Leadership: Healthy Perioperative Work Environments Matter

Empowering your nurses for excellence is how to get there.

Establishing and maintaining a healthy work environment (HWE) is vital for the well-being of healthcare professionals and the delivery of quality patient care. The American Association of Critical-Care Nurses (AACN) outlined evidence-based HWE standards in 2005 that promote patient safety, optimal outcomes and excellence in clinical practice. When the HWE score at Boston Children’s Lexington Ambulatory Surgical Center declined, a dedicated team of nurse scientists, leaders and perioperative nurses came together to address the concern and improve the work environment. Here are the steps we’ve taken to support and engage nursing staff, enhance nurse retention and cultivate a culture of excellence in perioperative care.

• Assessing the work environment. Between 2019 and 2022, annual assessments at the Lexington Ambulatory Surgical Center revealed a decline in the mean HWE score from 3.26 to 2.75. The cause of the dip was unclear, but could be related to returning to pre-COVID volumes after the short interruption during the pandemic. Regardless, recognizing the importance of addressing this trend, the nurse scientist team, along with Zachary DiPasquale, collaborated with the nursing team to identify key areas for improvement. After we took the actions steps to improve, the HWE score rose to 3.85 this year.

• Establishing the Healthy Work Environment Ambassador Group. We formed the Healthy Work Environment Ambassador Group to operationalize the AACN HWE standards. Comprised of perioperative services representatives, these ambassadors played a pivotal role in facilitating improvement initiatives and ensuring all stakeholders’ voices were heard. Their collaborative efforts and regular meetings with the leadership team allowed for a comprehensive exploration of the work environment challenges and opportunities.

• Enhancing skilled communication. Skilled communication is vital for fostering an HWE. To enhance communication transparency, standardized morning and afternoon huddles were implemented, which provided an intentional platform for interdisciplinary team members to share information and collaborate effectively. This created a culture of open communication and promoted cohesive teamwork.

• Fostering true collaboration. True collaboration involves engaging all team members and valuing their contributions. In line with this principle, a staff meeting-minute template and dissemination process were established. This ensured that important meeting outcomes were effectively communicated to all staff members, promoting a sense of inclusiveness and active participation.

• Empowering through appropriate staffing. Appropriate staffing is crucial to supporting an HWE. To empower perioperative team members, they were given the opportunity to update the competency-based orientation programs for the operating room and post-anesthesia care unit. This initiative recognized their expertise and empowered them to shape the orientation process, fostering a sense of ownership and investment in the success of new staff members.

• Promoting meaningful recognition. Meaningful recognition plays a vital role in acknowledging the value each team member brings to the organization. Understanding that generational differences may influence the perception of recognition, a survey was conducted to assess the understanding and experiences of meaningful recognition among perioperative nurses. The survey results guided the implementation of initiatives such as placing thank-you cards in the family waiting room and the creation of a certification wall to recognize the expertise of the healthcare team members. These initiatives aimed to foster a culture of appreciation, empowerment and validation.

• Empowering authentic leadership. Authentic leadership is essential for creating an HWE. At Boston Children’s Lexington Ambulatory Surgical Center, remote work options were introduced for nursing staff to review preoperative charts, promoting flexibility and work-life balance. Moreover, charge nurses were empowered with the autonomy to make decisions based on patient and clinical operations, further promoting authentic leadership and distributed decision-making.

Through the collective efforts of the Healthy Work Environment Ambassador Group, the HWE score at Boston Children’s Lexington Ambulatory Surgical Center increased from 2.75 to 3.85. This improvement reflects the dedication of perioperative nurses and their commitment to cultivating an HWE. However, the process of sustaining and further enhancing the HWE is ongoing, and it requires continuous collaboration, engagement and leadership involvement. More changes are coming here as we continue to improve.

The journey toward cultivating an HWE at Boston Children’s Lexington Ambulatory Surgical Center highlights the importance of embracing the AACN HWE standards. By prioritizing skilled communication, true collaboration, appropriate staffing, meaningful recognition and authentic leadership, nursing staff were empowered, engagement was bolstered and patient care was enhanced. This ongoing commitment to an HWE serves as a testament to the dedication and passion of perioperative nurses in delivering exceptional care to their patients. OSM