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Health SA Gesondheid (Online)

versão On-line ISSN 2071-9736
versão impressa ISSN 1025-9848

Health SA Gesondheid (Online) vol.27  Cape Town  2022 



Best practice recommendations for healthy work environments for nurses: An integrative literature review



Jean F. MabonaI; Dalena (R.M.) van RooyenII; Wilma Ten Ham-BaloyiII

IDepartment of Nursing Science, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
IIFaculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa





Healthy work environments that maximise the health and well-being of nurses are essential in achieving good patient and societal outcomes, as well as optimal organisational performance. While studies have been conducted on healthy work environments, there is no available evidence that an integrative literature review summarising best-practice recommendations related to healthy work environments has been conducted before. This review aimed to summarise existing best-practice recommendations related to a healthy work environment for nurses. An integrative literature review following the approach adapted from Whittemore and Knafl was used. Existing guidelines related to healthy work environments for nurses were searched. EBSCOhost (CINAHL, Medline), Biomed Central, Science Direct, PubMed and Google Scholar and organisational websites via Google were searched, followed by a citation search. Twelve guidelines were identified for data extraction and synthesis, and themes were subsequently formulated. Four themes emerged from the integrative literature review regarding a healthy work environment for nurses: (1) the need for effective nursing leadership, (2) effective communication as central to enhancement of a healthy environment, (3) effective teamwork as an integral part of a healthy work environment and (4) the need for professional autonomy. In summary, a healthy work environment for nurses requires leadership, effective communication, teamwork and professional autonomy.
CONTRIBUTION: The findings can be used to conduct quality studies related to healthy work environments for nurses in comprehensive health care settings, particularly those dealing with resource constraints. This can inform evidence-based recommendations and guidelines in these settings, as such guidelines are currently lacking

Keywords: best-practice recommendations; guidelines; healthy work environment; integrative literature review; nurses.




Healthy work environments that are caring and supportive to health professionals, including nurses, within their respective health organisations are vital (Wei et al. 2018). Healthy work environments are imperative to enhance recruitment and retention of health professionals, including nurses, and to maintain an organisation's financial viability (American Association of Critical-Care Nurses 2016; Shea 2015).

The Registered Nurses Association of Ontario (RNAO 2010:2) defines an optimal work environment as 'a practice setting that maximizes the health and well-being of professional nurses, quality patient or client outcomes, organizational performance and societal outcomes'. Several studies have identified a range of components as necessary for the existence of a healthy work environment, including Twigg and McCullough (2014), Guirardello (2017) and Maurício et al. (2017). These studies show that effective leadership at the organisational level must be present for leadership growth to be fostered in staff. Effective communication practices are critical. It is imperative that nurses participate in decision-making processes concerning patient care and that they should have a significant measure of professional autonomy and control over their environment.

Furthermore, an adequate number of staff, a steady supply of new entrants to the profession and an appropriate skill mix should be present and there should be recognition of the efforts and achievements of staff members (Moses 2021). Teamwork and collaboration are important in a health care team. Nurses play a vital role in health professional teams to ensure that the health system provides improved access to health services, high-quality patient care and sustainable and affordable health care systems (Manoj, Brough & Kalbarczyk 2020).

While studies have been conducted on healthy work environments, there is no available evidence that an integrative literature review summarising best practices related to healthy work environments has been conducted before. Thus, there is a need for this review aimed at summarising existing best-practice recommendations related to a healthy work environment for nurses.



This integrative literature review was conducted using five stages adapted from Whittemore and Knafl's (2005) approach. This study was part of a larger doctoral study aiming at developing a best-practice guideline for a healthy work environment for professional nurses working in the South African Military Health Service (Mabona 2018). This review was conducted by the first author under the supervision of the second author.

Review question

A focused review question was formulated using the acronym PICO as follows:

P- (Population or participants) = Nurses

I- (Intervention) = Guidelines for a healthy work environment

C- (Context) = Comprehensive health care settings (hospitals and clinics)

O- (Outcome) = Nursing staff that is supported and cared for.

The review question that was formulated to search for the relevant literature was the following: What existing guidelines are available regarding a healthy work environment for nurses in comprehensive health care settings?

Search for evidence

The following sources (both electronic and print) were accessed: EBSCOhost (CINAHL, Medline), Biomed Central, Science Direct, PubMed and Google Scholar. Organisation sites, such as those for the RNAO and National Institute for Health and Care Excellence (NICE), were searched via Google using a combination of key words. This was followed by checking of reference lists of relevant guidelines for further relevant literature. The search was conducted in March 2017 and updated in August 2021.

The following key words were used to facilitate the search: 'healthy OR positive work environment' AND 'best practice guidelines' AND 'nurse*' AND 'health care'. An experienced librarian was consulted to ensure a comprehensive search strategy.

The selection of the eligible evidence-based best-practice guidelines to be amalgamated into the research study was guided by the following inclusion and exclusion criteria. All Level I available evidence-based guidelines, according to LoBiondo-Wood and Haber's Levels of Evidence hierarchy (2017), focusing on healthy work environment for nurses and whose outcomes were enhanced work environments in comprehensive health care settings (hospitals and clinics), published in English (to avoid translation costs) between 2003 and 2021 (because of the scarcity of best-practice guidelines and as literature regarding the concept 'healthy work environment' dated around this period), were included. Because of the scarcity of guidelines, all guidelines related to health care professionals in general that included nurses as the target population were included. Only the latest version of a relevant guideline was included. Guidelines regarding healthy work environments outside of health professions and duplicated guidelines were excluded from the study.

The selection process involved reading titles and abstracts of the guidelines. Full texts of potentially relevant guidelines were obtained and read, using the inclusion and exclusion criteria to determine inclusion in the review. A total of 15 guidelines on healthy work environment for nurses were identified in the initial search. Of the 15 guidelines, two were duplicated and one was not considered for the study as this guideline did not meet the inclusion criteria (the population was not nurses). Thus, a final 12 guidelines were included in the critical appraisal process (see Figure 1).



Critical appraisal

Relevant guidelines were critically appraised by the first author and independent reviewer, using the Appraisal of Guidelines for Research and Evaluation (AGREE II) Instrument (Brouwers et al. 2016). This instrument assesses 23 items over the following six main domains: the scope and purpose of the guideline, stakeholder involvement, rigour of the guideline development, clarity and presentation of the guideline, and editorial independence of the developers, followed by two global rating items (Overall Assessment) (Brouwers et al. 2016). The highest score that can be attained by a single item is 7 and the minimum score is 1. The overall highest score for the six domains is 161 while the lowest is 23.

The percentage per guideline was calculated by dividing the score obtained by 161 and multiplied by 100. All guidelines that weighed 60% and above were regarded as rigorously developed and were therefore recommended and allowed for use in the current study. After critical appraisal was completed by both reviewers, consensus was reached to include all 12 guidelines for data extraction and synthesis (see Figure 1).

Data extraction

After critical appraisal, the data were extracted from the 12 guidelines. Data extraction focused on the objective of the guideline, the target population of the guideline, the guideline development group, systematic methods that were used to search for evidence, the criteria for selecting evidence, the methods for formulating the recommendations and, lastly, if the views of the funding body had not influenced the content of the guideline (see Table 1).

Data analysis and synthesis

Thematic analysis according to Cooper (1998) was used to synthesise the extracted data related to the major recommendations regarding healthy work environment for nurses. The extracted data were compared item by item, ordered, coded and categorised. Coded categories were further compared whereafter data were grouped together under themes and sub-themes. This analysis later provided the basis for the identification of themes that addressed healthy work environments for nurses.

Ethical considerations

This study was approved by the Faculty Research, Technology and Innovation Committee of the Faculty of Health Sciences, Nelson Mandela University. Consent was not obtained as this study did not involve any participants. Principles of honesty and transparency in the application of the stages of the methodology and accurately reporting of data as described by Wager and Wiffen (2011) were adhered to in conducting the study.



Four themes that support best-practice recommendations related to a healthy work environment for nurses emerged from the guidelines, namely:

  • the need for effective nursing leadership

  • effective communication as central to enhancement of a healthy work environment.

  • effective teamwork as an integral part of a healthy work environment

  • the need for professional autonomy.

As outlined in Table 2, most guidelines (n = 10) were developed in Canada by two organisations: RNAO (n = 9) and Government of Alberta (n = 1). The Workplace Health Association Australia (WHAA) and the Health Workforce Advisory Committee of New Zealand (HWAC) each developed one guideline.

Effective nursing leadership and teamwork were referred to most frequently as part of a healthy work environment for nurses, while professional autonomy was least mentioned. Five guidelines included all four themes (HWAC 2006; RNAO 2007a, 2008, 2013a, 2016), while three guidelines included three of the themes, followed by three guidelines including two themes and one guideline including only one theme. The themes that emerged from the integrative literature review are discussed in the sections that follow.

Theme 1: The need for effective nursing leadership

Of the 12 best practice guidelines, 11 guidelines considered nursing leadership as playing an important role in creating a healthy work environment (Government of Alberta 2011; HWAC 2006; RNAO 2007a, 2008, 2011, 2012, 2013a, 2013b, 2016, 2017; WHAA 2015). Effective nursing leadership and decision-making are essential ingredients in achieving a healthy work environment, shape the nursing profession and assist in developing policies on mentoring and evidence practice, which guides the profession through ever-changing times (HWAC 2006:9; RNAO 2013a:17). According to RNAO (2008:34), nurses 'require strong leadership at every level of the health care system hierarchy', including the bedside practice, establishing intra-professional collaborations and teamwork, and providing a physically safe environment by identifying and controlling psychological hazards in the workplace (Government of Alberta 2011:15; RNAO 2007a:40, 2016:46). This leadership should continually be developed and supported at all levels in order to build and sustain successful workplace health programmes (HWAC 2006:10; WHAA 2015).

Creating an empowering work environment through evidence-based transformational leadership is one of the leadership practices which depends on a relationship that is built on trust and respect. According to RNAO (2008, 2013a:17), an empowering work environment is characterised by providing 'access to information, support, resources, and opportunities to learn and grow', which must occur in a setting that encourages professional autonomy as well as institutional support. An empowering work environment encourages mutual learning and an increased responsibility and accountability among nurses (RNAO 2013b:38-39), while at the same time it prevents and mitigates nurse fatigue (RNAO 2011:30).

Leaders who create healthy work environments seek and acknowledge multiple perspectives, demonstrate understanding of issues, acknowledge and promote nurses' contributions, communicate successes to create confidence, have an open-door policy and support staff (RNAO 2007a:40, 2013a:34-35).

Furthermore, involvement of nurse leaders in staffing processes enhances health care delivery, nurse productivity and suitable employment of nursing staff. Nursing leaders should thus ensure that categories of competent nurses are employed and utilised to deliver safe care (RNAO 2017:31). Finally, managers should portray supportive leadership by acting as role models, clearly communicating expectations, and effectively prevent, mitigate, and manage conflictual situations (RNAO 2012:36).

Theme 2: Effective communication as central to enhancement of a healthy environment

Effective communication emerged as the overarching concept in 11 of the 12 guidelines reviewed (Government of Alberta 2011; HWAC 2006; RNAO 2007a, 2007b, 2008, 2012, 2013a, 2013b, 2016; WHAA 2015). Effective communication is demonstrated as being central to organisational practices, teamwork and relationships, and is referred to as the foundation of a healthy work environment (Government of Alberta 2011:19; HWAC 2006:15; RNAO 2007a:42, 2016:27). According to RNAO (2013a:36, 2013b:29), effective communication includes 'openness, honesty, respect for each other's opinions and effective communication skills' by nurses, including nurse leaders or managers.

Effective communication enhances working relationships, knowledge translation (which refers to the way research evidence is made obtainable and available for practice, planning, and policymaking while including all stakeholders), and reduces conflict that is responsible for errors - all of which lead to enhanced patient or client safety, satisfaction and, therefore, an improvement on the overall care of patients (RNAO 2007a:40, 2008:47, 2012:40, 2017:32). Furthermore, communication promotes cultural diversity as it encourages individual health care professionals to be aware of different communication styles that influence a culture of communication in culturally diverse settings (RNAO 2007b:33). Inter-professional care should be supported by organisations through improved communication, including the development of effective communication processes and feedback channels, having an appealing communications strategy to foster and maintain employee interest and participation, as well as enhancing consistent formal and informal communication among members of the inter-professional team (HWAC 2006:8-10; RNAO 2013b:41; WHAA 2015:19).

Theme 3: Effective teamwork as an integral part of a healthy work environment

Of the 12 best practice guidelines reviewed, nine guidelines support the notion that teamwork is critical to the enhancement of a healthy work environment (Government of Alberta 2011; HWAC 2006; RNAO 2007a, 2007b, 2008, 2013a, 2013b, 2016; WHAA 2015). The concept of teamwork emerged as one of the practices that organisations cannot function without. Teamwork is defined as 'a product of collaboration, which includes a process of interactions and relationships between health professionals' working in a team environment, creating and sustaining a healthy work environment (HWAC 2006:4; RNAO 2008:32, 2013b:24, 2016).

The terms 'teamwork' and 'collaboration' are used synonymously in the literature to express relationships between members of a team. Effective teamwork, which improves patient or client as well as team member outcomes, is created through both inter-professional collaboration (which refers to 'comprehensive health care services provided by multiple care givers working collaboratively') (RNAO 2013b:24) and intra-professional collaboration among nurses (which refers to collaborative delivery of quality care within and across settings by members of the same profession) (RNAO 2013b:26, 2016:27).

In a collaborative work environment, safety and quality patient care depend on teamwork which includes health professionals, patients and their families to enhance each professional's care expertise, and extends to include teamwork between employers and unions (RNAO 2007a, 2007b:35, 2013b:26). Teamwork promotes sharing of power, which occurs when each team member allows for an equal contribution to safe patient care irrespective of their educational or professional background. 'Willingness to share power' contributes to a healthy work environment where all health professionals as well as the patient/client feel 'engaged, empowered, respected and validated' (RNAO 2013b:26) and are allowed to work to their full scope of practice (HWAC 2006).

Teamwork also embraces collaborative leadership, which is referred to as 'a people- and relationship-focused approach' (RNAO 2013a:33, 2013b:26), as well as good communication (Government of Alberta 2011:17; WHAA 2015:19). Finally, the guideline by RNAO (2016:26, 35) called for governments to develop structures and procedures which support nursing participation in collaborative teamwork.

Theme 4: The need for professional autonomy

Five of the 12 guidelines suggested that professional autonomy was a vital component of a healthy work environment because nurses felt empowered by autonomous practice (HWAC 2006; RNAO 2007a, 2008, 2013a, 2016). Autonomy is defined as 'the freedom to act on what you know, to make independent clinical decisions and to act in the best interest of the patient', which promotes independent decision-making within one's scope of practice (RNAO 2007a:34). Autonomy is also referred to as making timely decisions, which is based on health professionals' expert judgement that requires them to act ethically, with expertise, and to take responsibility and accountability (HWAC 2006:14-15).

Furthermore, autonomy also refers to 'acting in the best interest of the patient or client', which includes the ability to carry out appropriate care, aligned with standards of practice, a code of ethics as well as organisational policies (RNAO 2007a:34). Professional autonomy enables nurses to construct innovative collaboration as it is linked to teamwork to advance primary health care, and collaboration and autonomy have reciprocal effects (RNAO 2007a:34-25, 2016:32). Nurses' ability to be autonomous must be supported and facilitated by nurse leaders as it is regarded as a 'healthy working style' (HWAC 2006:8, 14; RNAO 2007a:34). In a healthy work environment, an empowering environment that promotes professional autonomy and strong collegial support must be created (RNAO 2013a:17). Additionally, to enhance competency and skill in order to effectively make independent decisions and empower them, nurses should be provided with opportunities for personal, professional and spiritual development (HWAC 2006:14-15; RNAO 2013a, 2008).



The guidelines included in this review support the importance of effective nurse leadership, communication and teamwork, and, to a lesser extent, the need for professional autonomy in creating a healthy work environment for nurses in comprehensive health care settings. The identified recommendations related to leadership, communication, teamwork and professional autonomy were found to be interdependent in achieving and supporting a healthy work environment for nurses in these settings. Similar findings were reported by a qualitative study by Huddleston and Gray (2016), describing the perceptions of nurse leaders and direct care nurses related to a healthy work environment in acute care settings.

Nurse leaders seem to play a significant role in facilitating effective or authentic leadership, which can only be done through effective communication, for example, through open and honest communication, providing opportunities for (negative) feedback and being able to listen (Hartung & Miller 2013). They further play a role in enhancing teamwork by staying in tune with the needs of the team, as well as promoting autonomy of nurses in their team, for example, by allowing them independent decision-making or to solve an issue that is affecting patient care or healthy work environments (Hartung & Miller 2013; Nayback-Beebe et al. 2013). Furthermore, establishing trust between the management and bedside nurses is essential to enhance teamwork and collaboration (McCabe & Sambrook 2014, 2019). The nurse leader could facilitate and promote this trusting relationship through role modelling as well as developing training systems for managers and organisational executive teams for team building (Pattison & Kline 2015). Opportunities for growth and development must be provided to nurses. Education and training are essential to enhance autonomy and job satisfaction, which will lead to staff retention (Baljoon, Banjar & Banakhar 2018).

Enhancing a healthy work environment while considering the aspects of leadership, communication, teamwork and professional autonomy is important as it has direct impacts on job satisfaction and retention of nurses (Blake et al. 2013; Blosky & Spegman 2015; Brunges & Foley-Brinza 2014; Sherman & Pross 2010), on providing safe, ethical care of high quality that leads to better patient outcomes (Blosky & Spegman 2015;Clark 2009; Kossaify, Hleihel & Lahoud 2017; Leonard, Graham & Bonacum 2004; Sherman & Pross 2010) and on organisational performance (Sherman & Pross 2010).

It is expected that the identified recommendations related to effective nurse leadership, communication and teamwork, and the need for professional autonomy maximise the health and well-being of nurses, quality patient or client outcomes, organisational performance and societal outcomes as per RNAO's definition (RNAO 2010:2). However, nursing has undergone a global reform in the last few decades that is affecting the setting, and ultimately healthy work environments, including the introduction of new management practices, for example, new public management, performance management and resource management, new and advanced technologies, work practice change, as well as work intensification because of higher patient acuity, leading to job burnout and nurses potentially leaving the profession (Penque 2019; Rafferty et al. 2019; Robert 2019). The guidelines should thus reflect and adapt their recommendations to consider and accommodate the latest trends in creating healthy work environments for nurses. Furthermore, although most included guidelines were developed based on systematic reviews, these guidelines, except for one guideline (RNAO 2008), did not consider the physical safety as well as mental (mindfulness) health well-being of nurses, as contributing aspects to a healthy work environment. Mindfulness - awareness of the present moment - as taught through mindfulness meditation programmes, such as mindfulness-based stress reduction, could assist in enhancing the well-being of the nurse (Penque 2019). Additionally, as the ongoing Coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on nurses' mental and physical health because of increased workloads, and the risk of getting infected with COVID-19, causing work-related stress and affecting work environments, which has a direct impact on patient care (National Academies of Sciences, Engineering, and Medicine 2019), an urgent global call was made to prioritise mental health and well-being of nurses (Søvold et al. 2021). Thus, there should be more emphasis on these aspects in guidelines related to healthy work environments.

Finally, in order to create and maintain a healthy working environment for nurses in comprehensive health care settings, the identified recommendations related to nurse leadership, communication, teamwork and professional autonomy require the support and commitment from all stakeholders within the healthy work environment (Harmon et al. 2018). To support this, policies or programmes can be developed in order to develop healthy work environments (Blake 2016; Clark & Ritter 2018), taking into consideration the recommendations and limitations from the included guidelines identified in this review.



Although a comprehensive search of various electronic databases and grey literature was conducted with the assistance of an experienced librarian, limited databases were available and some organisations or developers of guidelines were not subscribed to by the University, and thus some guidelines may have been missed. Furthermore, although the guidelines included in this review were the most recent versions, they have not been updated with the most recent literature, and therefore gaps were identified, as reflected in the discussion. Additionally, the guidelines and evidence-based recommendations identified in this review were supported by studies predominantly from developed comprehensive health care settings, which differ from similar settings in resource-constrained environments, often found in developing countries (World Health Organization 2018). Although adequate resources are viewed as essential components in the nursing practice environment (Rivaz et al. 2017; Scott et al. 2019), there seems to be a lack of published studies related to healthy work environments for nurses in comprehensive health care settings, particularly in resource-constrained settings. This indicates a need to conduct quality studies (such as large randomised controlled trials or systematic reviews) in developing, resource-constrained comprehensive health care settings in order to provide context to evidence-based recommendations related to healthy work environments that could be used for these settings.



This integrative literature review summarised evidence-based recommendations of available guidelines and provided findings related to the enhancement of healthy work environments for nurses in comprehensive health care settings. The review identified four interdependent concepts required for a healthy work environment, namely, effective nurse leadership, effective communication, effective teamwork and the need for professional autonomy. There is a need for more research to support evidence-based recommendations, particularly targeting those comprehensive health care settings that deal with resource constraints. The findings of this review could be considered in the development of an evidence-based best-practice guideline promoting healthy work environments for nurses in resource-constrained settings, as such a guideline currently does not exist.



The authors would like to thank Vicki Igglesden for editing the article.

Competing interests

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

Authors' contributions

J.F.M. and D.R.M.v.R. were responsible for the study design. J.F.M. performed data collection and data analysis. D.R.M.v.R. supervised the study. J.F.M., D.R.M.v.R. and W.t.H.-B. were responsible for manuscript writing.

Funding information

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Data availability

Data sharing is not applicable to this article as no new data were created or analysed in this study.


The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.



American Association of Critical-Care Nurses (AACN), 2016, AACN standards for establishing and sustaining healthy work environments: A journey to excellence, viewed 28 July 2021, from         [ Links ]

Baljoon, R.A., Banjar, H.E. & Banakhar, M.A., 2018, 'Nurses' work motivation and the factors affecting it: A scoping review', International Journal of Nursing & Clinical Practices 5(1), 277.        [ Links ]

Blake, N., 2016, 'Programs that support a healthy work environment', AACN Advanced Critical Care 27(3), 266-268.        [ Links ]

Blake, N., Leach, L.S., Robbins, W., Pike, N. & Needleman, J., 2013, 'Healthy work environments and staff nurse retention: The relationship between communication, collaboration, and leadership in the pediatric intensive care unit', Nursing Administration Quarterly 37(4), 356-370.        [ Links ]

Blosky, M.A. & Spegman, A., 2015, 'Let's talk about it: Communication and a healthy work environment', Nursing Management 46(6), 32-38.        [ Links ]

Brouwers, M.C., Kerkvliet, K., Spithoff, K. & AGREE Next Steps Consortium, 2016, 'The AGREE Reporting Checklist: A tool to improve reporting of clinical practice guidelines', BMJ 352, i1152.        [ Links ]

Brunges, M. & Foley-Brinza, C., 2014, 'Projects for increasing job satisfaction and creating a healthy work environment', AORN Journal 100(6), 670-681.        [ Links ]

Clark, P.R., 2009, 'Teamwork: Building healthier workplaces and providing safer patient care', Critical Care Nursing Quarterly 32(3), 221-231.        [ Links ]

Clark, C.M. & Ritter, K., 2018, 'Policy to foster civility and support a healthy academic work environment', Journal of Nursing Education 57(6), 325-331.        [ Links ]

Cooper, H., 1998, Synthesizing research: A guide for literature reviews, 3rd edn., Sage, Thousand Oaks, CA.         [ Links ]

Government of Alberta, 2011, Best practices for assessment and control of psychological hazards: Best practice guidelines for occupational health and safety in the healthcare industry, viewed 01 September 2021, from         [ Links ]

Guirardello, E.D.B., 2017, 'Impact of critical care environment on burnout, perceived quality of care and safety attitude of the nursing team', Revista Latino-americana de Enfermagem 25, e2884.        [ Links ]

Harmon, R.B., DeGennaro, G., Norling, M., Kennedy, C. & Fontaine, D., 2018, 'Implementing healthy work environment standards in an academic workplace: An update', Journal of Professional Nursing 34(1), 20-24.        [ Links ]

Hartung, S.Q. & Miller, M., 2013, 'Communication and the healthy work environment: Nurse managers' perceptions', The Journal of Nursing Administration 43(5), 266-273.        [ Links ]

Health Workforce Advisory Committee (HWAC), 2006, National guidelines for the promotion of healthy work environments, Health Workforce Advisory Committee, Wellington, New Zealand.         [ Links ]

Huddleston, P. & Gray, J., 2016, 'Describing nurse leaders' and direct care nurses' perceptions of a healthy work environment in acute care settings, Part 2', The Journal of Nursing Administration 46(9), 462-467.        [ Links ]

Kossaify, A., Hleihel, W. & Lahoud, J.C., 2017, 'Team-based efforts to improve quality of care, the fundamental role of ethics, and the responsibility of health managers: Monitoring and management strategies to enhance teamwork', Public Health 153, 91-98.        [ Links ]

Leonard, M., Graham, S. & Bonacum, D., 2004, 'The human factor: The critical importance of effective teamwork and communication in providing safe care', BMJ Quality & Safety 13(suppl 1), i85-i90.        [ Links ]

LoBiondo-Wood, G. & Haber, J., 2017, Nursing research: Methods and critical appraisal for evidence-based practice, 9th edn., Mosby, New York, NY.         [ Links ]

Mabona, J.F.M., 2018, A best practice guideline for a healthy work environment for professional nurses working in the South African Military Health Service, PhD thesis in Nursing Science, Nelson Mandela University, Port Elizabeth.         [ Links ]

Manoj, M., Brough, R. & Kalbarczyk, A., 2020, Exploring the role and nature of trust in institutional capacity building in low-and middle-income countries: A systematic review, viewed 01 September 2021, from         [ Links ]

Maurício, L.F.S., Okuno, M.F.P., Campanharo, C.R.V., Lopes, M.C.B.T., Belasco, A.G.S. & Batista, R.E.A., 2017, 'Professional nursing practice in critical units: Assessment of work environment characteristics', Revista Latino-americana de Enfermagem 25, e2854.        [ Links ]

McCabe, T.J. & Sambrook, S., 2014, 'The antecedents, attributes and consequences of trust among nurses and nurse managers: A concept analysis', International Journal of Nursing Studies 51(5), 815-827.        [ Links ]

McCabe, T.J. & Sambrook, S.A., 2019, 'A discourse analysis of managerialism and trust amongst nursing professionals', Irish Journal of Management 38(1), 38-53.        [ Links ]

Moses, T.C., 2021, 'Improving staff retention in adolescent psychiatric residential treatment facilities', Walden Dissertations and Doctoral Studies, 10600, viewed 01 September 2021, from         [ Links ]

National Academies of Sciences, Engineering, and Medicine, 2019, A design thinking, systems approach to well-being within education and practice: Proceedings of a workshop, National Academies Press, Washington (DC).         [ Links ]

Nayback-Beebe, A.M., Forsythe, T., Funari, T., Mayfield, M., Thoms, Jr., W., Smith, K.K. et al., 2013, 'Using evidence-based leadership initiatives to create a healthy nursing work environment', Dimensions of Critical Care Nursing 32(4), 166-173.        [ Links ]

Page, M.J., McKenzie, J.E., Bossuyt, P.M., Boutron, I., Hoffmann, T.C., Mulrow, C.D. et al., 2021, 'The PRISMA 2020 statement: An updated guideline for reporting systematic reviews', BMJ 372, n71.        [ Links ]

Pattison, J. & Kline, T., 2015, 'Facilitating a just and trusting culture', International Journal of Health Care Quality Assurance 28(1), 11-26.        [ Links ]

Penque, S., 2019, 'Mindfulness to promote nurses' well-being', Nursing Management 50(5), 38.        [ Links ]

Rafferty, A.M., Busse, R., Zander-Jentsch, B., Sermeus, W., Bruyneel, L. & World Health Organization, 2019, Strengthening health systems through nursing: Evidence from 14 European countries, World Health Organization, Regional Office for Europe, Geneva.         [ Links ]

Registered Nurses Association of Ontario (RNAO), 2007a, Embracing cultural diversity in health care: Developing cultural competence, viewed 11 April 2022, from        [ Links ]

RNAO, 2007b, Professionalism in nursing, viewed 11 April 2022, from        [ Links ]

RNAO, 2008, Workplace health safety and well-being of the nurse, viewed 11 April 2022, from        [ Links ]

RNAO, 2010, The healthy work environments: Quick reference guide for nurse managers, viewed 28 July 2021, from         [ Links ]

RNAO, 2011, Healthy work environment: Mitigating nurse fatigue in health care, viewed 11 April 2022, from        [ Links ]

RNAO, 2012, Managing and mitigating conflict in health care teams, viewed 11 April 2022, from        [ Links ]

RNAO, 2013a, Developing and sustaining nursing leadership, viewed 11 April 2022, from        [ Links ]

RNAO, 2013b, Developing and sustaining inter-professional health care: Optimizing patients/clients, organizational and system outcomes, viewed 11 April 2022, from        [ Links ]

RNAO, 2016, Intra-professional collaborative practice among nurses, viewed 11 April 2022, from        [ Links ]

RNAO, 2017, Developing and sustaining safe, effective staffing and workload practices, viewed 11 April 2022, from        [ Links ]

Rivaz, M., Momennasab, M., Yektatalab, S. & Ebadi, A., 2017, 'Adequate resources as essential component in the nursing practice environment: A qualitative study', Journal of Clinical and Diagnostic Research 11(6), IC01.        [ Links ]

Robert, N., 2019, 'How artificial intelligence is changing nursing', Nursing Management 50(9), 30.        [ Links ]

Scott, P.A., Harvey, C., Felzmann, H., Suhonen, R., Habermann, M., Halvorsen, K. et al., 2019, 'Resource allocation and rationing in nursing care: A discussion paper', Nursing Ethics 26(5), 1528-1539.        [ Links ]

Shea, M.L., 2015, 'Determined persistence: Achieving and sustaining job satisfaction among nurse practitioners', Journal of the American Association of Nurse Practitioners 27(1), 31-38.        [ Links ]

Sherman, R. & Pross, E., 2010, 'Growing future nurse leaders to build and sustain healthy work environments at the unit level', The Online Journal of Issues in Nursing 15(1).        [ Links ]

Søvold, L.E., Naslund, J.A., Kousoulis, A.A., Saxena, S., Qoronfleh, M.W., Grobler, C. et al., 2021, 'Prioritizing the mental health and well-being of healthcare workers: An urgent global public health priority', Frontiers in Public Health 9, 679397.        [ Links ]

Twigg, D. & McCullough, K., 2014, 'Nurse retention: A review of strategies to create and enhance positive practice environments in clinical settings', International Journal of Nursing Studies 51(1), 85-92.        [ Links ]

Wager, E. & Wiffen, P.J., 2011, 'Ethical issues in preparing and publishing systematic reviews', Journal of Evidence Based Medicine 4(2), 130-134.        [ Links ]

Wei, H., Sewell, K.A., Woody, G. & Rose, M.A., 2018, 'The state of the science of nurse work environments in the United States: A systematic review', International Journal of Nursing Sciences 5(3), 287-300.        [ Links ]

Whittemore, R. & Knafl, K., 2005, 'The integrative review: Updated methodology', Journal of Advanced Nursing 52(5), 546-553.        [ Links ]

Workplace Health Association Australia (WHAA), 2015, Best practice guidelines, Workplace Health in Australia, viewed 01 September 2021, from         [ Links ]

World Health Organization, 2018, Delivering quality health services: A global imperative, OECD Publishing, Geneva.         [ Links ]



Dalena van Rooyen

Received: 01 Sept. 2021
Accepted: 20 Jan. 2022
Published: 25 Apr. 2022

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