Elevating professional well-being in healthcare

Abstract

A crosswalk of the NIOSH Impact Wellbeing^™ campaign and the ANCC Pathway to Excellence^® Framework

Since 2007, the American Nurses Credentialing Center’s (ANCC’s) Pathway to Excellence^® and Pathway to Excellence in Long-term Care^® Programs have gained international attention for providing healthcare organizations with an evidence-based blueprint for cultivating positive practice environments. The Pathway framework comprises six evidence-based and essential standards found in positive practice environments: Shared Decision-Making, Leadership, Safety, Quality, Well-Being, and Professional Development (see Figure 1). Pathway organizations worldwide have reported that integration of the Pathway framework translates to improved quality of care and enhanced professional nursing outcomes.¹

Figure 1:

ANCC Pathway to Excellence Framework

In recent years, addressing healthcare workers’ mental wellness and promoting professional well-being have risen to the forefront as critical imperatives for healthcare organizations worldwide. Findings from a 2023 Vital Signs report from the CDC, which revealed that 46% of healthcare workers reported experiencing burnout, underscore the urgency of this issue.² Moreover, as highlighted in the Addressing Health Worker Burnout report from the US Surgeon General, failure to proactively address mental wellness in work environments contributes to alarming rates of healthcare workers leaving their positions.³ The effects of burnout are far-reaching, extending beyond individual healthcare workers to impact various aspects of the complete healthcare ecosystem, such as quality of care, organizational productivity, and healthcare system sustainability.

In response to these challenges and to ensure that future healthcare workers can thrive, CDC’s National Institute for Occupational Safety and Health (NIOSH) developed the Impact Wellbeing^™ campaign to support hospital leaders, and in turn, their healthcare workforce, to enhance professional well-being.⁴ As part of the campaign’s resources, NIOSH, in partnership with the Dr. Lorna Breen Heroes’ Foundation, developed the “Impact Wellbeing Guide: Taking Action to Support Healthcare Worker Wellbeing.” The guide equips hospital leaders with six evidence-informed actions to reduce burnout and sustain healthcare worker well-being.⁵ This article explores the common ground between the ANCC’s Pathway to Excellence program and NIOSH’s Impact Wellbeing Guide, highlighting how both resources can provide hospital leaders with evidence-based tools to enact meaningful change, enhance worker well-being, and elevate organizational cultures in healthcare settings.

NIOSH’s Impact Wellbeing Guide

The Impact Wellbeing campaign provides hospital leaders with evidence-informed solutions to reduce healthcare worker burnout and sustain professional well-being.⁴ By equipping hospital leaders with actionable strategies to enhance professional well-being, the Impact Wellbeing campaign aims to provide hospital leaders with supplementary resources to accelerate their work in fostering environments in which healthcare workers thrive. The “Impact Wellbeing Guide: Taking Action to Improve Healthcare Worker Wellbeing” is central to the campaign’s efforts.⁵ The guide is specifically designed to assist hospital leaders in improving operational-level issues and, in turn, professional well-being by providing six evidence-informed actions:

1. Review Your Hospital’s Operations

2. Build Your Professional Wellbeing Team

3. Break Down Barriers for Help-Seeking

4. Communicate Your Commitment to Professional Wellbeing

5. Integrate Professional Well-being into Quality Improvement

6. Develop Your Long-Term Professional Wellbeing Plan

The comprehensive guide was real-world tested at six US hospitals and revised to incorporate practical insights. It’s built upon best practices and evidence-informed strategies designed to support leaders in fostering a work environment that prioritizes the well-being of healthcare workers. By focusing on operational-level interventions, the Impact Wellbeing Guide intends to empower hospital leaders with tools and resources to employ at their organizations to alleviate burnout and promote a culture of support.

ANCC’s Pathway to Excellence Well-Being Standard

To further emphasize well-being, a standard dedicated to well-being was integrated into the Pathway framework in 2016, combining previous criteria regarding compensation, recognition, and a balanced lifestyle. The introduction of the comprehensive Well-Being Standard highlights the program’s commitment to prioritizing clinicians’ mental, physical, and psychological health. The Elements of Performance (EOPs) included in Pathway’s Well-Being Standard emphasize the importance of organizations proactively assessing clinician well-being, implementing support processes to mitigate mental and physical stressors, and safeguarding nurses and other members of the healthcare team from the damaging effects of workplace violence, compassion fatigue, and burnout.⁶

Moreover, the Well-Being Standard includes essential principles, such as interprofessional collaboration, inclusivity, and the meaningful recognition of nurses’ contributions, which further enhance the overall quality of the practice environment and promote professional well-being.⁶ During the development of the 2024 Pathway Application Manual, the Well-Being Standard was further optimized to include EOPs to address raising awareness of mental health issues prevalent among nurses, optimizing organizational strategies to improve mental health and psychological safety, and implementing meaningful initiatives to enhance nurse leader well-being.

The alignment between the Impact Wellbeing Guide and the Pathway framework is evident in the shared mission to prioritize and enhance healthcare workers’ professional well-being (see Table 1). One key area of alignment is their joint emphasis on proactive organizational assessments. Action 1 of the Impact Wellbeing Guide emphasizes the need for hospital leaders to conduct an operational assessment to identify existing workflows and systems that either support or hinder staff well-being. Similarly, the Pathway framework’s Well-Being Standard highlights the importance of organizations proactively assessing clinicians’ physical and mental well-being, specifically to aid in developing and implementing the support processes to promote resilience and prevent burnout.

Table 1:

Crosswalk of the Impact Wellbeing Guide and the Pathway to Excellence Framework

NIOSH Impact Wellbeing Guide	ANCC Pathway to Excellence® Framework
Guide intended user: Hospital leaders who can make systems-level changes, including executive, C-suite level sponsors. Provides concrete steps to help leaders accelerate or supplement their work on professional wellbeing, no matter where they are in their journey.	Intended user: Healthcare leaders; evidence-based blueprint for creating practice environments where nurses and the healthcare team feel supported, empowered to participate in decision-making, and where their well-being is prioritized. The Pathway Framework for Positive Practice Environments identifies essential elements referred to as Elements of Performance (EOP) in the following standards:  Standard 1: Shared Decision-Making  Standard 2: Leadership  Standard 3: Safety  Standard 4: Quality  Standard 5: Well-Being  Standard 6: Professional Development Pathway-designated organizations across the globe have reported that adoption and integration of the Pathway framework results in improved quality of care and enhanced professional nursing outcomes.
Action 1: Review Your Hospital’s Operations Purpose: The purpose of Action 1 is to connect with colleagues within your organization to gather information about current efforts that support healthcare workers’ wellbeing. Capturing this information is an essential and foundational step to implementing the guide at your hospital so you can build on existing wellbeing work and avoid duplication. Key concept: Reviewing your hospital’s current operations is the first step to understanding how your hospital supports the wellbeing of healthcare workers. This action equips you with a high-level summary of efforts already underway, so you’re not duplicating energy and resources.	Standards 1 and 5 Pathway organizations foster a culture of interprofessional shared decision-making and demonstrate a commitment to enhancing the overall well-being of their workforce. They regularly assess employees’ unique physical and mental wellness needs, implementing targeted initiatives to address these needs. Nurses play an active role in discussions and the selection of well-being initiatives. Intent: By involving the workforce in these discussions and decisions, organizations increase the likelihood that the selected initiatives will be utilized and result in meaningful impact.
Action 2: Build Your Professional Wellbeing Team Purpose: The purpose of Action 2 is to assemble a Professional Wellbeing Team that will lead efforts in your hospital in support of professional wellbeing. Key concept: Building a Professional Wellbeing Team ensures that executive leadership commits time and resources to protect, improve, and sustain the professional wellbeing of healthcare workers. Building this team keeps professional wellbeing centered in your hospital’s operations without putting the work only on one position or department. It also serves as a dedicated resource to assess and address working conditions, implement an action plan, and communicate progress to leadership and staff. Additional context: The guide recommends that the Professional Wellbeing Team is cross-department and multidisciplinary, including members from executive leadership, the healthcare workforce, patient safety and quality teams, diversity, equity, and inclusion (DEI) teams, etc.	Standards 1, 2, 4, and 5 Improving organizational culture requires commitment from everyone. Senior leaders at Pathway organizations demonstrate their commitment to enhancing staff well-being and resilience by integrating purposeful goals into the organization’s strategic plan, ensuring that strategic goals and objectives remain a priority through periods of change. The CNO advocates for nurses and serves as a role model for nurse managers, who safeguard well-being at the unit level. Pathway organizations foster a culture of diversity, equity, inclusion, and belonging (DEIB); they encourage and value the sharing of different perspectives, innovative thought, and respectful interprofessional collaboration to optimize their workforce and improve quality outcomes. Intent: Effective, intentional strategic planning is a key driver of organizational change and establishes the foundation for cultural transformation. Incorporating both interprofessional collaboration and shared decision-making ensures input from the multidisciplinary team is heard. Doing so increases the likelihood of program acceptance among participants, ensuring an ongoing, organization-wide focus on workforce well-being despite any planned or unplanned leadership or organizational changes.
Action 3: Break Down Barriers for Help-Seeking Purpose: The purpose of Action 3 is to review and update your hospital credentialing application questions and identify confidential ways for healthcare workers to seek support. Key concept: Data show that intrusive and stigmatizing questions on hospital credentialing applications prevent many healthcare workers from seeking help. Auditing and updating hospital credentialing questions removes barriers to care. It also sends a clear message to healthcare workers that your hospital supports their mental health. Additional context: The guide provides additional information about how to reduce barriers to help-seeking among unlicensed or uncredentialed healthcare workers. For example, healthcare workers who access mental health and substance use support or counseling at the hospitals where they work are often treated by their colleagues. This can lead to loss of confidentiality and risk of facing both individual and social stigma. It is strongly encouraged that hospitals provide an alternative outside of their hospital network, such as through a different hospital or an unaffiliated online platform.	Standard 5 Pathway organizations foster a psychologically safe work environment and are committed to supporting the mental health of their employees. They aim to both normalize the dialogue about mental health struggles and mitigate factors that prevent employees from seeking help. Intent: Increased awareness of mental health issues and available organizational resources contributes to the overall well-being of nurses and the healthcare team. Recognizing, addressing, and offering evidence-based strategies to enhance mental well-being during work hours encourages a proactive approach to mental health, fostering a culture that values self-care and seeks support when needed.
Action 4: Communicate Your Commitment to Professional Wellbeing Purpose: The purpose of Action 4 is to develop a plan for two-way communication with hospital staff about your wellbeing work. Communicating with your workforce helps build trust between leaders and workers, generates buy-in, and creates opportunities for staff to provide feedback. Key concept: Clear, consistent, and open communication with staff is an essential part of professional wellbeing. Developing a plan to communicate about wellbeing work throughout the process helps keep your healthcare workforce informed and able to give input about: changes your Professional Wellbeing Team is making, how it positively impacts them, and what is to come.	Standards 3 and 5 CNOs and nurse managers at Pathway organizations are accessible and foster bidirectional communication between direct care staff and leaders. They empower direct care nurses to openly communicate about issues or concerns that impact their well-being, creating a safe environment that empowers healthcare workers to openly provide feedback without fear of retribution. Pathway organizations seek direct care nurses’ input when selecting well-being initiatives for implementation, ensuring meaningful initiatives will be selected based on the expressed needs of the nurses. Intent: Creating a culture of respect and two-way communication between employees and leaders builds trust and encourages employees to continue to share concerns. Staffing concerns often lead to increased stress and burnout among healthcare workers. A safe environment that allows healthcare workers to participate in planning well-being initiatives, create schedules that promote their personal well-being, voice concerns about patient safety, and work collaboratively with managers increases job satisfaction and retention.
Action 5: Integrate Professional Wellbeing into Quality Improvement Purpose: The purpose of Action 5 is to integrate professional wellbeing measures into an ongoing quality improvement project at your hospital. It is important to consider the impact on your workforce when undertaking any quality improvement project, regardless of whether or not it seems directly related to wellbeing. Key concept: Hospitals must take steps to ensure that healthcare workers can do their work while limiting administrative and operational burdens. It is important to consider how projects aiming to address these burdens could impact your healthcare workforce. Quadruple Aim Quality Improvement recognizes professional wellbeing as a key outcome that is essential to improving your hospital.	Standards 3 and 4 Pathway organizations emphasize and prioritize the well-being of their employees. They foster interprofessional collaboration to improve quality outcomes, including staff well-being, through providing opportunities for multidisciplinary teams to work collectively to meet measurable quality indicator targets. Direct care nurses at Pathway organizations participate in processes to select, implement, and evaluate new technology or innovations intended to streamline workflows, reduce burdens, and enhance the practice environment. Intent: When staff feel that they are valued and that their well-being is a priority, engagement improves and staff are more likely to contribute to advancing the mission, vision, and quality outcomes at the organization. Interprofessional collaboration assists in equally distributing the workload across teams to alleviate administrative burdens while also ensuring the voices of relevant stakeholders are considered.
Action 6: Develop Your Long-term Professional Wellbeing Plan Purpose: The purpose of Action 6 is to develop a Professional Wellbeing Plan that sustains your hospital’s commitment to professional wellbeing. Key concept: To sustain an environment where healthcare workers thrive, it is essential to create a long-term Professional Wellbeing Plan. The plan should include goals for individual support, measurement, and operational improvement over three specific time periods. Additional context: The guide recommends that the plan include the following categories: (1) individual support goals (focus on improving individual professional wellbeing among staff); (2) measurement goals (focus on continuously assessing professional wellbeing among staff); and (3) operational improvement goals (focus on implementing operational changes that support professional wellbeing).	Standards 4 and 5 Senior leadership at Pathway organizations integrate well-being into the strategic plan, communicating the organization’s ongoing commitment to enhancing overall workforce well-being. The organization continually assesses the unique physical and mental wellness needs of its workforce and fosters interprofessional collaboration to develop evidence-based initiatives to address those needs. Intent: Including well-being in the organization’s strategic plan ensures continuous assessment of employee well-being and evaluation of measures to prevent and address burnout year-round. Prioritizing well-being creates a more resilient workforce. When healthcare workers feel their well-being is a priority, they are more likely to be engaged in their work, contributing positively to the organization’s overall performance.
Associated reference(s): www.cdc.gov/niosh/impactwellbeing www.cdc.gov/niosh/impactwellbeing/guide/	Associated reference(s): www.nursingworld.org/~49b95d/globalassets/organizational-programs/pathway-to-excellence/resources/pathway-to-excellence-relevant-literature.pdf nursingworld.org/pathway

Additionally, the Impact Wellbeing Guide and the Pathway program both recognize the importance of an organization-wide, interprofessional approach to addressing burnout and promoting professional well-being in healthcare settings. Action 2 of the Impact Wellbeing Guide encourages leaders to assemble an interprofessional team devoted to professional well-being, ensuring that the work is centered within the hospital’s operations without assigning responsibility to only one position or department. Similarly, the Pathway framework’s Shared Decision-Making and Leadership standards advocate for interprofessional collaboration as a core component of positive practice environments, promoting camaraderie, inclusivity, and belonging among healthcare professionals to improve quality of care and professional well-being.

Through their shared focus on proactive assessment, collaboration, and inclusivity, the Impact Wellbeing Guide and the Pathway program work in tandem to increase awareness of and destigmatize mental health issues prevalent among healthcare workers. Recognizing, addressing, and offering evidence-informed strategies to enhance mental well-being during work hours encourages a proactive approach to safeguarding mental health, fostering an organizational culture that encourages staff to seek support when needed. By aligning the principles and objectives of the Impact Wellbeing Guide with the Pathway framework and associated EOPs, hospital leaders can develop comprehensive strategies to enhance professional well-being among healthcare workers and cultivate a supportive organizational culture that prioritizes mental health at the same level as operational performance.

Implications for practice and policy

By integrating the actions in the Impact Wellbeing Guide with the essential standards in the Pathway framework, healthcare leaders demonstrate their commitment to advancing professional well-being by improving the operational-level issues. The evidence-based standards in the Pathway framework provide a blueprint for fostering staff engagement, empowerment, and organizational excellence. When combined with the Impact Wellbeing Guide’s focus on reducing burnout and sustaining professional well-being, healthcare organizations gain a comprehensive strategy to address the holistic and operational needs to improve professional well-being.

By implementing the actions outlined in the Impact Wellbeing Guide and the EOPs within the Pathway framework, hospital leaders can proactively assess organizational practices, build interprofessional teams dedicated to well-being, and demonstrate their commitment to supporting staff. These efforts address immediate concerns related to burnout and mental illness and aid in developing long-term plans to foster a culture of continuous support within healthcare organizations.

Furthermore, the integration of the Impact Wellbeing Guide and the Pathway framework has significant policy implications for healthcare settings in the US. By embracing these frameworks, policymakers and organization leaders not only improve staff satisfaction and patient outcomes but also contribute to the development of national policies that prioritize the mental health and well-being of the healthcare workforce. As healthcare organizations strive to meet the standards set forth by accrediting and regulatory bodies, policymakers can leverage the alignment of these frameworks to identify systemic gaps and develop recommendations for promoting professional well-being beyond the organization-level healthcare setting.