Healthy Work Environment - Interview with Dr. Beth Ulrich

[allnurses]

The 2018 Marguerite Rodgers Kinney Award for a Distinguished Career was awarded to Beth Tamplet Ulrich, EdD, RN, FACHE, FAAN at the 2018 American Association of Critical Care - National Teaching Institute annual conference. While at the NTI conference, Mary Watts, BSN, RN, allnurses.com Community Director interviewed Dr. Ulrich and discussed her career and some of her accomplishments.

Dr. Ulrich received her bachelor's degree from the Medical University of South Carolina, her master's degree from the University of Texas Health Science Center at Houston, and her doctorate from the University of Houston in a collaborative program with Baylor College of Medicine.

When she moved to El Paso, Texas; due to her husband's job, she started in dialysis and learned from the ground up as dialysis was in infancy. She worked to set standards of care and is a past president of the American Nephrology Nurses Association (ANNA).

While earning her doctorate, she worked in hospital administration developing nursing simulations and nurse residency programs. She became interested in the healthy work environment and began her work with the American Association of Critical Care Nurses (AACN).

She assisted with development of the first Healthy Work Standards survey in 2005. Dr. Ulrich stated that AACN brought together "an expert panel to create the standards.” In 2006, it was decided to "obtain opinions from those nurses with boots on the ground; the staff nurses who do the doing every day.” She further explained that AACN is "absolutely committed" to obtaining information to help the bedside nurse work in the safest environment possible.

The 2005 survey was a snapshot. By the 2008 survey, AACN began to assemble comparisons of data which expanded when the 2013 survey data was added and AACN was able to took at trends. Now in 2018, AACN has received over 8000 responses to their current survey. Every time the survey is done, there are more and more nurses responding. Mary stated, "nurses see the value in these surveys because they want changes" via the published results.

Dr. Ulrich continued, "When we first looked at this, we were looking for a baseline. In 2013, we saw the down turn of the economy: nurses were returning to work, they were changing from part time to full time, or for those who were working full time, they were looking for overtime.” In this scenario where the economy dictated how much you needed to work, there were not a lot of changes in the work environment regarding safety as income was the number one reason to work.

Mary asked, "What contributes to an unhealthy work environment?”

Dr. Ulrich answered that inappropriate staffing - results showed that 39% of the respondents reported they had appropriate staffing. Another more concerning result was that 32% stated that <50% of the time, they had adequate staffing. "This is pretty scary for the patients and the nurses". Dr. Ulrich pointed out that "staffing isn't just about the patients; it's about the nurses too, because when staffing isn't adequate, nurses don't practice at the top of their license. They get done what they have to get done. They don't get to do the things only nurses can do - the critical thinking things, the discharge planning, comforting, teaching patients and families. They have to do tasks and then nurses aren't satisfied with their jobs.” This results in decreased job satisfaction. Staffing is more than just about enough nurses to take care of the patients. It reflects on everything in the work environment.

"I was surprised at the high number of incidents of discrimination with the 2018 survey.” This included verbal and physical abuse experiences. "We capped it at 200 incidents in the survey.”

Nurses aren't leaving nursing, they are leaving the hospitals - they have many options. They aren't limited to work in the hospitals. "Once a nurse, always a nurse,” stated both Mary and Dr. Ulrich in unison.

The survey results are published in Critical Care Nurse, AACN's clinical practice journal. Link to study

Allnurses.com extends their gratitude to Dr. Ulrich and AACN for continued support in disseminating vital information for nurses.

[traumaRUs, MSN, APRN]

Great interview with some good answers to some common problems.

[katherinebrewer7]

Great interview. This is a part of what I'm looking at in my doctoral research - work environment and impacts on nurse well-being. Even though well being is complex, the work environment does contribute to the overall health and work enjoyment of nurses. Evidence shows that well-being also contributes to patient outcomes.

[tnbutterfly - Mary, BSN]

@katherinebrewer7 , I'm glad you liked the interview. If you would like to talk to Dr. Ulrich, I can probably get the contact information. She is very knowledgeable about this topic.

I'd love to hear more about your doctoral research.

[Daisy4RN]

I am glad that she is doing this research in order to provide data to enact changes. I hope that administrators listen. Patients and nurses deserve much better!

[Dr. Samoya]

I focused on HWE for my Master’s and Doctoral work. I created a toolkit for nurse leaders to use when working to establish these standards in their work environment. It is an evidence based toolkit with resources to use and literature to support each standard. I would love for you to check it out and see if it can assist you or be part of your doctoral project. The toolkit is located on the AACN website under the resources for HWE. If you have any questions you can contact me at: [email protected]

I am happy to know others are continuing to show interest in this topic! There’s a lot of room for improvement!

[tnbutterfly - Mary, BSN]

@Dr. Samoya thank you for sharing this resource with us.

[katherinebrewer7]

@tnbutterflyThank you!! I would love to contact her. My research right now is for my PhD dissertation - it focuses on nurse well-being, bullying, and organizational culture regarding bullying. I am measuring a new variable in work environment for nurses called institutional betrayal. I hope to expand to longitudinal studies when I graduate, and to expand the model to look not only at nurse well-being as an outcome but also patient outcomes.

[katherinebrewer7]

@Dr. Samoya I definitely will!!

[tnbutterfly - Mary, BSN]

@katherinebrewer7 I will send you a private message.