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Guest Editorial

O'Connor, Mary, PhD, RN, FACHE; Guest Editors; Drenkard, Karen, PhD, RN, NEA-BC, FAAN; Guest Editors

Nursing Administration Quarterly: April/June 2019 - Volume 43 - Issue 2 - p 99–100
doi: 10.1097/NAQ.0000000000000347
Guest Editorial

The authors declare no conflict of interest.

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The obligation to create a healthy work environment for patients, families, employees, and communities seems evident. The Quadruple Aim1 added the concept of employee satisfaction as a key building block to safety and high-quality health care organizations. In addition, the business case is clear, as a more satisfied, safe, and healthy workforce results in lower turnover and improved employee retention. Only through a healthy work environment do the employees have high trust and high levels of fulfillment, allowing them to care for others in a safe and holistic care environment.

These concepts of healthy work environments are woven throughout the AONE Nurse Executive Competencies2 as well as the American Nurses Association policy on the work environment.3 In these days of political unrest and increasing violence, hospitals and health care workplaces are no longer a sanctuary. The long history of vertical, horizontal, and lateral violence must end. While the evidence for shared governance and interprofessional and autonomous practice abounds, dictatorial and territorial hierarchies continue their measures of control. Courageous nurse leaders, creative solutions, and practices are needed not only for success but also for survival in the health care industry. Addressing issues from basic safety to creating cultures of caring, equality, and inclusion must be a priority for nurse administrators.

There are many ways to address the work environment from the individual leader to delivery systems to leadership cultures. In this issue, articles that examine characteristics of the individual include the article by Persaud as she examines the challenge of unconscious biases and how these can be turned into strength with self-awareness and consciousness of action or our undoing in ignoring these traps of our own thinking. In addition, Massey and Wisser explore the plight of the introvert leading in a world where being an extrovert is valued and viewed as necessary for effective leadership.

Looking more broadly from the individual to systems are Shirey and colleagues who describe a successful interprofessional care team. The team exhibits collaboration, team relationships, and quality outcomes through their commitment to the well-being of each other and the team.

Finally, in an integrative review, Crawford and colleagues examine the evidence related to incivility and unprofessional work environments. Their findings illustrate the breadth of this problem that needs to be addressed beginning in the academic and following into the practice environments. Their literature review and analysis include evidence-supported recommendations for creating healthy cultures.

The goal is to create safe and healthy environments for patient care and for staff, within complex systems with many stakeholders, all of whom are supported by the actions of courageous Nurses and Nurse Leaders. We hope you enjoy the depth and breadth of the articles focused on this important area of practice.

—Mary O'Connor, PhD, RN, FACHE

—Karen Drenkard, PhD, RN, NEA-BC, FAAN

Guest Editors

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1. Bodenheimer T, Sinsky C. From Triple to Quadruple Aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12(6):573–576. doi:10.1370/afm.1713.
2. American Organization of Nurse Executives. Nurse executive competencies. Published 2015. Accessed November 26, 2018.
3. American Nurses Association. Healthy work environment. Accessed November 26, 2018.
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