When the American Organization for Nursing Leadership (AONL) Workforce Compendium Section 2 arrived in my email, I was delighted to see that two of my passions were the topics: relational leadership and positive practice environments. In the spirit of celebrating Nurses' Week this month, my fervent hope is that every nurse fully experiences both concepts in their workplace culture as they're foundational to our success in moving forward. We've known this for a long time, way before the pandemic.
Forty years ago, we learned what type of culture creates a magnet for staff recruitment and retention: a positive practice environment with relational leaders. The original research describing “Magnet” hospitals was published in 1983 by McClure and colleagues. Let me repeat, 1983.
The American Association of Critical-Care Nurses (AACN) Healthy Work Environment (HWE) standards have been around since 2005. Amanda Bettencourt, president of the AACN, stated in a February interview with Becker's Hospital Review that failing to provide safe, healthy work environments is a foundational crack in hospital systems, contributing to the national shortage of nurses. She notes, “There is a lot of talk about changing the work environment, but not enough action.”
Bettencourt also states that having the right number of nurses won't lead to retaining them without an HWE; it's quality, not necessarily quantity. There's much empirical evidence supporting the relationship of HWEs to well-being and workforce outcomes, and it's been around for a long time. Would we have had less burnout and perhaps even averted, or lessened, the workforce destabilization if an HWE was standard in all areas of nursing practice?
The American Academy of Nursing recently published recommendations to advance system-level change for nurse well-being. You guessed it, one of them is to “reinforce nursing expertise and leadership in establishing healthy work environments through legislation and regulation,” and to determine evidence-based practices to advance HWEs. The Academy elevates this thinking to the policy level. There are other foundational concepts to a positive culture, including respect, positivity, belonging, well-being, and psychological safety. They all involve great leadership and are all part of a positive practice environment. The AONL compendium recommends focusing on engagement, recognition, appreciation, teamwork, and reducing work burden. They're not the first to focus on these factors. And that's my point: none of this is newly discovered information.
Three major, impactful nursing professional organizations are saying the same thing. It's time for more action and less talk. This is aligned with the results of our third Nursing Management Wellness Survey in this issue (see p. 26), connecting the dots between nurse leader joy at work, wellness, and HWE elements.
Why did it take so long to promote positive practice environments and relational leadership? We've known its importance for decades, albeit there's a lot more empirical evidence now. Yes, the pandemic brought us to our knees; we're crawling our way back and need reinforcement of what works. It's still disappointing to be focused on these critical concepts as if they were new. We could have done better sooner.