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

Background: 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.

Local problem: 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.

Methods: 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.

Results: 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.

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