Pathway Practice Standards are based upon expert nurse input, nursing literature and research that supports the qualities of a positive practice environment. All 12 standards apply to health care organizations and long term care institutions. Additional standards apply to the long term care environment.
1. Nurses Control the Practice of Nursing
A shared governance model centers a healthy work environment for nurses. RNs directly involved in decisions that affect nursing practice with demonstrated autonomy and responsibility experience higher job satisfaction and contribute to improved quality of care and safety for patients. 3, 10, 11, 15
2. The Work Environment is Safe and Healthy
An environment where safety is paramount for both nurses and patients is essential to the delivery of quality nursing practice. Studies indicate that work environments with a culture of safety demonstrate a reduction in work-related injuries. 16, 25 A supportive work environment that encourages the health and well-being of staff is also essential.
3. Systems Are in Place to Address Patient Care & Practice Concerns
Pathway-designated organizations provide dispute mechanisms to address patient care and practice concerns without retribution. Silence and poor communication lead to patient safety issues and reduced job satisfaction. 2, 20 In 2009, the Joint Commission recognized implemented a standard to address conflict-and-dispute resolution in health care.17 In A study by Siu, Laschinger, and Finegan demonstrated that positive work environments enhance nurses' conflict-management skills, thus influencing unit effectiveness.22
4. Orientation Prepares Nurses for the Work Environment
An orientation program for all nurses new to the organization must be in place. Studies show a conscious orientation to the profession for new graduate nurses creates a profound effect on nurse turnover, retention, and satisfaction.18, 21 A comprehensive orientation can impact a nurse's decision to stay at an organization and can influence the level of quality care delivered.4
5. The CNO is Qualified & Participates in All Levels of the Organization
The Chief Nursing Officer ( CNO) is the highest nursing authority within a health care organization with the proper qualifications and a seat at the executive table for decisions about patient care delivery. The influence of CNO leadership on nursing care and patient care quality is identified as a key element for elevating nursing practice.8
6. Professional Development is Provided & Used
Health care organizations that offer professional development opportunities have higher RN job satisfaction and retention rates.26 Development opportunities may include career ladders, continuing education, certification, involvement in professional nursing organizations, and academic degrees. Fostering nurses' professional development results in increased knowledge and quality.9, 29
7. Equitable Compensation is Provided
Compensation influences a nurse's decision about where to work and where to continue working.14 Compensation is routinely evaluated in Pathway to Excellence organizations.
8. Nurses are Recognized for Achievements
Recognition is an important factor in nurse retention and satisfaction and confirms nurse contributions are valued. A study by Tourangeau and Cranley showed praise and recognition are key predictors in nurses' intention to continue working in their organization.24 Nurse achievements are known to colleagues and consumers alike .
9. A Balance Lifestyle is Encouraged
Nurses who work in an environment that encourages a healthy work–life balance are more likely to be satisfied.19, 28 Further, Leiter and Laschinger discovered a professional practice environment plays a key role in predicting nurse burnout.13 Nurses must care for themselves so they can provide optimal care to those in need. Programs to enhance work-life balance may include flexible scheduling, childcare, employee assistance, and wellness programs.
10. Collaborative Relationships are Valued & Supported
A collaborative atmosphere supports a culture of safety that results in better patient outcomes and greater job enjoyment and satisfaction.3, 12, 15, 27 Healthy work environments demonstrate collaboration among health care professionals as a key component for the delivery of safe, quality care, with the added benefit of higher job satisfaction for all disciplines involved.
11. Nurse Managers are Competent & Accountable
Strong nursing leadership is one of the top reasons nurses stay at an organization. Nurses who trust their leaders and work in an open environment that embraces patient safety are more likely to continue on the job.3, 5, 23, 27 Nurse managers must possess the knowledge, skills, and experience to effectively perform their roles and be accountable for outcomes.
12. A Quality Program & Evidence-Based Practice are Used
Evidence-based practice is an essential component of improved patient outcomes.7 A robust quality program with clinical decisions based on solid evidence translates into better patient outcomes. Nurses play a key role in quality initiatives for patient care improvements, and lead efforts to implement best practices in patient care.
In addition to the practice standards above, long term care institutions are required to meet standards unique to their health care setting.
- Certified Nurse Assistants (CNAs) are included in the nursing community.
- Educational standards are temporarily established for Directors of Nursing (DON).
- Standards about staff education regarding zero tolerance of resident abuse and neglect; and policies/protocols on the use of restraints and prevention of falls.
- A person-centered model of care is understood.
Learn more about Pathway to Excellence in Long Term Care®.