Creating a safe patient handling program can help reduce injuries and time lost due to injury.
Working in healthcare poses many safety concerns, including exposure to illness, physical injury, and workplace violence.
According to the Occupational Safety and Health Administration (OSHA), in 2020, hospitals recorded nearly three times more work-related injuries and illnesses for every 100 full-time employees than in all industries combined.
One concern for nurses is the use of equipment to handle patients who are less mobile and need assistance, says Deana Sievert, Chief Nursing Officer at Ohio State Wexner University and Ross Heart Hospitals.
“Nurses are utilizing many different pieces of equipment to complete patient care,” Sievert said. “Those pieces of equipment can be very heavy or difficult to move.”
“It is more common than it should be for nurses to sustain musculoskeletal injuries such as pulled or strained muscles, and damage to bones or joints,” Sievert added, “and these can range from small sprains to career ending injuries.”
CNOs must ensure that there are proper safe patient handling procedures in place so that nurses avoid sustaining injuries.
Policies and procedures
Sievert believes CNOs need to build a culture focused on safety, where nurses have the tools they need to be successful. The policies created for safe patient handling should promote the concepts of a no-lift environment, and treat the use of safe patient handling equipment as a non-negotiable.
“Creating a ‘no lift whenever possible’ culture is something each CNO should strive for,” Sievert said. “It is imperative to ensure that nurses have [the] appropriate pieces of equipment that assist with lifting, repositioning, increasing mobility, walking aides, and emergency equipment when lifting may be necessary.”
Sievert recalls one of the most successful no-lift cultures she worked in, where there was a safe patient handling coordinator who visited each department and made the no-lift expectations clear. The safe patient handling coordinator also evaluated each department and identified needs, providing the appropriate equipment for each kind of care.
“Safe patient handling equipment was in all areas of the hospital including ambulatory areas,” Sievert said, “and the hospital had overhead patient lifts in each patient room.”
Additionally, there were safe patient handling coaches on each unit, according to Sievert.
“These coaches were key to departmental culture,” Sievert said. “All of this body of work helped significantly drive down injury costs and days lost to injury.”
According to OSHA, having a written safe patient handling policy ensures implementation and continued success. Programs will work when there is consistent leadership making safe patient handling a visible priority, and when nurse managers and frontline staff members are involved during the development stage.
OSHA provides a safe patient handling checklist that health systems can use to evaluate their programs. The checklist is broken up into several sections:
Policy development
Management and staff involvement
Needs assessment
Equipment
Education and training
Program evaluation
CNOs can use this resource to see which areas in their safe patient handling programs are well developed and which components of the programs might need more attention.
Training
To make safe patient handling programs a success, CNOs need to make sure that nurses receive the proper training, and that they understand the equipment and procedures to the fullest extent.
Sievert recommends that training follow the resources the organization has in place to address physical hazards.
“Training should be crystal clear in regard to the culture the organization wants to create, the expectations, and resources available,” Sievert said. “Creating that culture is key to success, and training and retraining is critical.”
According to OSHA, all staff, including physicians, must be trained in safe patient handling, through onsite demonstrations of equipment use and maintenance and broader education programs. OSHA provides the following recommendations to create a safe patient handling training program.
Train all relevant workers on using mechanical lift equipment
Refresh, remind, and require ongoing training
Use mentors and peer education
Train caregivers to check each patient’s mobility every time
Engage patients and their families
For more information on OSHA’s recommendations for safe patient handling, click here.
It's important that your health system stands out, says this CNO.
On this week’s episode of HL Shorts, we hear from Cassie Lewis, Chief Nursing Officer, Bon Secours Richmond Market, about how CNOs can distinguish their health systems to new nurses during the recruiting process. Tune in to hear her insights.
Here are some best practices for recruiting, according to CNOs.
There are many strategies to help with recruiting, with varying degrees of success. CNOs need to focus on those solutions with proven positive outcomes to build their workforces.
Here are five tips for recruitment, by CNOs, for CNOs.
Hear about best practices for recruiting from these nurse leaders.
The nursing shortage is placing a heavy burden on health systems and making acquiring new talent extremely tedious.
However, the market does continue to grow.
According to new data from the Bureau of Labor Statistics (BLS), in January 2024, jobs in healthcare rose by 70,000, with 17,000 of those positions being in nursing and residential care facilities.
CNOs should take advantage of this growth and take a look at their recruiting processes.
There are many strategies to help with recruiting, with varying degrees of success. CNOs need to focus on those solutions with proven positive outcomes to build their workforces.
Here are some best practices for recruitment, by CNOs, for CNOs.
Provide unique experiences
CNOs should be as creative as possible when it comes to recruiting, according to Cassie Lewis, Chief Nursing Officer for the Bon Secours health system’s Richmond market.
“No longer are the days where you can expect just to post a job and have all these people apply,” she said.
Lewis said Bon Secours is creating programs to attract candidates that make the health system stand out in a crowded market. One of those programs involves a 10- to 12-week accelerated pathway in which new graduate nurses can rotate between different units to find out which would be a good fit.
Having the new nurses feel comfortable in their units also helps retain them, said Lewis.
“A nurse residency program is not unique to Bon Secours,” she said, “but how do we make it unique to where we can advertise it as doing something a little bit differently for new graduate nurses?”
Energize the community
Messaging is important when it comes to recruiting new nurses.
The pandemic had a two-fold impact on the public’s outlook on nursing, according to Lisa Dolan, Chief Nursing Officer at Ardent Health Services. People saw and understood the value of nursing, while simultaneously not wanting to become a part of the industry.
To combat this, CNOs should create efforts showing that nursing and other jobs in healthcare are a viable option with promising career paths.
“Trying to help reenergize the public about healthcare careers and how fulfilling they can be is a key piece,” Dolan says, “and a key role for CNOs going forward in their communities.”
Recruit inclusively
Diversity, equity, and inclusion (DEI) is key to recruiting as well.
D’Andre Carpenter, Senior Vice President and Chief Nurse Executive at Allina Health, believes CNOs must recruit with DEI principles in mind.
“[We must tap] into those communities of team members and others that really want to break into the profession of healthcare,” he said, “but they have barriers that often prohibit them from doing that.”
Lewis believes it is crucial that the workforce represents the community it serves.
“It’s not just about tapping into one school and having one unique workforce that all looks the same, acts the same, and does the same thing,” he said. “We [need to] create a workforce that mirrors our communities that our patients can trust.”
Create the right environment
Culture can be a major deciding factor for nurses choosing a health system, and creating a supportive, safe, and healthy environment for nurses is critical.
Lewis emphasized the importance of creating a culture where people want to come to work, and where leadership is visible to them, so the nurses know the “why” behind policies.
“Compensation doesn’t feel so important when you have a place that you truly enjoy [working at],” Lewis said, “and [when you] feel supported by your leaders.”
Carpenter said leaders must create an enticing environment with a healthy workforce balance and growth opportunities. Nurses want to know where they will be in the next five to 10 years, and CNOs should provide those pathways.
“[Engage] with team members in ways that are meaningful to [the nurses],” Carpenter said. “[Have] conversations about where they want to take their career, even for those that are just starting.”
Academic partnerships
Another key factor for recruitment is partnering with academic institutions. According to Dolan, the partnerships should be symbiotic, creating new pipelines for nurses into the industry while supporting the institutions themselves.
“If we can…help augment their staffing and clinical instructors, and allow them to take additional students,” Dolan said, “[that] would all be very helpful as well.”
For more information on academic partnerships and recruiting, read here.
This CNO says a healthy work environment is crucial to building a sustainable health system.
A large part of nurse dissatisfaction involves working in poor conditions. Nurses are overworked because of staffing shortages, they’re exhausted by heavy workloads, and they’re often dealing with workplace violence and other external disruptors.
A healthy work environment is necessary for nurses to thrive, and for patients to get the highest quality care and experience when visiting a health system. We sat down with Deana Sievert, Chief Nursing Officer at Ohio State Wexner University and Ross Heart Hospitals, to learn more about how CNOs can create better conditions for their nurses.
A healthy work environment is critical to maintaining sustainable health systems.
A large part of nurse dissatisfaction involves working in poor conditions. Nurses are overworked because of staffing shortages, they’re exhausted by heavy workloads, and they’re often dealing with workplace violence and other external disruptors.
A healthy work environment is necessary for nurses to thrive, and for patients to get the highest quality care and experience when visiting a health system.
Here’s what CNOs need to know about healthy work environments, according to Deana Sievert, Chief Nursing Officer at Ohio State Wexner University and Ross Heart Hospitals.
CNOs must have a strike contingency plan, according to this CNE.
On this week’s episode of HL Shorts, we hear from Chaudron Carter, Executive Vice President and Chief Nurse Executive at Temple Health, about how CNOs can develop a plan for continuing operations in the event of a nursing strike. Tune in to hear her insights.
Would you recommend having a plan in place for dealing with potential strike activity?
Any organization that's embarking on a contract negotiation should have a contingency operations plan.
Most organizations that are unionized know what it is, and it is based on, “If there is a strike, how can you continue operations?” That [includes] dietary, housekeeping, radiology, and how we continue to operate as normal, or [with] some resemblance as normal, when the nurses go out on strike. [That could involve] hiring an agency to bring in a contingency workforce.
The plan is huge because nursing touches all aspects of an organization, and so you have to think of the most minute things to the larger scale items. Instead of having five Med Surg units, how can you collate them into two or three, and what areas can you downsize in to continue to still provide the same quality of care to the patients that are coming in your doors.
So that contingency plan is an operations plan that mitigates any issues around continuing operations as it relates to a strike.
A healthy work environment is crucial to building a sustainable health system.
What is a healthy work environment?
A large part of nurse dissatisfaction involves working in poor conditions. Nurses are overworked because of staffing shortages, they’re exhausted by heavy workloads, and they’re often dealing with workplace violence and other external disruptors.
A healthy work environment is necessary for nurses to thrive, and for patients to get the highest quality care and experience when visiting a health system. Here’s how CNOs can create better conditions for their nurses.
Characteristics
Healthy work environments exist when several conditions are met, according to Deana Sievert, Chief Nursing Officer at Ohio State Wexner University and Ross Heart Hospitals. First and foremost, nurses need to be challenged to practice at the top of their licensure.
“When we talk about having meaningful, purposeful work that [nurses] need [to] have a healthy work environment,” Sievert says, “I think being able to practice at top of licensure is one of those key things.”
Nurses also need to feel like their voices are respected and heard as part of the team, and not just on the front lines, she says. Respect needs to come from the top, in the C-Suite and the board rooms, all the way to the bottom.
Shared governance models are also critical.
“That has to be saturated throughout the organization,” Sievert says, “simply because of the impact that [nurses] have on patient care, and the volume of [nurses] that exist in organizations.”
Additionally, healthy work environments have clear and proportional escalation pathways that equip nurses to solve problems. This could apply to patient care or to concerns with recruitment or competitive wages. Sievert also points out that high team engagement is critical, and can help staff approach issues in a healthier way.
“I think an engaged team is really the key,” she says. “If they’re not engaged, I don’t think that it’s even an option to have a healthy work environment.”
AACN standards
The American Association of Critical-Care Nurses (AACN) has outlined six essential standards that provide evidence-based guidelines for nurses to be successful. They are:
Skilled communication
True collaboration
Effective decision making
Appropriate staffing
Meaningful recognition
Authentic leadership
The AACN believes that healthy work environments are those in which these six guidelines are fully integrated and are helping to create “effective and sustainable outcomes for both patients and nurses,” According to Vicki Good, Chief Clinical Officer at the AACN.
“They’re all equally important and they all interrelate,” she says, “so you can’t have one without having the others present.”
From the CNO perspective, Sievert says she is pleased with the AACN guidelines, and that the organization has done a good job adding meaning behind each standard and outlining how to accomplish them.
“I think honestly our colleagues at the AACN have done an amazing job of really trying to capture those buckets,” Sievert says, “and that’s a task to capture the parts of a healthy work environment.”
Sievert says there is an opportunity for the AACN to amplify concerns with nurse well-being and self-care at work, not just when they go home.
“I think we could do a better job at incorporating [self-care] into the day-to-day work environment,” she says.
Sievert thinks the AACN should also focus on workplace violence.
“I know we’re all really struggling with [workplace violence],” Sievert says, “and I think that it would be great if we call that out maybe a little bit more.”
Outcomes
A healthy work environment offers many benefits to nurses. Such an environment improves recruitment, retention, and patient care, and there are less safety incidents.
“I think the literature is strong on this,” Sievert says. “The research shows that [hospital acquired conditions] improve.”
Good agrees, stating that the research shows the impact of healthy work environments on maintaining staff and patient outcomes.
“The evidence is clear that having a healthy work environment is [a] cornerstone to nurse well-being and retention,” Good says, “but now the research even demonstrates [the impact on] our patients.”
There are intangible benefits as well. Nurses and patients feel safer, and there is a stronger connection between leadership and nurses. Sievert emphasizes that in her career, she’s had a much stronger connection with her frontline teams, and vice versa, in healthier work environments.
“That whole body of teamwork really connects and moves things forward,” she says. “It makes all of our jobs easier [when] you’ve got that bidirectional flow of communication.”
Good concurs, citing that patient outcomes improve, there is less nurse turnover, burnout and moral distress decrease, and both the perception and actual quality of care improve.
“Not only does the perception of quality of care go up,” Good says, “[but] the actual quality of care goes up when you have a healthy work environment.”
Solutions
So how can CNOs create healthy work environments?
It starts with being the voice for the nurses, Sievert states. CNOs and CNEs represent nurses during meetings every day, in front of directors and managers in the boardroom.
“It’s definitely about being their voice because they don’t get that opportunity,” Sievert says, “and they rely upon that CNO [or] CNE role to be that voice.”
CNOs need to be able to represent nurses in the right way. This means being aware of the issues they face on a daily basis, and staying connected with nurses to understand what they need. Leaders must also be able to communicate feedback from those board meetings to the frontlines, and keep their teams posted with current updates.
“I think [it’s important to make sure] that you close that loop,” Sievert says, “because otherwise, I think our staff lose faith in regard to what we’re actually advocating for and what we’re working on.”
Good believes that CNOs should be role models for creating healthy work environments, and specifically for good communication, collaboration, and effective decision making. Leaders should also mentor nurses and ensure that they are fundamentally involved in decision making and establishing the framework for a healthy work environment.
“[CNOs] have to foster the visibility and enthusiasm for establishing a healthy work environment,” Good says.
Good also recommends building the AACN standards into performance management systems for nursing staff, so that healthy work environment behaviors become the expectation. To further spread those principles, the AACN has created a program called the Healthy Work Environment (HWE) National Collaborative.
According to Good, the HWE National Collaborative is a mentorship and co-learning program that includes nurses, physicians, administration, and ancillary services all working together to build healthy work environments. The two-year program launches in April 2024, and will be in 45 hospitals across the country.
“We will provide coaches, guidance, educational sessions, and mentor sessions to encourage and help the teams problem solve,” Good says, “and [to find out] what the biggest issues they need to solve for are in their work environment to improve it.”
Good says this kind of work is unprecedented on a national level.
“The national studies have shown us that the work environment has got to be improved,” Good says, “but there’s not a global approach to it.”
The program will cover many topics, and the AACN expects to see positive outcomes in recruitment and retention, staff and patient satisfaction, and workplace violence prevention. Good says the goal is also to disseminate research on why focusing on the work environment is going to impact all of those issues, and to teach organizations how pull together teams to work towards a common goal.
Lastly, Good hopes the collaborative will teach health systems how to implement healthy work environment standards.
“They’ve been out there for almost 20 years,” Good says, “[and] we’ve continued to struggle in how we disseminate them and operationalize them.”
To learn more about the HWE National Collaborative, visit the program page here.
Bon Secours’ new Richmond market CNO is excited to take on her new role after holding many leadership positions within the system already.
Cassie Lewis has held a variety of leadership positions since joining Bon Secours in 2012. During the last 11 years, she has served as the chief nursing and quality officer for the Providence Group within Bon Secours Mercy Health, regional director of Advanced Practice, and lead nurse practitioner and co-director of St. Mary’s Hospital in Bon Secours’ Richmond market.
Lewis now serves as the new chief nursing officer for the Bon Secours Richmond market. She says she has a passion for blending the perspectives of providers and nurses together and uses that knowledge to lead, and she has a vision for building a sustainable workplace culture where nurses feel safe, seen, and heard.
For our latest edition of The Exec, we sat down with Lewis to discuss her thoughts on advancing nurses’ careers, reflecting the community in your staff, and the messaging of virtual nursing. Tune in to hear her insights.
Supporting nurses' education might be key to solving the staffing crisis.
Recruitment and retention are particularly difficult right now in healthcare, especially in nursing.
Health systems are struggling to find new nurses who will stay at their hospitals permanently. Many veteran nurses are retiring and taking their knowledge and experience with them. This combined with the overall shortage of staff leaves new nurses feeling overworked and without the guidance and mentorship of their predecessors.
Here's what you need to know about building academic partnerships to improve recruitment and retention, according to Maribeth McLaughlin, VP and CNE at UPMC.
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