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April, May, June 2010

ANA\C The Nursing Voice • Page 7

Nursing Practice ANCC’s Pathway to Excellence Program

Ellen Swartwout, RN, MSN, NEA-BC

Introducing the Pathway to Excellence® Program

The American Nurses Credentialing Center’s (ANCC) Pathway to Excellence® credential is granted to healthcare organizations that create work environments where nurses can flourish. The designation supports the professional satisfaction of nurses and identifies best places to work.

To earn Pathway to Excellence status, an organization must integrate specific Pathway to Excellence standards into its operating policies, procedures, and management practices. These standards are foundational to an ideal nursing practice environment with a positive impact on nurse job satisfaction and retention. Pathway to Excellence designation confirms to the community that the healthcare organization is committed to nurses, recognizes what is important to nursing practice, and values nurses’ contributions in the workplace. Nurses know their efforts are supported. They invite other nurses to join them in this desirable and nurturing environment.

ANCC grants Pathway to Excellence designation for three years. Any healthcare organization, regardless of its size, setting, or location, may apply for this mark of excellence.

Program History

In 2003, the Texas Nurses Association (TNA) established its Nurse-Friendly™ hospital program to improve the workplace and positively impact nurse retention. With the help of a five-year funding grant from the U.S. Health Resources and Services Administration (HRSA), the program sought to enhance both the quality of patient care and professional satisfaction of nurses working in rural and small hospitals in Texas. TNA designated its first Nurse-Friendly facility in 2005.13,14

The program attracted many inquiries from other states about possible expansion. Texas Nurse-Friendly sought to transfer their program to a robust, collegial organization that could build on this success, while assuring the program’s integrity as it expanded nationwide. ANCC was able to facilitate the expansion of the Texas Nurse- Friendly program into a national program and expand the high quality and superb reputation of the TNA Nurse- Friendly hospital program into ANCC’s existing portfolio of credentialing activities. ANCC acquired the program in 2007.

In re-launching the Nurse-Friendly hospital designation to a national audience, ANCC renamed the program Pathway to Excellence®.

Healthy Work Environments Make a Difference

The impact of healthy work environments on nurse satisfaction and retention is evident in the literature.2,6,9 In addition, many studies have indicated a strong impact of a positive work environment on patient safety, patient satisfaction and quality care.1,3,4

Research has shown the nurse practice environment greatly influences many factors that affect both the nurse and patient. One key priority in healthcare is the safe delivery of nursing care. The Institute of Medicine’s (IOM) report indicated that between 44,000 to 98,000 deaths occur annually due to medical errors.5 Nurses are among the healthcare professionals who practice in a complex environment and can impact patient safety through their clinical practice.

At the core of the Pathway to Excellence program is a nursing practice environment that supports shared governance, interdisciplinary collaboration, leadership, quality, safety, professional development and work- life balance. Tested in Magnet environments, similar characteristics have translated into better patient outcomes, nurse satisfaction and quality care.1,10,11

The ability for nurses to problem solve, collaborate with other disciplines and handle conflict is critical to quality patient care. In a study by Siu, Laschinger & Finegan (2008), positive work environments enhance nurses’ conflict management skills, thus influencing the unit effectiveness.

Each Pathway to Excellence practice standard supports the essential components of a healthy work environment. The evidence indicates that organizations that embrace the elements of a positive nursing practice environment have a great impact on nurse satisfaction and retention, a key component of a Pathway to Excellence designation. Results have also demonstrated an influence on patient safety and quality care as well. It is evident that a healthy work environment does indeed matter for both nurses and patients.

The Vision for the Pathway to Excellence Program

A vision is a statement about the desired future. When thinking about the future, Pathway to Excellence healthcare organizations will be known for creating work environments where nurses can flourish. They will be places identified as nursing practice settings where a collaborative atmosphere prevails with a positive impact on nurse job satisfaction and retention. They will be seen as best places to work because a balanced lifestyle is encouraged, where nurses feel their contributions are valued as patient care partners in health care to the community.

Pathway to Excellence Standards

Based on evidence and expert nurse input, the Pathway to Excellence Practice Standards represent qualities that both nurses and researchers agree are critical to high quality nursing practice, professional development, and job satisfaction. ANCC encourages the use of these standards in all nursing practice environments. The Pathway to Excellence practice standards are:

  • 1.

    Nurses Control the Practice of Nursing

  • 2.

    The Work Environment is Safe and Healthy

  • 3.

    Systems are in Place to Address Patient Care and Practice Concerns

  • 4.

    Orientation Prepares New Nurses

  • 5.

    The Chief Nursing Officer is Qualified and Participates in all Levels

  • 6.

    Professional Development is Provided and Utilized

  • 7.

    Competitive Wages/Salaries are in Place

  • 8.

    Nurses are Recognized for Achievements

  • 9.

    A Balanced Lifestyle is Encouraged

  • 10.

    Collaborative Interdisciplinary Relationships are Valued and Supported

  • 11.

    Nurse Managers are Competent and Accountable

  • 12.

    A Quality Program and Evidence-Based Practices are Utilized

What Makes this Program Unique?

ANCC’s Pathway to Excellence Program® recognizes the foundational elements of an ideal nursing practice environment whereas, the Magnet Recognition Program® recognizes excellence in nursing and patient care. Pathway to Excellence standards focus on the workplace, a balanced lifestyle for nurses, and policies and procedures that support nurses on the job. Written documentation and a confidential, online nurse survey confirm the standards are met.

Is Your Organization Ready?

Use the Pathway to Excellence self-assessment tool at www.nursecredentialing.org to determine if your organization is ready to begin the application process.

E-mail the Pathway to Excellence Program Office at pathwayinfo@ana.org if you have questions.

Learn More Watch for upcoming articles with more information about the Pathway to Excellence program. Topics include:

  • The Many Benefits of Pathway to Excellence Designation

  • Getting Started: Organizational Assessment and Gap Analysis

  • The 12 Practice Standards and Elements of

Performance How to Apply Designation





credentialing programs certify nurses in specialty practice areas; recognize healthcare organizations for promoting safe, positive work environments through the Magnet Recognition Program® and the Pathway to Excellence® Program; and accredit providers of continuing nursing education. In addition, ANCC’s Institute for Credentialing Innovation provides leading-edge information and education services and products to support its core credentialing programs.


  • 1.

    Aiken, L. H., Clarke. S.P., Sloan, D.M., Lake, E. T. & Cheney, T. (2008). Effects of hospital care environment on patient mortality and nurse outcomes. American Journal of Nursing, 38(5), 223-229.

  • 2.

    American Association of Critical Care Nurses (AACN). AACN standards for establishing and sustaining healthy work environments: A Journey to Excellence. American Journal of Critical Care, 14(3), 187-198.

  • 3.

    Armstrong, K., Laschinger, H., & Wong, C.(2009). Workplace empowerment and Magnet hospital characteristics as predictors of patient safety climate. Journal of Nursing Care Quality, 24(1), 55-62.

  • 4.

    Hughes, L.C., Chang, Y. & Mark, B.A. (2009). Quality and strength of patient safety climate on medical -surgical units. Health Care Management Review, 34(1), 19-28.

  • 5.

    Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press. 2000: 1-16, 49-58.

  • 6.

    Laschinger, H.K. (2008). Effect of empowerment on professional practice environments, work satisfaction, and patient care quality: Further testing the nursing worklife model. Journal of Nursing Care Quality, 23(4), 322-330.

  • 7.

    Laschinger, H. K., & Leiter, M.P. (2006). The impact of nursing work environments on patient safety outcomes: The mediating role of burnout and engagement. Journal of Nursing Administration, 36(5), 259-267.

  • 8.

    Leiter, M.P. & Laschinger, H.K. (2006). Relationships of work and practice environment to professional burnout: Testing a Causal Model. Nursing Research, 55(2), 137-146.

  • 9.

    Pinkerton, S. (2005). AACN standards for establishing and sustaining healthy work environments. Nursing Economics, 23(3), 138-140.

  • 10.

    Schmalenberg, C.& Kramer, M. (2008). Essentials of a productive nurse work environment. Nursing Research, 57(1), 2-13.

  • 11.

    Schmalenberg, C.& Kramer, M. (2008). Clinical units with the healthiest work environments. Critical Care Nurse, 28(3), 65-77.

  • 12.

    Siu, H., Laschinger, H.K. & Finegan, J. (2008). Nursing professional practice environments: Setting the stage for constructive conflict resolution and work effectiveness. Journal of Nursing Administration, 38(5), 250-257.

  • 13.

    Texas Nurses Association (TNA). (2005).TNA designates first Nurse-Friendly hospitals. Texas Nursing, April-May, 8 &10.

  • 14.

    Texas Nurses Association (TNA). (2005). Benefits of an achievement. Texas Nursing. September-October, 11-12.

Work-life balance and recognition for one’s contributions in the workplace are important factors in the prevention of burnout. In a study that tested the Nursing Worklife Model, which measured the relationship between the nurse work environment and patient safety outcomes, it was demonstrated that the quality of the nurses’ work environment mediated with burnout and engagement, influenced patient safety outcomes.7 Another study of the Nursing Worklife Model, indicated that a professional practice environment had an impact on predicting nurse burnout.8

The Pathway to Excellence Designation Evaluation Process Case Study: A Pathway to Excellence Facility

About the American Nurses Credentialing Center

The American Nurses Credentialing Center (ANCC), a subsidiary of the American Nurses Association (ANA), provides individuals and organizations throughout the nursing profession with the resources they need to achieve practice excellence. ANCC’s internationally renowned

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