Beyond Nurse Residency

Building Healthy Work Environments For Nurses And Teams

• Nicole Weathers, DNP, RN, NPD-BC • Season 3 • Episode 3

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In this episode of the Beyond Nurse Residency Podcast, host Nicole Weathers sits down with Rebekah Marsh, BSN, RN, CCRN, President of the American Association of Critical-Care Nurses, to break down what truly makes a healthy work environment in nursing. Together, they explore AACN’s evidence-based Healthy Work Environment Standards, why they matter now more than ever, and how they directly influence nurse engagement, retention, satisfaction, and patient outcomes.

Rebekah shares practical strategies for getting started, meaningful insights from national AACN data, and her personal perspective on implementing culture change at the unit and system level. Whether you're a leader, educator, or new graduate nurse, this episode offers actionable steps—and inspiring vision—for building stronger, more collaborative, more supportive teams.

About our Guest:
Rebekah Marsh, BSN, RN, CCRN,
President of the American Association of Critical-Care Nurses
https://www.aacn.org/about-aacn/board/rebekah-marsh
https://www.aacn.org/aacn-theme
https://www.aacn.org/nursing-excellence/healthy-work-environments
LinkedIn Profile

Selected Publications:
https://www.aacn.org/blog/three-reasons-nurse-leaders-should-prioritize-healthy-work-environment

Supporting nurses is our priority. Visit https://nursing.uiowa.edu/ionrp to explore our resources for new graduate nurses and beyond.

Setting The Stage On Engagement

Host Nicole Weathers

You're listening to the Beyond Nurse Residency Podcast, an educational series where we interview experts on all topics related to the transition of new graduate nurses into practice and beyond. I'm your host, Nicole Weathers, Director of the Iowa Online Nurse Residency Program. Thanks for joining us. Let's jump in. Since the start of this season, we've been talking about the importance of engagement. We began by looking at factors that shape engagement and then moved into identifying key ingredients needed to create an environment where nurse engagement can actually flourish. Last month, our guest, Dr. Dan Lose, identified the work environment itself as one of those essential ingredients. And we spent time unpacking the infrastructure that needs to be in place to create that strong culture. So this month I thought it would be perfect to dig in a little bit deeper to this idea of a strong culture and explore the concepts around healthy work environments. So what it is, why it matters, how we can influence it, and some actionable strategies our listeners can use to get started. To help us explore all of this, I'm joined today by Rebekah Marsh, president of the American Association of Critical Care Nurses.

Rebekah Marsh

Hi, I'm so glad to be here. Thanks for having me. My name is Rebekah Marsh, and as you heard, I'm the president of the American Association of Critical Care Nurses. We are the largest specialty nursing organization in the world with over 135,000 members. So that's an incredible honor for me to be the president. It's a volunteer job. So I do have a full-time job in my full-time job. I live in Seattle, Washington. I'm a clinical nurse educator. I teach uh ECG classes and support telemetry areas. And I've worked at Harborview Medical Center since I was a new grad nurse, right out of school, where I started out in our neuroscience ICU. And Harborview is a really exciting, it's a community safety net hospital, it's a level one trauma center, and it's an academic teaching center. So it's a very complex healthcare environment. And I really love the work that I do both in my day job and in my volunteer work with AACN.

Host Nicole Weathers

So when we hear this term healthy work environment, what does that really mean in nursing practice?

Origins, Evidence, And AACN Standards

Rebekah Marsh

Yeah, well, I'll give you a short answer and then a bit of a longer story to go with it. I think the short answer is that healthy work environments is a set of evidence-based standards that were developed and published by AACN. And those standards include appropriate staffing, true collaboration, skilled communication, authentic leadership, effective decision making, and meaningful recognition. And then there's the longer story that goes with it. Um I'd like to kind of jump back, if I can, to the early 2000s. And there was a nursing, a nursing shortage, um, which may sound familiar to people. And um that shortage highlighted the impact of unhealthy work environments on recruitment and retention. There was an incredible study called the Silence Kills Study. It looked at the impact of not feeling safe to speak up and how that really impacts patient safety. So, from this information, the leaders at AACN were having strategic conversations about what they could do to address these problems in the work environment. And out of those conversations came the first published healthy work environment standards. And they were evidence-based standards. Um, they were first published in 2005, and there was a second edition in 2016. And there's another on the visible horizon. So these have been updated over time. Then in 2009, we developed the HWEAT, the Healthy Work Environment Assessment Tool, which was uh later uh validated. And this survey tool has been administered at the national level to follow workforce trends on the health of the work environment for nurses since the mid-2000s. And we keep collecting that data. And on top of that, people keep doing research studies on what the health of the work environment does to impact both uh clinical outcomes, nurse satisfaction, and the fiscal bottom line in hospitals. So these are not just feel-good standards, these have impacts for both the retention of nurses, the satisfaction of nurses, and our ability to deliver high-quality care. That's what our patients deserve. That's why we are nurses. That's why healthcare exists. So, um, and the longer answer is that um healthy work environments evolved out of a need to have standards that show us what human work should look like. And that's what we do in healthcare. And no matter how advanced healthcare becomes, it is the human work that we actually do have to prescribe and provide directions for because it turns out that we don't just do it naturally. You know, the more complicated healthcare systems get, the more we actually need these tools to come back together and uh to do uh high quality work. And I think we all want to feel like we belong in the work environment. We want to feel like we may make an impact. And I think that the standards are a vehicle for that as well. So, no small thing. I think healthcare is by and for people. So um it's uh it makes a lot of sense to me that nurses would be the people that would um demonstrate specifically what facilitates human work. But I want to be really clear that the healthy work environment standards, they're not just for nurses, they're for teams and they're for everybody. And maybe, maybe for your family life too, possibly.

Host Nicole Weathers

Oh, absolutely. I mean, I could I all of these things that we talk about, I think a lot of times when it comes to, you know, the work that we do, it's applicable in so many, you know, different systems, so many different areas of our lives. And you just explained that so well, very succinctly, but very thoroughly. And so I really appreciate your explanation of that. And I think a lot of conversations that we've had over the years always kind of come back to the basics, right? So as much as we advance technology and we, you know, make our systems more and more complex, a lot of our solutions always point back to pretty basic things to help us do those things that we're after, right? So the clinical outcomes, like you said, the satisfaction, and then the bottom line for our organizations.

Rebekah Marsh

Yeah, I actually find that kind of reassuring that it always comes back to that. I think that basic caring is why we pursue nursing.

Why It Matters For New Nurses

Host Nicole Weathers

So you you got in a little bit already to why it matters, right? You talked about the clinical outcomes, the nurse satisfaction, the financial outcomes. You know, are there other reasons why you think this concept is really critical for everyone, of course, but you know, maybe specifically even talking a little bit about our new graduate nurses?

Rebekah Marsh

Nurses who work where they've implemented the standards, at least one standard in a deliberate way, say that they have experienced less moral distress than those who work in an environment where they haven't implemented the standards. They report better perceived staffing. They feel they're they are able to deliver better patient care. And so that is the kind of environment where any new-to-practice nurse can thrive. Actually, any nurse can thrive and really get satisfaction from the work that they have chosen. And uh, when we thrive, we're less eager to leave uh a new position. And that means a lot for hospitals' bottom lines in terms of saving orientation dollars, but it also means that we start to accumulate that knowledge base. And that's what a new nurse wants, also. We really need new nurses for their fresh eyes. Like they are so valuable to show us what they have most recently learned in school, their fresh perspective on how we do things, their questions about why we do it that way, which it's always um both equally part frustrating because you don't always remember or understand why you did it that way. But so imperative that they remind us that it's we must know why we do it that way. So I really love working with new nurses, but they want experienced nurses to work with them. So it matters for new nurses to see this in the environment for themselves and because they know that they're going to be joining a team, a team with like a depth of skill. I think uh we need healthy work environments for nurse managers because they have a really hard job and they have a really high attrition rate, and we need it for administrators and medical providers. And that's again the place where the new grad nurse wants to work is where all of these people have an essential role on the team. They know their role, but everyone is free to speak up. Everyone is empowered to speak up, everyone is a part of collaborating to make effective decisions. I think like we can show that implementation makes a difference and that nurses who work in an environment where they've implemented the standards, they're not planning to leave their current position. And that matters for all the reasons that you need a team.

Host Nicole Weathers

Thank you for sharing that, you know, statistic of organizations that have implemented at least one of these standards are showing improvements in these areas. Uh, I am totally a person who believes in evidence-based practice and using research to guide what we do. And so I think those outcomes speak volumes as to the importance of this work. And I think it's really important, and especially for leaders, when everything feels like an urgent matter that we need to address, the idea of these standards really help give leaders and educators direction on where to focus. Because I think that's kind of sometimes the hardest part of really making improvements is prioritizing where we should focus first or kind of what are the most important things for us to address. So I really appreciate that this research and this work has been done to give us more of a roadmap, if you will, of what it is that we need to be focusing on.

Rebekah Marsh

Yeah, we need instructions. It helps us do our work better.

From Assessment To Actionable Roadmaps

Host Nicole Weathers

So you talked about the fact that there's, you know, the standards have been identified, an assessment exists. Um, is there more out there? Is there a roadmap? Is there guidance on, and then here's what you do about it?

Rebekah Marsh

Yes, there is a lot of information out there. I think that sometimes the amount of information on healthy work environments and healthy work environments implementation can be overwhelming at first. Um, you're like, where do I start? And so um I would say you start with a lot of grace because there's a lot of positive impact from even having the conversations and learning about them. I'll give you a little bit of uh my own story. When I first learned about the healthy work environment standards, I was very new as a nurse educator. And I brought them forward to my leadership because I was so enthusiastic about the concept and about the evidence base. Um, and it really um it wasn't the right timing at my organization. We were really on um on a journey to um do some other really essential work, and I was asked to not talk about the healthy work environment standards anymore, which at its face value is a little weird. I mean, I think the the decisions in healthcare are so complicated. But uh what that did for me was I was like, okay, that's cool. I won't talk about them, but it doesn't mean I can't read about them or like learn about them or maybe think about them. So it didn't actually um dissuade me at all from learning about them. And for a long time I kind of had a lot of resentment about that because I wanted to do more. I wanted to share with a team because I I've said and I do believe that they are best implemented at the team level when you're sharing a language and you're working on something collaborative. But learning them for myself has actually been incredibly meaningful also. I now kind of understand them as a leadership model of how do you just you apply them to every clinical topic that you do. Um, you know, you have centerline infections. Well, you need um appropriate staffing. Nurses need to know how to appropriately do a sterile dressing change, providers need to know how to do a sterile insertion. Everybody has a role in that. So that's appropriate staffing. There's a lot of true collaboration. We just talked about provider-nurse roles. Every single component of the standards can be applied to all of the issues. And if I hadn't done a lot of work with learning them myself, I wouldn't really understand it as a leader in that nuanced way. And so I think it's so utilitarian to do a healthy work environment project on your unit and people begin to learn about what it is. But that for leaders, it's not just something that you help your staff do, it's something that you kind of embrace as a philosophy that drives a culture. And you can't have a culture if everybody isn't doing it. I've seen uh people embrace the idea of this is a simple project. And I think I'm really trying to emphasize it can be that. And you might get positive benefits from it, at least in the temporary, but to um really get the most personal satisfaction out of it, it doesn't matter what your role is. There's a way to employ these for yourself and to look at your work environment and how you're impacting it. And um, I think uh that's fun for me.

Host Nicole Weathers

And I don't want to put you on the spot, but I would love to talk through a little bit of like how you see these applying to sort of that transition to practice or nurse residency space, since that's a lot of what we talk about on this show.

Applying Standards To Residency And QI

Rebekah Marsh

So I love working with our nurse residency in my own hospital, and our nurse residents do a practice improvement project. So I think that that's where it could be um immediately employed in at least in my own organization, and that I really appreciate the shared leadership ideals that are also part of the standards. True collaboration leads to effective decision making. So um I think a new grad would want to see that as something that's actually practiced. And that um I know not every new graduate nurse is excited about a practice improvement project, but I super remember when I was a new nurse back in the dark ages, um, that uh if I wanted to do a practice improvement project, I essentially had to do it volunteer time because getting paid time to do that wasn't something that nurses were even eligible for. So to me, it's you are being paid to do quality work. This is an advancement for our profession. Um, this is what nurse autonomy looks like. And then that will help me lead into another really important AACN initiative, which is our Clinical Scene Investigator Academy. And they that's a program that teaches frontline nurses to do quality improvement projects, a lot like nurse residency programs. And so all of our CSI teams in uh the recent year have really been looking at healthy work environment topics and seeing um what can these teams of frontline nurses do to show return on investment for uh projects that are driven by healthy work environments? And we're really grateful that um Johnson & Johnson has partnered with AACN to fund grants for a lot of these teams so hospitals are able to apply to have the faculty come and teach this content at little to no cost through J&J's generous support. We ask why do you want to invest in this? And it's because of that return on investment. It's because we're showing that connection to um retention and that uh not only retention, but saving cost avoidance dollars in the healthcare environment. The LA General uh team, after implementation of healthy work environments across their system, um, their new grad retention rate uh went up to 93% and their nursing turnover, I think, went down from 22% to 9.6% in two years. And so new grads can see a place they want to stay, a place where there's actual ways for them to get involved in changing practice if they want. And if that's not what they're looking for, they should at least be excited that that's possible because that door has been closed for us uh uh for a long time.

Host Nicole Weathers

And I love that residency programs are a great sort of avenue to introduce these, this type of work from the very beginning. So I'm a lot like you, where this wasn't a thing, this wasn't a possibility for me when I first started as a nurse. Like it wasn't until I was a nurse for two, three, four years that you actually got the opportunity to even engage in this kind of work. And so it's sometimes hard for me when I meet new grads or I hear from some of our partner organizations that the new grad doesn't value that part of our program. Um, it can be a little frustrating for me, I'm not going to lie, because we know how important this is. We know how much this actually impacts the meaning of their work and how they feel about their work. Um and so sometimes we have to kind of, I don't want to say force them through things they don't really on first glance think they want. Uh, but I'm all I'm with you. Like this is important stuff. Um, and whether or not they they like it or not, at least let's introduce them and then let them sort of decide beyond residency if it is work that they want to continue to engage in. But if we're not introducing it from the get-go, um, we're not going to build that sort of culture, that environment where this is possible.

Pitfalls And The One-And-Done Trap

Rebekah Marsh

Yeah, my appeal for liking it at least a little bit is that it is the root of nurse autonomy. Practice improvement is the root of nurse autonomy. And advocacy is not just telling people what you think they should do, but doing the work to diplomatically um come to consensus in true collaboration. It really makes things more possible. It's how we all want to be treated. And so I think just being open to the idea of getting involved with practice improvement because you know that that's where you want to receive care. That's where you want your mom to receive care, is in a hospital where the nurses are actively involved in improving the care that's delivered. It just is more than an ideal to me. It does seem like really important, like you said. I think it's worth doing. I get a little excited about practice improvement. That's my other favorite topic. So, and and CSI, I think is the Clinical Scene Investigator Academy, is that perfect blend of implementing healthy work environments. And I think that that's where I can see all of the potential of it in nurse residency programs and in shared governance councils. That's where I think it could really thrive.

Host Nicole Weathers

Yeah, I absolutely. And it has to be introduced, you know, somewhere, right? And so it's great that we we do learn a lot of these concepts in our academic preparation, whether it's an associate degree nurse or a bachelor degree nurse, we are getting some of this around quality and safety and evidence-based practice and making change. And that's great. And it's great kind of in in theory, if you will. I they they do need to be exposed to, and what does this actually look like in my organization with the systems that we have in place, with the problems that we we are sort of facing? Uh, and we want them to know that I do have a voice, right? And I I wrote down the quote you know, this is the root of autonomy for nursing, is to be engaged in this work, which is so important, I think, not only for moving our profession forward, improving patient outcomes, but also creating sort of these work environments where um nurses want to stay. You know, another note that I wrote as you were sort of talking about this is I began to like look at I have the different standards pulled up on my screen here. And in my mind, I'm thinking, and these are all so important. And for a successful implementation of a residency program, right? We need appropriate, we need to have enough players at the table to stand this thing up. We need to have collaboration between unit leaders and our education department. We need to have that leadership that really sort of engages with our staff. We need skilled communication around this, whether that's with our new residents or whether that's between our education department and our unit leaders, uh, effective decision making, meaningful recognition, all of those things are things I think we are constantly sort of talking with our organizations and our partners about. And it's through this conversation that I've sort of connected the dots between those conversations and how they're actually spelled out here in your healthy work environment standards.

Rebekah Marsh

And so it's not that hard to put them together in a way that makes common sense. But just as we said earlier, common sense is not enough. We do have to have an evidence base and say this is where you start. But they really make common sense. So once you start using them, it's almost hard to stop. Yeah. And why should you stop? Because it's just impactful in really positive ways. And it is a QI model in that it never ends. There is no golden crown for the perfect healthy work environment. Um, is skilled communication is my number one project for the rest of my life. I so work on it every single day, and then I fall on my face because it's just the hardest one. But it's it's really essential. And we see that every every handoff, every shift change. Um, we need skilled communication and ways to teach it. So um, yeah, very exciting. I'm glad you got the trick.

Host Nicole Weathers

Yeah, absolutely. So, you know, we've talked about how this, you know, the different things that this can influence, right? So you talked about moral distress, staffing, you know, per perception of the care that we're we're giving, um, nurse satisfaction, all sorts of things. Maybe the the reverse is obvious, like when these things aren't present, what happens? Um, I don't know if you want to talk a little bit about that or if there's evidence out there or or research that you want to share about organizations when when this isn't maybe a priority or these things aren't present.

Engagement, Relationships, And Culture

National Collaborative And Free Tools

Rebekah Marsh

So um AACN has done a national survey every two to five years since 2006. Um, and we're right now working on uh we just collected data and survey responses just um this year in collaboration with UPenn to do our our sixth national research study on the health of the work environment. And um so we've been following this trend for a while now. And during the pandemic, we knew that the health of the work environment had been impacted. We heard the stories and it was a little early to deliver our survey, but we went ahead and put it out early because we wanted to capture the impact of this global event on nurses. And it was across the board the standards dropped. So we can measure that and say, wow, that's really impactful. But we saw in that same study those pockets of where they had implemented it was better. So um we know it can be worse. We can see the impact on that. We know that quality was an issue during the pandemic. Um, we know we were struggling with that. So uh it was a giant experiment that we hope we never repeat again. But there's a lot of lessons there. Um, I think other things that can go wrong when you see it implemented. Uh, the one and done phenomenon. It's this year's flavor, it's this year's initiative because we saw a talk on it at a conference, and we're going to do a project on it, and it's all meaningful recognition. There's meaningful recognition is so awesome. I have nothing against meaningful recognition, and yet it ceases to become meaningful when it's prescriptive. And uh sometimes it uh it becomes the what people think is the easy one, and it's actually pretty hard because to make it meaningful, it needs to be personal, and that's relational. And um, relational is skilled communication, and that's hard. So I think uh approaching this as a one and done phenomenon is a bit of a mistake, and you can show people the wrong message when you implement it in that way. It may seem to widen a perceived divide of not understanding how things work. And there is a divide right now in nursing between uh whatever you want to call uh leaders and frontline. Even though I am one of those uh saps that believes that all nurses are leaders intrinsically at our core. Um, but uh there is a gap between uh leaders and frontline. When we look at the survey results um in the healthy work environment assessments, there is a different perception of the environment depending on which side of that you sit. So we see things differently and we see each other differently. And when you don't uh do this as a committed effort, uh, you can just um show them what they thought they already knew. So it's really effective when it's implemented at the team level and the unit-based level, but it has to be at every level of practice. And so if you do it at the team level and unit level and the managers involved, you will expect to see the scores for the manager improve. But that um that administrator who doesn't come by won't see those scores. And um, the idea that it's just how it is that administrator scores are always um a little bit uh more challenging to achieve um in terms of being being seen as connected to units. I think that that's just an excuse. I hate to say it, but I think that's just an excuse. It really, if you have a relationship with people, they know it.

Host Nicole Weathers

And that was a big thing that Dan talked about last month and Katie Boston- Leary talked about the month before, was about the importance of relationships and all of this. Um, when we're talking about nurse engagement, when we're talking about, you know, the infrastructure that we need to create this healthy work environment. Um, it always came back to relationships and both of those conversations.

Rebekah Marsh

Yes, it is, I think it is about relationships. And I didn't see that at first about the healthy work environment's um standards. If I'm really honest, I can play an extrovert, but I am very um much an introvert. My journey with both uh the healthy work environment standards and with being the president of AACN has taught me one thing, and it is the value of relationships. Like that's everything. And um, we will accomplish a lot if we can focus on relationships and we will struggle when our relationships struggle.

Host Nicole Weathers

So we started in the year talking about engagement. Dan identified this idea of culture or healthy work environments as a key ingredient of nurse engagement. And when I say nurse engagement, I mean, you know, they're physically, cognitively, emotionally invested in the work that they're doing. I mean, that's really kind of the goal of what we need, I think, as a profession, what our organizations need. It's something that benefits both the individual and the organization. Do you agree that that culture or healthy work environments is a key ingredient for engagement? And is there any research through the AACN that sort of makes that connection?

First Baby Steps To Start

Rebekah Marsh

Um, we have right now our some of our work that is uh pending, um being ready for publication. We have a healthy work environment national collaborative that's going on. And um they have 135 interprofessional teams working on various projects using the healthy work environment framework lens. And they are using implementation science and they are engaging across like the CSI teams are mostly frontline nurse leaders, and that's a really important piece. But uh these uh collaborative teams are including uh leaders at every level. And so we're really taking a lot more of a big data approach with this collaborative and trying to make those connections because we know that the connections we've made so far have helped people see this as a path. But if we can make more connections, just like you say, and more connections to patient outcomes, then we really have momentum. And um this is to serve the greater good, to serve the patient outcomes. If we can lock that in, that's our purpose. So more to come, I think. Um, in we're looking across patient care continuums. So um AACN is often thought of as um for acute and critical care nurses, but this is something that works in ambulatory settings in clinics, and um across that full patient care continuum. It's just something that we think is um a gift to the world that needs to be shared. Um, the tool is free, the healthy work environment assessment tool, the validated tool is free to administer. Anyone can administer it. There's a lot of free material on our website to get started. And we want you to collect your own data.

Host Nicole Weathers

Yes. Yeah. No, I mean, 135 teams are working on this. That is amazing. You've got a lot of uh momentum behind this work. Uh, and I can't wait to continue to sort of follow that along. So uh we'll be sure to link uh the AACN's website and um specifically the information that you've shared uh about the healthy work environments in the the show notes for this episode. So for our listeners, that's where you can look to get that information. Um, you know, we've talked about uh, you know, where to start. Uh so you've talked about like, you know, and just picking one of these standards to maybe focus on. You've said there's sort of a roadmap or a toolkit that's out there. For our listeners, one practical first baby step towards this. What would you suggest?

Rebekah Marsh

Start with the grace to stumble through it and then go and read the standards. And there are some case studies in there. Just start you thinking about what they look like. And then you really can pick any one standard. My personal recommendation is you get a lot of traction in just implementing one. Don't pick the hardest problem first. Pick something that's a little bit entrenched already and build it better. You know, start with a glimmer, start with something that um is already sort of working and you just want to dial it in, but have conversations with people about it and share the language, engage with the interdisciplinary team, engage with your leadership or with your frontline staff. Um, and then find your way forward together. It's never going to be perfect. It is about people feeling like they're engaged with it. Yeah, that would be my best advice is to not get so worried about fixing it all at once. There's six standards, but you get benefits from starting with any one of them.

The Future: Interdisciplinary And AI

Host Nicole Weathers

And I think that is such good advice. I know it's our human nature to go towards like, let's do this assessment, let's see where we are doing the worst, and let's tackle that first. But this idea of starting maybe with one that we're doing okay, like there's room for improvement and building, and then seeing that be a success, and then sort of maybe working our way down to maybe some of those more difficult ones. Uh, I think that is great advice, whether we're talking about this or maybe any area of improvement, uh, that kind of try to try to, you know, avoid thinking that A, we have to fix it all at once, and B, that we have to start on the hardest area.

Rebekah Marsh

We are such funny um creatures in healthcare to make everything about the biggest emergency. And I have to remind myself constantly um to make uh manageable things manageable for myself. Yeah. Don't make it hard.

Host Nicole Weathers

Okay, so looking ahead now, uh healthcare obviously is changing very fast. Um, I swear, the only constant in healthcare, right, is change. So, how do you see this concept of healthy work environments maybe evolving into the future?

Rebekah Marsh

Well, I think our move to make it interdisciplinary, um, we made our healthy work environment assessment tool interdisciplinary a couple of years ago. And that was critical. Because I think getting it out of um being something that is exclusive to nurses is really, really important. So I think that uh we will continue to expand this work. And if we continue to expand it outside of nursing, we will see the ease of implementation. Um, you know, I think it will just get a little bit easier to do if we're all working together. A lot of people are forecasting changes to professional work with advances in technology and AI. And I agree that it will also transform nursing. But as we already talked about, a lot of nursing is human-focused. And so here's a real opportunity to think about how AI may change our work for the better and make it more healthy if nurses are included in the table to design solutions. Things like ambient listening do have the potential to reduce our charting. Um, I think that it's also like I get very future thinking. So I'm a sci-fi nerd, and uh, so I can get very into thinking about a world where ambient listening also identifies the health of the work environment rapidly instead of waiting for your one-year survey. You get alerts that there are stressors in the environment. And we work in a just culture in my future. So this is never used against you. This is used for um system improvement to make sure that we are boosting, you know, time for communication or so putting out good, meaningful recognition to people in the right moments. Um, so I'd like to think that nurses are going to be involved in designing these changes and that we will live in a just culture and that the world in the future is a very exciting place and we have time for caring. And that's what we were meant to do.

Host Nicole Weathers

I mean, our listeners can't see what my eyes did when you said that idea of like use not just using this ambient listening to improve our charting and things like that, but using it as a tool to really have a pulse on what's happening with our staff.

Rebekah Marsh

And in a way that's caring.

Host Nicole Weathers

Right. In a way that is here to help make things better. And like you said, um, not, you know, you know, punish people or come down on people because of it.

Systemwide Adoption And Final Reflections

Rebekah Marsh

But yeah, we would have a structure for that with healthy work environments. We would have a basis for for thinking about that. So I think we've done the foundational work. I'm impressed that AACN uh took it from a conversation about how to address retention issues in the work environment. And um, what I have learned from healthy work environments also is the power of incremental change. And I think that's both for AACN to keep growing this thing and to see no end in sight for how big we can make this for people. Um, but also its impact on me as a leader personally to have it be kind of just an idea inside of me that now is a philosophy that that I continue to um embrace as a real golden thread, but an evidence-based one. Because, you know, like I said, I'm a science nerd. Yeah, it's exponential and um it just start your journey incrementally. And who knows where our future will take us.

Host Nicole Weathers

So, you know, we've talked about a lot today. We've talked about, you know, the healthy work environment standards, what they are, why they matter, what it influences, where to start if we're looking at, you know, starting on this journey and then some really amazing ideas of maybe what's uh in the future for us. But when it comes to creating healthy work environments, and I ask this question of sort of everybody who comes on the podcast, but what's one thing that you've seen organizations doing that you think makes the biggest difference and you wish more organizations would adopt?

Rebekah Marsh

There is um an amazing blog that I can share in the links uh for people that are interested. I think that there are some real amazing uh nurse leaders, uh chief nurse officers who are implementing this at the system level and also making it something that each nurse has a hand in. And I think that that those examples are really exciting to me because it's uh walking the talk and everybody's doing it at every level of practice and it it becomes a part of a culture. That's uh I think it's something that you have to maintain, but isn't it? I would aspire to maintain such a culture. I I like to see these examples of it being um everywhere in the environment. Should be for everyone.

Host Nicole Weathers

Absolutely. I think it it really should. And I would love to check out um that blog if you feel free to share that, and we'll get that in the show notes as well. All right. Well, Rebekah, thank you so much for joining us on this episode of the Beyond Nurse Residency Podcast. I know I've learned so much. I always take notes during the episodes and scroll things down. Um, and so many great uh quotes from you, so much great information, and I know our listeners will feel the same way.

Rebekah Marsh

Well, thanks for having me. I had a lot of fun.

Host Nicole Weathers

Wait, before you go, I want to make sure you know all about our suite of resources you can use to support your new graduate nurses. This includes our Academy, a coaching program designed for organizations as they prepare for the implementation and ongoing sustainability of a nurse residency program. Work one-on-one with residency program experts to make sure your organization is residency ready. Our Clinician Well-being course is an asynchronous online course that aims to enhance the well-being and resiliency of healthcare professionals, equipping them with the necessary psychological capital to navigate challenges inside and outside of work. Supporting nurses is another asynchronous online course for preceptors, mentors, and coaches to learn the skills they need to support any new hire. Both of these offerings can be used as a standalone professional development opportunity or to augment any nurse residency program. And we can't forget about the program that started it all, the Online Nurse Residency Program. This includes a comprehensive curriculum designed to support new graduate nurses applying all the knowledge they learned in school to their practice. We focus on professional skills, personal well-being competencies, and new graduate nurses even get the opportunity to create real change in their own organization. Offered completely online and in a blended format, this program is highly adaptable to all clinical practice settings. You can learn more about all of these programs and more of what we offer using the links in the show notes below.