In the business sector, employees occasionally have the misfortune of laboring within what might be termed: “the toxic workplace,” a culture of insensitive or inept management that breeds discord and a desire to escape. But in healthcare, the toxic workplace is truly dangerous, both in terms of patient impact as well as the risk of driving talented nurses away from the places they are most needed.
A September ’06 survey of 4,000 critical care RNs* revealed the alarming truth that more than one in five nurses have experienced physical abuse on the job, three in five have experienced verbal abuse, and one in five have experienced sexual harassment. Almost all physical abuse stems from patients or patient families, and verbal abuse comes from a combination of these two sources as well as from physicians. And while the survey indicated that RNs have high levels of respect for each other, respect for nurses by administrators and physicians was perceived to be low.
Where an atmosphere of disrespect, abuse and unsafe conditions presides, nurses can become drained, disheartened and broken — it’s intolerable to consider.
Many clinicians think so, too.
In November the AACN launched a joint effort with four other professional medical societies aimed at raising the bar on patient safety and staff retention — as part of the broad adoption of the AACN “Standards for Establishing and Sustaining Healthy Work Environments,” these organizations publicly advocated six evidence-based, relationship-centered standards to cultivate healthy work environments that comprise (1.) skilled communication, (2.) true collaboration, (3.) effective decision making, (4.) appropriate staffing, (5.) meaningful recognition and (6.) authentic leadership.
“Nurses are the backbone of our healthcare system and deserve not only professional respect but a work environment that allows them to provide their skills, compassion and leadership abilities in caring for patients,” said John E. Heffner, M.D., president of the American Thoracic Society. “...These standards are increasingly important considering that nurses are now in dangerously short supply, especially in our nation’s ICUs. Achieving the standards’ goals will improve patient care and create a work environment that more nurses will want to join.”
We address some of the factors that contribute to a healthy work environment in this issue. Our Special Report, titled “All Things Bedside,” features practical thoughts about nurse retention plus a nurse/IT professional’s perspective on implementing POC mobile computing tools for staff. We look at ways to clear the clutter in the ICU to keep nurses close to their patients, and we showcase Children’s Hospital of Dayton as an exemplary model of a streamlined, family-centric ICU design. Please look for our discussion on patient transport, too, which underscores the technologies that are preventing physical strain on clinicians while ensuring better patient safety.
Many challenges remain in hospitals today to remedy the ills against caregivers and to equip them with better tools that cultivate rather than impede their gifts for healing. Even so, the same survey that uncovered so much abuse also found that the vast majority of critical care RNs are likely to recommend a nursing career to others and are committed to remaining in their profession. They bear more in a day than most of us nonclinical folks probably recognize — with great anticipation I’ll be watching for widespread, tangible evidence of improvements to their world.
Thanks for reading.

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