on policy and some on organization. But it did bring in more of the nursing piece, more of the direct care nurse piece of the work. So we had five imperatives. Again, you saw to reform the work environment. And again, you saw to innovate the models for care delivery, establishing staffing standards that ensure quality care, improve regulatory efficiency, and value the unique contribution of nurses. When you ask nurses what's important to them, it is important that they are valued for the work that they do. So when you're working with the nurses, don't forget to say, well, you know, that was amazing. It goes a long, long way. In my career, I've been lucky enough to work with surgeons and trauma surgeons throughout my career. And they really, really respected the work we did, and that's what kept me there. I've been in the same organization for 37 years. So I really love my docs, and I love the work, the collaborative work that we do. The other things that are coming up in the future is creating the staffing standards for adult critical care, and that will be published soon. And then staffing resources on our webpage. We have blogs, journals, and articles and innovations from our community. And then advancing the implementation of the AACN standards for establishing and sustaining the healthy work environment. So that is what we have. Thank you. Well, thank you, Terri.

unhealthy work environments

nursing satisfaction

COVID-19 impact

healthy work standards

nurse retention