Let's see if I can do this without being too cranky...
A lot of what makes a quality practice environment comes down to autonomy and feeling valued for the work you do. If a person has some control over their worklife and working conditions, they feel valued and have no difficulty meeting both internal and external standards of care. An environment such as this fosters high morale among its members and perpetuates itself. When a person is not given the ability to make decisions or choices about his worklife or practice, or credit for a job well done, it is dehumanizing and demoralizing. Morale, once lost, is hard to regain. (Just ask the members of the Broken Hearts Club at Winnipeg Children's Hospital.
) As JMP
said, there are vast differences between units within the same facility. You can pick out the environments that provide staff with the tools to maintain a quality work environment by looking at the job postings. If there are always no vacancies on a unit, that's a big clue, and vice versa.
Where I work, conditions have deteriorated in the 17 months I've been here, and I'm finding myself looking at my decision to take this job, and realizing that I'm stuck, having spent far too much money and effort moving and settling in a new city. I have very little control over my worklife, from minor things, such as always getting the assignments nobody else wants and having to take my break at the very end of the shift, to major, like having my schedule changed without consultation and not getting my vacation granted when I've followed the proper, convoluted method of making such a request, instead going onto a list for last-minute vacation, granted on a shift-to-shift basis dependent on workload. Do I feel valued and respected? Not a bit.
In some ways I feel sorry for middle management, because they're really caught between a rock and hard place. They know that what's going on isn't good for the unit, but are powerless to do anything much about it. They get their instruction from a faceless higher power who has no understanding of what it is that nurses do, or how things really work on an inpatient unit. Anything they try to do to mitigate the decisions from on high falls short. No one can serve two masters so they choose the ones holding the money.
Lower-level management is maybe even more powerless, since any decisions they make can be overridden by anyone on a rung above. The team-leaders are the ones who understand the issues facing a unit best, but have the least ability to effect change. Staff meetings are held in our unit q other month; they are unpaid, thus are poorly attended and accomplish very little. A notice is posted a couple of weeks before the meeting date asking for people to write down their concerns, sign their names and be prepared to address these at the meeting. (Very few items are ever written on these notices, for obvious reasons.) They are held over the supper hour, in the staff break room. The only people generally who attend are those staff who are in the room having their suppers. (They call that a break?) I have attended two meetings, several things dear to my heart were discussed, a plan was made to deal with them, and NOTHING changed. This is at the heart of the reason why most of my coworkers are unwilling to get involved in a battle to improve our environment. They've seen time and again that nothing changes.
In collaboration with some of my coworkers who aren't afraid of the fallout, I am currently drafting what I call my List of Burning Questions with No Really Good Answers about working conditions in our unit, and will present it to management when I've polished it up. There can't be any answers if no one asks the question.
Nurses, although we represent the largest group of health care providers, are very low on the totem pole when it comes to respect from above. A quality environment depends on mutual respect and appreciation for each party's role in getting the job done. The Alberta Association of Registered Nurses does provide practice consultation services as you described, vislandnurse. However, they have publicly stated that they will not become involved in any organized attempts to improve working conditions or support the nurses working for such change. What's a nurse to think when our regulatory body isn't even willing to help?
Okay, I fell better now... :stone maybe.