Canadian Community Health Nursing Standards of Practice (CCHN ...

Step 2b. Assessing the
Organizational Environment.
The key objective of this step is to assess the organizational
environment with a view to integrating the CCHN Standards
into the existing structures and processes that support quality
practice. Knowing what is already in place provides a basis
for change. Teams may feel reluctant to do this type of
assessment because it is outside their normal responsibilities.
However, it is important to identify what is or is not available
in order to be able to work with the supportive factors and
overcome the challenging ones.
Increasingly, governments and professional nursing
organizations are recognizing the importance of quality
practice environments to ensure safety, support and respect
for all persons in the work environment (Canadian Nurses
Association, 2001; College and Association of Registered
Nurses of Alberta (CARNA), 2003; College of Registered
Nurses of British Columbia (CRNBC), 2005; Nurses
Association of New Brunswick (NANB), 2005; O'Brien-
Pallas et al., 2005). The CNA has identified five attributes of
a quality practice environment. These are:
Organizational supports: The organization’s mission,
values, policies and practice should support and value nurses
and the delivery of safe and appropriate nursing care.
Professional development: Professional development is
more than the annual performance appraisal. It begins with
hiring and includes introducing new staff into the
organization, promoting continuing education and reflective
practice, position-specific training and promoting professional
development. The CCHN Standards can contribute to
professional development by providing consistency in the
development of job descriptions and performance assessment,
and provide a framework to guide continuing education. The
availability of nursing human resources is an issue across
Canada. An organization that supports and encourages a
lifelong learning philosophy and promotes a learning
environment is more likely to recruit and retain nurses.
Nursing leadership: There should be competent and wellprepared
nursing leaders at all levels in the organization.
Workload management: There should be sufficient nurses
to provide safe, competent, ethical care.
Control over practice: Nurses should have responsibility,
authority and accountability for nursing practice.
These attributes have been translated into quality of work
life indicators (QWIs) that make a measurable difference for
professional nurses. The indicators are being incorporated into
the Canadian Council on Health Services Accreditation’s
(CCHSA) 2004 Achieving Improved Measurement (AIM)
Accreditation Program, which is used to accredit healthcare
organizations in Canada (CCHSA, 2004). The CCHN
Standards speak to the community health nurse’s
responsibility with regard to the practice environments;
incorporating the Standards into administrative tools will
further facilitate integration of the Standards and contribute to
a quality practice environment.
If all five attributes are available at a high level, it is likely
that integration of the CCHN Standards will be relatively
straightforward. If some are at a low level, the team will not
be able to work as quickly. By doing the stakeholder
assessment and organizational environmental scan together,
the team will be able to see where opportunities exist and
develop a realistic action plan.
The Environmental Scan Worksheet is designed to gather
information on the attributes of a quality work environment
as outlined above. Sample information is included. A blank
worksheet can be downloaded from the CD.
Envir onm ent
16 Community Health Nurses Association of Canada