National Nurse Work Environments - October 2021: A Status Report.

BACKGROUND: The health of nurse work environments has been shown to affect both patient and nurse outcomes. In 2005, the American Association of Critical-Care Nurses published the AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence, and a second edition was published in 2016. The American Association of Critical-Care Nurses conducted critical care nurse work environment studies in 2006, 2008, 2013, 2018, and, most recently, October 2021, which was expanded to include registered nurses in all areas of practice. OBJECTIVE: To report the results of the October 2021 study with comparisons to previous studies and recommendations for continued improvement and to evaluate the current state of nurse work environments. METHODS: An online survey was used. A total of 9862 registered nurses responded to the survey; 9335 met the study criteria of currently practicing as a registered nurse. RESULTS: The health of nurse work environments has declined dramatically since the 2018 study. However, as in 2018, evidence of a positive relationship exists between implementation of the American Association of Critical-Care Nurses Healthy Work Environment Standards and the health of nurse work environments, between the health of nurse work environments and job satisfaction, and between job satisfaction and the intent of nurses to leave their current positions or to stay. CONCLUSION: It is time for bold, intentional, and relentless efforts to create and sustain healthy work environments that foster excellence in patient care and optimal outcomes for patients, nurses, and other members of the health care team.

Critical Care Nurse Work Environments 2018: Findings and Implications.

BACKGROUND: The health of critical care nurse work environments affects patient and nurse outcomes. The results of the 2018 Critical Care Nurse Work Environment Study are reported here with comparisons to previous studies and recommendations for continued improvement. OBJECTIVE: To evaluate the current state of critical care nurse work environments. METHODS: An online survey was used to collect quantitative and qualitative data for this mixed-methods study. A total of 8080 American Association of Critical-Care Nurses (AACN) members and constituents responded to the survey. RESULTS: The health of critical care nurse work environments has improved since the previous study in 2013; however, there are still areas of concern and opportunities for improvement. Key findings include documented absence of appropriate staffing by more than 60% of participants; an alarming number of physical and mental well-being issues (198 340 incidents reported by 6017 participants); one-third of the participants expressed intent to leave their current positions in the next 12 months; and evidence of the positive outcomes of implementing the AACN Healthy Work Environment standards. CONCLUSION: Evidence of the relationship between healthy nurse work environments and patient and nurse outcomes continues to increase. The results of this study provide evidence of the positive relationship between implementation of the AACN Healthy Work Environment standards and the health of critical care nurse work environments, between the health of critical care nurse work environments and job satisfaction, and between job satisfaction and the intent of critical care nurses to leave their current positions or stay.

Assessing the Impact of Telemedicine on Nursing Care in Intensive Care Units.

BACKGROUND: Information on the impact of tele-intensive care on nursing and priority areas of nursing care is limited. OBJECTIVES: To conduct a national benchmarking survey of nurses working in intensive care telemedicine facilities in the United States. METHODS: In a 2-phased study, an online survey was used to assess nurses' perceptions of intensive care telemedicine, and a modified 2-round Delphi study was used to identify priority areas of nursing. RESULTS: In phase 1, most of the 1213 respondents agreed to strongly agreed that using tele-intensive care enables them to accomplish tasks more quickly (63%), improves collaboration (65.9%), improves job performance (63.6%) and communication (60.4%), is useful in nursing assessments (60%), and improves care by providing more time for patient care (45.6%). Benefits of tele-intensive care included ability to detect trends in vital signs, detect unstable physiological status, provide medical management, and enhance patient safety. Barriers included technical problems (audio and video), interruptions in care, perceptions of telemedicine as an interference, and attitudes of staff. In phase 2, 60 nurses ranked 15 priority areas of care, including critical thinking skills, intensive care experience, skillful communication, mutual respect, and management of emergency patient care. CONCLUSIONS: The findings can be used to further inform the development of competencies for tele-intensive care nursing, match the tele-intensive care nursing practice guidelines of the American Association of Critical-Care Nurses, and highlight concepts related to the association's standards for establishing and sustaining healthy work environments.

Telenursing in the intensive care unit: transforming nursing practice.

In tele-intensive care units, informatics, telecommunication technology, telenursing, and telemedicine are merged to provide expert, evidence-based, and cutting-edge services to critically ill patients. Telenursing is an emerging subspecialty in critical care that is neither well documented in the extant literature nor well understood within the profession. Documentation and quantification of telenursing interventions help to clarify the impact of the telenurse's role on nursing practice, enhancement of patient care, patient safety, and outcomes. Tele-intensive care unit nursing will continue to transform how critical care nursing is practiced by enhancing/leveraging available resources through the use of technology.

Professional accountability in the tele-ICU: the CCRN-E.

The American Association of Critical-Care Nurses (AACN) is the world's largest specialty nursing organization. The AACN Certification Corporation provides credentialing to validate nursing practice in acute and critical care. The advent of tele-ICU nursing added a challenge to the application of certification in a new specialty area. Nurses working in a tele-ICU have many years of experience in hands-on acute or critical care nursing at the bedside. In their role as tele-ICU nurses, these skills are applied to the assessment, evaluation, and decision support of care for critically ill patients in various acute and critical care units from remote locations connected directly to the ICU through high-speed audio and video technology. This article outlines the journey of the advent of the CCRN-E (registered nurse in critical care) credential and its place in the new specialty of tele-ICU nursing practice.

Toward a healthy work environment.

Patient safety and the quality of patient care have become important topics in U.S. hospitals in recent years. Nearly all hospitals have made mechanical and procedural changes to improve safety. But a truly healthy hospital is one in which caregivers, especially nurses, are treated with respect. The American Association of Critical-Care Nurses argues that a genuinely healthy work environment has six qualities: skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition of staff members' contributions, and authentic leadership. Although training is often needed to create a respectful and healthy workplace, some leaders are reluctant to allocate dollars on what they see as "soft" relationship issues. However, hospital leaders dedicated to improving safety and quality of care will see that they cannot afford to neglect such issues.