A Multimodal Approach to Transform Culture by Implementing AACN's Healthy Work Environment Standards

Organizational culture and work environment are important factors in retaining staff members and achieving good patient outcomes. The COVID-19 pandemic exacerbated existing challenges for nurses and the health care organizations employing them.

Following the COVID-19 pandemic, the nursing staff turnover rate at Los Angeles General Medical Center in Los Angeles, California, reached 20.62%, an all-time high. A quality improvement project was initiated to improve the organization's culture in order to increase retention and improve other nurse-sensitive indicators.

The quality improvement project was intended to implement as many as possible of the 6 healthy work environment standards established by the American Association of Critical-Care Nurses (AACN): Effective Communication, True Collaboration, Appropriate Staffing, Authentic Leadership, Meaningful Recognition, and Shared Decision-Making. Key elements of the project were the implementation of professional shared governance, a new graduate transition to practice program, a mobile application to improve communication, a grant-funded project to decrease burnout, the AACN Clinical Scene Investigator Academy, a leadership development program, and a new staffing and scheduling system.

The quality improvement program resulted in improved patient outcomes, reduced nurse turnover, an increased rate of nurse certification, a higher proportion of nurses educated at the bachelor of science in nursing level or higher, and decreased overall costs.

Implementation of a quality improvement program focusing on the 6 AACN healthy work environment standards can improve the nursing work environment.