February 2020 American Nurse Journal 33 ANA ON THE FRONTLINE NEWS FROM THE AMERICAN NURSES ASSOCIATION nn Creating space for innovation34 American Nurse Journal Volume 15, Number 2 By Elizabeth Moore, MFA W hile the idea of innovation can conjure images of high-tech gad- gets and artificial intelligence, more often innovation is a result of changes in approach or philosophy that allow nurses to make an even greater impact on patient care. The American Nurses Association (ANA) “Leading innovation in nursing work- shop,” held in Silver Spring, Maryland, last fall, gave nurses a methodology to help them approach innovation in their practices. The innovation workshop is just one of the programs from ANA that aims to build a nursing culture of innovation. “We are sup- porting the growth of nurse-led innovation across our profession and at the national level to build a ‘healthier world through the power of nursing,’” said Oriana Beaudet, DNP, RN, PHN, vice president of innovation for the ANA Enterprise. “The complexity of healthcare re- quires nurses to be expansive in their thinking and with their actions across all levels of practice to transform the future of healthcare. I was once told, ‘Every nurse uses the science of nursing and the art of improv.’ The moment where knowledge and cre- ativity intersect is where innovation begins to emerge.” Culture change Christi Zuber, PhD, MHA, RN, brought her perspective and vast experience in the field of human-centered design as the workshop instructor. Starting out as a home health nurse, Zuber found that she loved look- ing at the context of her patients’ lives and figuring out ways to optimize their care. Zuber later served as an administrator in a children’s hospital where she fo- cused on implementing innovative patient- and fami- ly-centered care programs. She has since become an expert in the practice of human-centered design as an approach to innovation. Zuber often hears nurses say that although they’re creative and have many ideas, they feel stuck or un- empowered because innovation isn’t part of their or- ganization’s culture. “Leadership is really important for a culture of innovation, but those working on the frontlines or in middle management can take it upon themselves to build a real movement of innovation,” she said. In her research, Zuber termed these move- ments “microclimates for innovation,” which can have a profound impact on the organization and those who work within it. Microclimates for innovation, Zuber explained, arise from a key set of behaviors and conditions that ex- emplars have created to make innovation happen. A few of those include leveraging the aid of an advo- cate who provides the support needed to try things on a larger scale. Innovators make connections with people throughout their organization to build a sys- tem that helps them grow their capabilities from small, quick bedside hacks, for example, to larger projects with broader reach. They share stories and experiences with others to inspire them and build momentum for the work ahead. “Approaching inno- vation through the lens of human-centered design (also known as design thinking) provides you with a tangible methodology to make your innovation vi- sions a reality,” Zuber said. Innovating better patient care ANA offers RNs creative approaches to bring about change NURSING PRACTICE Christi Zuber February 2020 American Nurse Journal 35 “You can become part of microclimates or you can create them,” added Zuber, who is founder and man- aging director of Aspen Labs, a design and innova- tion consultancy practice based in Denver, with asso- ciates around the globe. “You can make an impact at the department level. Find peers, become an advo- cate, share stories, and people will see that you’re doing things in a different way. You might inspire an- other person or two, five, or 10 people—even an en- tire organization or practice. With the fluidity of net- works and social media, the sky is the limit.” Alternative way of thinking Nurses also can apply analogous thinking—using in- formation from another industry, for example, to find solutions to healthcare problems. “In thinking about how to get the influenza vaccine to more people, you might consider how restaurants use drive-throughs,” Zuber explained. “This is a tool in your methodology tool kit you can use. It helps to get us out of our men- tal valleys.” Learn more about nursing and creativity in Zuber’s article, “Creativity and innovation in health care,” in the January/March 2018 issue of Nursing Administration Quarterly . Speak up about accomplishments Nurses need to see the real power they have and ar- ticulate their value so they can insert their voices into conversations about innovation. “Don’t be shy about sharing your accomplishments and connecting with others to build real coalitions for change,” Zuber said. She also recommends that nurses invest in and build their leadership skills just as they do their clinical skills. “The more we show that there are nurses who are innovating and leading, the more nurses will see that they can do it, too,” Zuber said. Nursing perspective Workshop attendee Meenu Bansal, MSN, RN, CPN, clinical coordinator of products and technology, nursing professional practice, at Akron Children’s Hospital in Akron, Ohio, was recruited to her hospi- tal’s innovation center specifically to add a nurse’s perspective. She believes nurses are natural innova- tors because they’re accustomed to creating work- arounds on the job. “Nurses think creatively to make sure their pa- tients get the best care,” she said. Bansal was able to apply the tools she learned to the real-world envi- ronment. She is now working on several projects with the innovation center team, including one that’s in the prototype phase. “I love gener- ating ideas and helping narrow them down to what can potentially work,” she said. “Using the human- centered design model introduced in the workshop reminds me that even though business and technolo- gy are valuable, we always need to start with the us- ers and their values. It also helps us see the bigger picture.” — Elizabeth Moore is a writer at ANA. Innovation resources from ANA Visit ANA’s web portal Innovation in Nursing and Healthcare (nursingworld.org/practice-policy/in- novation-in-nursing), which includes ANA’s Inno- vation Roadmap, innovation framework (see framework, at left), and sections on nurse innova- tion highlights, resources for future nurse innova- tors, upcoming events, and awards. “The innovation roadmap: A guide for nurse lead- ers” covers the characteristics of innovation and the components of innovation and team collabo- ration. The roadmap is available for download at nursingworld.org/globalassets/ana/innovations- roadmap-english.pdf ANA’s online course bundle, “Creating an innova- tion culture and design thinking,” provides tools for exploring creativity in nursing and building your problem-solving skills, and a mastering de- sign-thinking module that will help stretch your imagination. The two courses in the bundle, “Creativity in nursing—America’s best kept secret” and “Creat- ing a culture of innovation: De- sign thinking and why it matters to nurses,” are presented by Karen Tilstra, PhD, a licensed ed- ucational psychologist and co- founder of several innovation labs. The bundle can be com- pleted at your own pace. To learn more and register, visit nursingworld.org/continuing-ed- ucation/creating-an-innovation- culture-and-design-thinking. Meenu Bansal36 American Nurse Journal Volume 15, Number 2 A NA Enterprise Chief Executive Officer Loressa Cole, DNP, MBA, RN, FACHE, NEA-BC, has been named one of Mod- ern Healthcare’s “100 Most Influential People in Healthcare.” This awards and recognition program honors individuals in healthcare who are deemed by their peers and an expert pan- el to be the most influential in the field. Modern Healthcare also honored Cole on its 50 Most Influential Clinical Executives list earlier this year. An accomplished healthcare leader, Cole was appointed as the ANA Enterprise CEO in 2018 and is active in many professional orga- nizations. Previously, she served as the American Nurses Credentialing Center executive director and executive vice president, president of the Virginia Nurses Association, and currently is a member of the American Organization for Nursing Leadership, the Virginia Organiza- tion of Nurse Executives, and the American College of Healthcare Executives. The “100 Most Influential People in Health- care” honorees come from all sectors of healthcare, including hospitals, health sys- tems, insurance, government, vendors and suppliers, policy, and trade and professional organizations. Cole and fellow honorees are high- lighted in the December 9, 2019, print edition of Modern Healthcare and online at ModernHealthcare. com. Nurses Making Policy: From Bedside to Boardroom , co-published by ANA and Springer Publishing Company, was named a 2019 Book of the Year by the American Journal of Nursing . The book, edited by ANA Past Presi- dent Rebecca Patton, DNP, RN, CNOR, FAAN; former ANA Board Member and American Nurses Foundation Chair Margarete Zalon, PhD, RN, ACNS-BC, FAAN; and Ruth Ludwick, PhD, RN-BC, APRN-CNS, FAAN, is a practical how-to guide written to help advanced students and nurse leaders develop health policy com- petencies to advocate for patients from the bedside to the larger political arena. The book examines the pivotal role of nurses involved in health policy, making it an essential resource for nurses pursuing advanced education and desiring to enhance their expertise in making policy and facilitating change. Read more at download.lww.com/wolterskluwer_vitalstream_com/PermaLink/ AJN/A/AJN_2019_12_04_AJN_0_SDC1.pdf. A merican Nurses Association (ANA) President Ernest Grant, PhD, RN, FAAN, participated in the Men in Nursing campaign, published by Media Planet as a supplement to USA Today in December 2019. The supplement raised awareness of resourc- es for men in nursing to provide support and advance their careers. “As the first man elect- ed president of ANA, I’m so proud of all the men who step up and bring their skills and voices to this vital profession,” Grant said. In his article, “Shattering myths about men in nurs- ing,” Grant expressed the need to promote realistic images of nurses and increase the diversity of nurs- ing across ethnicities and genders. Currently, about 9% of nurses in the United States are men. Grant al- so noted the high representation of men in nursing as nurse anesthetists. “A nursing workforce with strong diversity ensures that all patients and populations re- ceive optimal, empathic care that improves health literacy,” Grant said in the article, de- scribing nurses’ role in patient education. Grant also encouraged efforts to recruit more men into the nursing profession, noting the need to start early to create awareness of male role models in nursing and provide programs for high school students to learn about the opportu- nity to pursue nursing as a career. Read the supplement at educationandcareernews. com/campaign/men-in-nursing. ANA President Grant shares perspective in Men in Nursing campaign ANA Enterprise CEO among healthcare’s most in昀uential ANA book Nurses Making Policy receives accolades RECOGNITION Ernest Grant Loressa Cole February 2020 American Nurse Journal 37 IN BRIEF T he American Nurses Associa- tion (ANA) together with Johnson & Johnson launched SEE YOU NOW, a podcast that shines a light on the nurses chal- lenging the status quo as change catalysts in health and innovation. The podcast premiered January 28 to kick off the Year of the Nurse in 2020. “Nurses combine hands-on patient ex- perience, resourcefulness, and innate innovative mindsets that need to be broadly recognized, harnessed, and celebrated,” said Lynda Benton, senior director of corporate equity at Johnson & Johnson. “SEE YOU NOW aims to bring insights gained by nurses through di- rect patient care and across all aspects of the healthcare system to a broader audience, sparking ideas for future innovations in listeners wherever they may be in their careers and around the world.” SEE YOU NOW will prompt listeners to see nurses as they may never have before—as leaders, innovators, and entrepre- neurs with the power to improve patient care and help strengthen health systems. The podcast is host- ed by nurse economist and tech en- thusiast, Shawna Butler, MBA, RN. “Nurses are actively creating new solutions to redesign care delivery to meet the emerging needs of peo- ple and communities across the healthcare continuum,” said ANA Vice President of Innovation Oriana Beaudet, DNP, RN, PHN. “SEE YOU NOW acknowledges nurses’ rich his- tory of effecting change and show- cases the indisputable impact of the nursing profes- sion on the world we live in.” SEE YOU NOW is available for download on Apple Podcasts, Google Podcasts, Stitcher, and Spotify. For more information, visit seeyounowpodcast.com and follow the social conversation at #SeeYouNow. T he American Nurses Association (ANA) con- gratulates nurses for maintaining the #1 spot in Gallup’s annual Most Honest and Ethical Pro- fessions Poll for the 18th consecutive year. The Amer- ican public rated nurses the highest among a host of professionals, including medical doctors, dentists, and pharmacists. Nurses taking the top spot in Gallup’s most recent poll comes as ANA celebrates the “Year of the Nurse” in 2020, which was designat- ed by the World Health Organization (WHO) in honor of the 200th birth anniversary of Florence Nightingale. “I am extremely proud that nurses everywhere have been bestowed this won- derful accolade by the people whose lives they touch every day,” said ANA President Ernest Grant, PHD, RN, FAAN. “The fact that nurses have been consistently voted the most honest and ethical professionals is a testament to their commitment to patients and the greater good. We’ll work hard to keep their good faith throughout 2020 and beyond. I couldn’t think of a better way to enter into the Year of the Nurse.” According to the poll, 85% of Americans rated nurses’ honesty and ethical standards as “very high” or “high.” The second highest-rated professionals, engineers, were rated 19 percentage points behind nurses. “Gallup announcing nurses as the most trusted pro- fession is not only another reason to celebrate nurses during the Year of the Nurse, but also an opportunity to shine a light on this noble profession,” said Grant. “This milestone celebra- tion offers a platform to raise the visibility of nurses and increase the capacity of the nursing workforce. Nurses occu- py many roles in our so- ciety and are on the frontlines when it comes to immunizations, natural disaster preparedness, shaping health policy, and advocacy. For this reason, nurses are critical in improving the landscape of health and healthcare because an effective health- care system is one that values all nurses.” ANA will promote inclusivity and wide engagement of all nurses throughout the Year of the Nurse. This includes expanding National Nurses Week to a month-long celebration to elevate and celebrate the profession with all nurses and the public. Learn more at pages.nursingworld.org/yearofthenurse. New innovation podcast spotlights untapped nurse potential Nurses declared most honest, ethical for 18 years straight38 American Nurse Journal Volume 15, Number 2 T he January 31 topic of OJIN: The Online Journal of Issues in Nursing celebrates nurses and offers examples of practice changes by individual nurses and nursing organizations. Check out the six new articles in “The Year of the Nurse in 2020: Nurse led initiatives in policy, practice, and education.” “Nurses leading the way to better support family caregivers,” by Susan C. Reinhard, PhD, RN, FAAN, and Andrea Brassard, PhD, FNP-BC, FAAN, summa- rizes current evidence from the AARP Survey Find- ings and Update to inform nurses and other provid- ers about how to educate family caregivers through resources and discuss proactive outreach based on the CARE Act. Authors Ellen Martin, PhD, RN, CPHQ, CPPS, and Cindy Zolnierek, PhD, RN, CAE, offer exemplars il- lustrating state-level policies that regulate the prac- tice environment and discuss protections in “Be- yond the nurse practice act: Making a difference through advocacy.” “A nursing approach to the largest measles outbreak in recent U.S. history: Lessons learned battling home- grown vaccine hesitancy,” by Blima Marcus, DNP, RN, ANP-BC, OCN, describes this nurse-led outreach, provides useful tips to address vaccine hesitancy, and offers evidence-based answers to vaccine myths. Sofia A. Aragon, JD, BSN, RN, and her colleagues share the successes of Action Now!, a movement spearheaded by the Washington Center for Nursing, the Washington Board of Nursing, and the Council on Nursing Education in Washington State in the article, “Nurses at the table: Action Now! for nursing educa- tion.” In “Learning about rurality: From classroom to com- munity,” Ruth Mielke, PhD, CNM, WHNP-BC, FACNM, and colleagues share the experience of preparing women’s health advanced practice RNs to serve a population in rural California. Authors Michael Villeneuve, MSc, RN, FAAN, and Claire Betker, PhD, MN, RN, CCHN(c), offer examples of the impact of Canadian nurses and nursing associ- ations to build, overhaul, and improve health systems and influence health policy in their article, “Nurses, nursing associations, and health systems evolutions in Canada.” Read these stories and more at ojin.nursingworld.org. OJIN rings in the Year of the Nurse ANA NEWS Statement of ANA position ANA believes that nurses must provide compas- sionate, comprehensive, and person-centered care to all people, inclusive of at-risk populations such as people with IDD who experience health disparities across practice settings. The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or popu- lation, according to the ANA Code of Ethics for Nurses with Interpretive Statements . By virtue of their disability, people with IDD often require support across the lifespan, which encompasses support for the individual, family, caregiver, and community. Nursing care for people with IDD should focus on individual needs and strengths, rather than a diagnosis or label. Nurses are well positioned to advocate for the rights of people with IDD, as well as protect them from potential- ly harmful factors, such as victimization, abuse, neglect, and discrimination. Read the full statement on nursingworld.org at (bit.ly/36QAwfE). Making a difference P eople with intellectual and developmental disabilities (IDD) experience myriad dispar- ities related to healthcare and access to it. In 2019, the American Nurses Association (ANA) Board of Directors approved a position state- ment, Nurse’s Role in Providing Ethically and De- velopmentally Appropriate Care to People with Intellectual and Developmental Disabilities . This position statement is intended to support people with IDD by respecting and understanding differ- ences and enabling them to realize their full po- tential in health situations while building on exist- ing strengths and skills as active, engaged citizens, so that others can benefit from their tal- ents and abilities. February 2020 American Nurse Journal 39 To: Ethics inbox From: Concerned RN Subject: Bedside arraignments I am a medical-surgical nurse and admitted a pa- tient to my unit who was arrested and injured during the commission of an alleged crime. The hospital allowed a television news crew to come in- to my patient’s room and record his court arraign- ment, which will be aired on a local station. I feel this was a violation of patient privacy. How is this fair and what should I have done? From: ANA Center for Ethics and Human Rights Thank you for sending this challenging dilemma. First, the nurse’s ethical obligation is to the patient. Be sure your patient is medically stable and that you and your colleagues are safe. Next, determine if your hospital has a policy or resources to help resolve the issue so you can focus on patient care. Ideally, a person charged with a crime has a formal reading of charges filed in a courtroom. These ar- raignments can involve videotaping the process to prevent having to transport defendants to the court- room. However, an ethical dilemma presents when those charged become patients in a hospital, with the possibility of the arraignment being televised publicly. To understand the obligations of nurses in this situation, it’s important to understand the need to maintain the duty of care by protecting the rights of vulnerable populations, including the right to pri- vacy and confidentiality. The Code of Ethics for Nurses with Interpretive Statements (nursingworld.org/coe-view-only) spec- ifies that nurses must preserve the rights of vulner- able groups, including those who may be socially stigmatized. Nurses must safeguard the right to privacy for all patients. Provision 3.1 states, “The need for healthcare does not justify unwanted, un- necessary, or unwarranted intrusion into a person’s life. Privacy is the right to control access to, and disclosure or nondisclosure of, information pertain- ing to oneself and to control the circumstances, timing, and extent to which information may be disclosed.” Televised arraignments at the bedside may involve publicizing private patient information, including his or her location, that the patient hasn’t authorized. Furthermore, revealing this information could be un- safe for nurses and others at the hospital. For exam- ple, furtherance of the original alleged crime or acts of retaliation may place other pa- tients and staff at risk. Interpretive Statement 3.1 asserts that nurses must advocate for environments that “provide sufficient physical privacy, including privacy for dis- cussions of a personal nature.” As advocates for the patient, nurses must be vigilant in pursuing policy guidance from hospital leaders to address the privacy concerns and legality of the arraignment. Patient advocacy requires assess- ment of the patient’s condition. This should include how the pa- tient clinically responds to the ar- raignment and whether the condi- tions of the arraignment lead to health complications. The nurse also must determine whether the hospital arraignment is ethically appropriate for the patient. Nurses should consider factors such as safety, pa- tient autonomy, privacy, respect, and trust. Trust is central to the nurse-patient relationship (In- terpretive Statement 3.1), so nurses should help en- sure that personal health information is protected. Nurses are encouraged to demonstrate moral cour- age and advocate for patients in these difficult and often time-pressured situations. If nurses are work- ing in organizations that lack policies or standards regarding recording or videotaping patients, they are encouraged to bring these concerns to the orga- nization’s leadership team. — Response by Renata Iskander, intern, ANA Center for Ethics and Human Rights, and Liz Stokes, JD, MA, RN, director, ANA Center for Ethics and Human Rights Ethics of bedside arraignments Reference Legal Information Institute. Rule 10. Arraignment. law.cornell. edu/rules/frcrmp/rule_10 Do you have a question for the Ethics Inbox? Submit at ethics@ana.org. FROM THE ETHICS INBOX40 American Nurse Journal Volume 15, Number 2 W hen the ANA Enterprise launched Healthy Nurse, Healthy Nation TM (HNHN) with the goal of transforming the health of the na- tion by improving the health of the nation’s registered nurses, it was clear that support would be need- ed from others who care about nurses. The newest champion of nurses’ health is a global leader in healthcare support services— Compass One Healthcare. A com- bination of Crothall Healthcare and Morrison Healthcare, Compass One Healthcare has expertise in food and nutrition and provides a variety of other services including facilities management, laundry and linen, and patient transport. All of their business lines touch nursing in some way. Now they will join the HNHN national movement as a partner to support content and challenges related to nutrition. Nurses tend to have a suboptimum diet. The Office of Disease Prevention and Health Promotion and Di- etary Guidelines for Americans recommend that all individuals eat between three to five servings of whole grains and five to nine servings of fruits and vegetables daily. But in a 2019 HNHN survey, 72% of nurses said they consume three or fewer servings of fruits and vegetables daily. In the same survey, 30% of nurses said they don’t feel they have access to healthy food choices at work. Research shows that when clinicians are healthy, they provide better counsel to patients about healthy be- haviors. Research also has linked nutrition quality to decision making. “We need to innovate to help nurses be as healthy as they want to and can be. It requires us to engage with the most creative, committed healthcare partners,” said American Nurses Foundation Executive Director Kate Judge. “We believe our work with Com- pass One will inspire new solu- tions that can help nurses across the country and the globe. That, in turn, will help improve the health of patients.” “In our healthcare space, nursing is the cornerstone,” said Senior Vice President of Stra- tegic Partnerships Bart Kaericher. “That’s why this partnership with Healthy Nurse, Healthy Nation is so exciting for us. We can make a huge difference for our nurse partners by offering healthy and delicious meals and by taking some of the stress off by providing a safe environment of care.” HNHN engages more than 500 partner organizations and over 130,000 participants to act in five key do- mains—physical activity, rest, nutrition, quality of life, and safety. Both individuals and organizational part- ners can learn about HNHN by visiting hnhn.org. To make a financial contribution and support nurses’ health visit givetonursing.org. A merican Nurses Association (ANA) President Ernest Grant, PhD, RN, FAAN, officially kicked off the Year of the Nurse with a live interview January 14 on NPR’s 1A program. Grant and ANA Past President Pamela Cipriano, PhD, RN, NEA- BC, FAAN, shared insights on the state of nursing today, the challenges of the profes- sion and the value of nurses. Listen to the program and share the link (the1a.org/ shows/2020-01-14/calling-the-shots-in-the- year-of-the-nurse-and-midwife) with colleagues, friends, and via your social media channels. The ANA Enterprise is elevating and celebrating the essential, robust contributions of nurses as the world recognizes 2020 as the “Year of the Nurse.” By high- lighting the vital role of nurses, we aim to spur ex- panded investment in education, practice, and research, as well as increase the number of nurses who serve in leadership positions. Despite the high regard of the public, nurs- es are wholly underrepresented in media coverage of health care issues. Additionally, many myths and misperceptions about nursing persist. To help address this, we are asking nurses to share their stories, photos, and videos with ANA to help us communi- cate a contemporary and accurate view of nurses and the critical work we do. Be sure to visit ANA’s Year of the Nurse webpage (pages.nursingworld.org/yearofthenurse) for the of- ficial Year of the Nurse logo and updates on future activities. We can’t do it alone Kicking off the Year of the Nurse on NPR FOUNDATION NEWS ANA ENTERPRISE NEWSMyAmericanNurse.com February 2020 American Nurse Journal 41 PRACTICE MATTERS Key components for optimal staffing New principles help make this complex goal attainable. By Kendra McMillan, MPH, RN N URSE STAFFING is essential to the delivery of safe, quality healthcare in every practice setting. Nurses have a unique knowledge and under- standing of how to respond to changing patient and unit needs, making them critical stakehold- ers in staffing decisions and how those deci- sions play out. Staffing is more than just num- bers; it’s an equitable distribution of nursing resources across units and shifts. So, what’s necessary to make optimal staffing a reality? In 2019, the American Nurses Association (ANA) released an update to its Principles for Nurse Staffing ( nursingworld.org/PrinciplesFor NurseStaffing ). The principles address the key components needed to achieve optimal staffing and patient outcomes, as described here. The patient. Staffing decisions should be based on individual patient needs, stability, di- agnosis severity, and required care. What’s the level of direct care needed per patient and what are the care and discharge planning needs? Also consider age- and language-spe- cific resources, time spent on transfers off the unit for procedures, patient and family educa- tional needs, and the availability of family and social support. Staffing guidelines should be based on patient safety indicators and accom- panied by enough resource allocation for care coordination and patient education. Nurse and healthcare team. The nurse’s individual characteristics—including experi- ence, knowledge, skill set, educational prepa- ration, and competence with technology and clinical interventions—directly affect care out- comes. After considering the patient’s needs, what’s the skill level of the nurse and health- care team, and how do you match the two? Does the person in charge of staffing under- stand the skill level of each healthcare team member to ensure appropriate matching? Are ancillary staff available to carry out non-nurs- ing tasks? Staffing plans require flexibility to adapt to changes in patient status and to ac- commodate for admissions, transfers, and dis- charges. Staffing also must account for the al- location of time and resources needed for mentoring and skill development activities. Organization and workplace culture. Optimal staffing balances safe, quality care with nursing resources and costs. When achieved, nurses are practicing to the full extent of their education and licensure and have the neces- sary resources to provide care. A healthy work environment with a value-based culture that supports respect, trust, collaboration, and eth- ical decision-making within the healthcare team is essential to patient care and staffing alignment, and it’s vital for nurse satisfaction. Practice environment. A culture of safety plays an integral role in achieving appropriate staffing. Unit-by-unit changes within a shift re- quire continuous monitoring and real-time ad- justments to provide optimal care. A supportive practice environment with clear policies facili- tates nurse well-being and allows adequate time for meal and bathroom breaks, overtime regula- tion, and limits on shift length to ensure that staff health and safety needs are met. Nurses have a professional obligation to report unsafe conditions and inappropriate staffing levels and the right to do so without the fear of reprisal. Evaluation. The evaluation plan must be valid and reliable and accurately capture the outcomes, costs, and time needed to provide nursing care. Ongoing assessment of an orga- nization’s overall health with respect to turnover, retention, frequency of overtime, and the need for supplemental staffing also are es- sential elements to watch. Appropriate nurse staffing is an asset to our ever-evolving healthcare system. Viable solu- tions for optimal staffing may be complex, but they are attainable. AN Kendra McMillan is senior policy advisor for the American Nurses Association, Nursing Practice and Work Environment department. A culture of safety plays an integral role in achieving appropriate staffing.Next >