Well-Being Excellence™

FigureTHE PERVASIVE ISSUE of health worker burnout has led to increasing turnover rates, workforce shortages, negative impacts on patient outcomes, and increased costs.1,2 The National Academy of Medicine (NAM) identified burnout as a critical concern and convened a group of more than 200 healthcare professionals, including nurses, physicians, and pharmacists, to develop the National Plan for Health Workforce Well-Being, launched in October 2022.3 This plan underscored the urgent need for structured and effective well-being initiatives. Despite widespread agreement with these recommendations, many organizations struggle to effectively prioritize and implement the essential elements of well-being programs. Furthermore, numerous organizations have existing well-being programs but lack mechanisms to assess their effectiveness. Without proper assessment and validation, it's difficult to ascertain if the well-being initiatives are making a meaningful impact on nurses and other team members. Feedback from nurses often reveals that, despite the best intentions, organizations invest in initiatives that aren't important to staff, don't interest employees, or don't enhance the team's well-being. In response to these challenges, the American Nurses Credentialing Center (ANCC) developed Well-Being Excellence™. Well-Being Excellence provides clear and actionable guidance. It offers an evidence-based framework that identifies the essential elements of a well-being program that are most significant to employees and provides a method to validate their effectiveness by giving voice to the workforce and inviting them to provide their perceptions of the work environment.4 One of the most crucial aspects of the framework was making all settings (including nonclinical) eligible and including the entire workforce. By making the framework applicable to all settings, nurses, regardless of where they work, have access to supportive work environments that promote their well-being. And including the entire workforce ensures a comprehensive approach to well-being that acknowledges how the work environment impacts the diverse roles within an organization. By involving everyone, the program also fosters a culture of inclusivity and collective responsibility for well-being. This holistic approach recognizes that burnout and stress can affect all employees and impact overall organizational performance. Ultimately, this inclusive strategy promotes a healthier, more resilient workforce, enhancing job satisfaction, retention, and overall productivity. LITERATURE REVIEW Workplace culture and leader well-being Organizational culture and staff well-being aren't static. Proactive organizations will regularly engage in assessments and discussions with employees on the current status of the culture and staff well-being to identify improvement opportunities and enact associated targeted interventions (strategies).5 Leaders are at the helm of organizations, and leaders' well-being is vital to their ability to be highly functioning and productive. When conditions are less stressful, leaders can best support their direct reports and colleagues. Leaders experience different stressors and well-being needs than nonleaders, and organizations need to assess leader well-being and develop associated strategies that are useful and meaningful to senior leaders and managers.6 Inclusivity The organization and its leaders set the tone and expectations for an inclusive atmosphere, and inclusive environments have more engaged employees who are willing to give more physical, mental, and emotional capital. Successful inclusive endeavors support employees' perceptions that they belong and that their uniqueness is appreciated.7 Employees feel they belong when they have a voice and a seat at the table. A sense of belongingness can be achieved through interprofessional decision-making and collaboration to set goals and action plans, which are associated with improved outcomes, joy at work, and less burnout.8-12 Shared decision-making For team members to consistently contribute to shared decision-making activities, leaders must accommodate their time to participate in these opportunities so that processes and outcomes can be improved and work satisfaction enhanced.13 Employees should be involved, through shared decision-making, in selecting, planning, and evaluating technologies that can improve work efficiency and quality. Involving employees in these decisions positively impacts perceptions of ease of use, facilitating conditions, and social influence.14 Just culture A strong organizational culture both encourages and supports employees to self-report mistakes. Dialogue around workplace mistakes should include a variety of voices and maintain a future focus, avoid blame, and aim for solutions. The benefits of an environment in which it's safe to speak up include open communication, reduced stress, psychological safety, a sense of ownership, and higher morale.15-17 When employers address obstacles to performing work, such as excessive administrative tasks and documentation, employees experience increased productivity, improved morale and job satisfaction, reduced stress and burnout, enhanced quality of work, improved patient care, and cost savings.18,19 Meaningful recognition Meaningful recognition that's provided when employees go above and beyond enhances work engagement, psychological health, and job satisfaction; leaders should engage employees to identify modes of recognition that most resonate with them.20-22 Organizations should assess employees' self-identified professional goals and needs to provide support toward achieving these goals. Defined goals provide direction for what needs to be achieved, motivate employees to rise to challenges, and enhance confidence for future endeavors.23 Physical and emotional wellness Strategies are necessary to support employees' schedules to accommodate their personal needs because decreased absenteeism and better physical health are associated with flexible work arrangements.24 Organizations should make evidence-based mental health resources available to employees and enact strategies to enhance employee emotional wellness, including support for employees who experience a work-related adverse situation. When evidence-based mental health strategies are implemented, rates of stress, anxiety, depression, emotional exhaustion, compassion fatigue, and burnout decrease.25 Important aspects of well-being include physical health, physical activity, and making healthy nutrition choices. People who are both physically active and eat a healthy diet have lower mortality, so employers should promote and raise awareness for these efforts.26 Additionally, organizations note improvements in absenteeism and productivity for employees who are physically active and eat a nutritious diet.27 INCLUSIVE CRITERIA Well-Being Excellence was strategically designed to include all employees, regardless of their role within the organization. The criteria ensure that all employees are fully supported in their well-being while at work, fostering an organizational culture where employees' health and happiness are prioritized. A primary aspect of this inclusivity is ensuring that employees at all levels are active participants in selecting and regularly evaluating workforce well-being initiatives that are meaningful to them. By directly engaging employees in this process, organizations demonstrate their commitment to understanding and addressing the unique needs of their workforce, which helps employees to feel heard, valued, and supported and leads to greater employee engagement, satisfaction, and overall positive experience. The criteria also emphasize collaboration among employees at all levels to promote teamwork and ensure diverse perspectives and representation in decision-making and instill a sense of belonging. When employees from diverse backgrounds actively participate in collaborative decision-making, it creates a more inclusive workforce where all employees have an active role in shaping initiatives that impact their well-being at work. In addition to promoting inclusive participation, Well-Being Excellence ensures that organizations have systems and processes in place that consider the physical, mental, and psychological well-being of all employees. When organizations design work environments to prioritize all aspects of employee well-being, employees are more effective in their work and responsibilities. Well-being is a universal need; therefore, it's essential for the criteria to be applicable and inclusive of all employees because true workforce well-being can't be achieved unless every individual within an organization feels supported. Intentionally designing the criteria to account for the diverse needs of all employees challenges organizations to prioritize employees' access to resources, initiatives, and opportunities to enhance their overall well-being. TIERS Well-Being Excellence offers three levels of recognition to accommodate organizations at various stages in their workforce well-being journey. These levels provide a flexible framework that encourages organizations to continue their progress while also providing opportunities to celebrate achievements along the way. The first recognition level is designed for organizations that have established the foundational elements of an employee well-being program (seeTable 1). This tier integrates core well-being components, such as regularly assessing employee well-being, promoting team collaboration, engaging employees to identify obstacles to their well-being, and providing access to well-being resources. Organizations at this stage have established the foundation for future initiatives to develop and evolve. Table 1: - Well-Being Excellence™ element concepts Foundational elements Advanced elements Employee well-being is part of the organizational strategic plan and employee well-being is regularly assessed. Employees are involved in the identification and selection of well-being initiatives. Leader well-being is regularly assessed. Strategies are in place to address the well-being needs of senior leaders and managers. Strategies to improve workforce well-being are part of orientation and ongoing throughout the year. Workforce well-being initiatives are developed, implemented, and evaluated by employees to ensure the initiatives are meaningful. The organization supports the recruitment and retention of a diverse and inclusive workforce, and strategies are in place to promote a sense of belonging. Strategies that are used to promote a sense of belonging are evaluated for effectiveness and action plans are made based on the assessment. Diverse interprofessional teams collaborate through shared decision-making for policy development and quality improvement efforts. Using data, interprofessional teams engage in goal setting, action planning, monitoring, and continuous improvement. Key performance metrics are regularly assessed to address associated findings. Accommodations are in place to ensure team members can participate in shared decision-making activities. Formal shared decision-making structures are regularly evaluated for their effectiveness and action plans are enacted to address gaps identified. There's zero tolerance for racism and discriminatory behaviors, and staff can safely report discrimination without retaliation. Follow-up is provided to staff members who report racism and discrimination acts in the workplace. Safety measures are in place that protect staff from verbal and physical abuse. Bullying, harassment, and workplace violence are monitored, measured, and tracked, and follow-up and support are provided to those impacted. Proactive measures are in place to keep employees physically safe, and a mechanism exists for employees to report unsafe working conditions. Employees are engaged at regular intervals to identify improvements to workplace safety. Employees are encouraged and supported to self-report mistakes in the workplace without fear of retribution. Dialogue occurs regularly with employees to discuss workplace mistakes as a learning opportunity and strategies to prevent recurrence. Employees are regularly and actively engaged to identify obstacles that hinder them from fulfilling their primary responsibilities. – Employees who are the end-users of relevant technologies are involved in the selection, planning, and evaluation of technologies to improve work efficiency and quality. Employees are supported in utilizing new or enhanced technologies beyond their initial launch. Colleagues and leaders provide meaningful recognition to employees who go above and beyond. Leaders engage employees in identifying recognition initiatives that are meaningful to them. Employees' self-identified professional goals/needs are assessed annually, and the necessary support to facilitate professional goal achievement is provided. – Leadership competencies are assessed at onboarding to identify baseline knowledge, skills, and abilities that are essential for leaders to excel in their roles. Learning needs are assessed beyond onboarding. Individualized learning opportunities are identified, and subsequent plans are developed for leaders, including access to mentors. Strategies are in place that support employees to create work schedules that accommodate their personal needs. – Strategies and policies are in place that ensure uninterrupted rest and meal breaks and restrict mandatory overtime. Mandatory overtime is restricted, and utilization of rest and uninterrupted meal breaks is monitored for compliance. Evidence-based mental health resources are made readily available to address employee mental health needs. Strategies are in place to assess and improve employee emotional wellness. Employees who experience work-related adverse situations are offered support for their emotional wellness. Strategies are in place that promote physical health and physical activity. Employees are involved in the selection and evaluation of offerings that promote physical activity. The organization raises employee awareness for making healthier food and beverage choices. – The midlevel recognition is designed for organizations demonstrating advanced performance in their well-being efforts (seeTable 1). These organizations' programs are experiencing positive results. This level of recognition requires organizations to engage employees at a much higher level and actively track the effectiveness of their program initiatives. The highest level of recognition is designated for organizations that have validated the effectiveness of their well-being program directly through an employee feedback survey. This recognition level underscores the importance of implementing well-being initiatives that are meaningful and beneficial to employees. The three-tiered framework enables recognition of organizations for their accomplishments, regardless of where they are in their workforce well-being journey and provides a clear pathway for continuous improvement by motivating organizations to enhance their efforts to reach a higher level of success. DEVELOPMENT PROCESS The initial expert panel convened at the American Nurses Association headquarters and was led by three Commission on Pathway to Excellence (COPE) representatives who are responsible for the strategic governance and oversight of the Well-Being Excellence program. The panel reviewed the credential's purpose and project timeline, discussed the definition of well-being, and provided recommendations based on current research and existing worker well-being programs. Ongoing panel discussions focused on key concepts, including organizational culture, emotional environment, working conditions, and operational environment, which enabled the panel to identify new and refine existing criteria. The expert panel also evaluated various validation methods. Data gathered from focus group discussions confirmed the need for the credential and its potential benefits for organizations and employees. Final discussions resulted in the refinement of eligibility requirements, criteria, and validation methods, including the introduction of a three-tiered recognition system. The expert panel played a key role in shaping the credential's design, ensuring its relevance and alignment with other ANCC products. A pilot program, involving six organizations, was launched in June 2024. HOW WELL-BEING EXCELLENCE AND PATHWAY TO EXCELLENCE DIFFER Pathway to Excellence recognizes an organization's overall culture and its commitment to creating and sustaining a positive practice environment, for all employees, with a particular focus on nurses. Six standards encompass the Pathway to Excellence framework—shared decision-making, safety, quality, leadership development, professional development, and well-being. Although other healthcare employees benefit from the culture shift that occurs on the journey toward Pathway to Excellence, it's the nursing staff who validates, based on survey results, that the organization meets or exceeds the elements of performance required for designation. Because the elements of performance for each of the six standards within the Pathway to Excellence framework span the entirety of the organization and require the collaboration of organizational stakeholders, the designation is bestowed upon the organization as a whole. The Pathway to Excellence designation has been proven to be transformative across diverse healthcare settings, fostering environments where employees feel supported and safe. This leads to higher employee engagement and contributes to a more productive and thriving workforce. The Well-Being Excellence credential focuses exclusively on an organization's well-being program and evaluating its effectiveness in supporting the well-being of all employees. The framework helps organizations build robust well-being initiatives that span across four key areas—organizational culture, emotional environment, working conditions, and operational environment. Three levels of recognition were designed—bronze, silver, and gold—with the highest level requiring employee validation through a survey. The Pathway to Excellence designation distinguishes an organization for the creation of a positive work environment, whereas the Well-Being Excellence credential accentuates an organization's programs and initiatives that effectively support the health and well-being of the workforce. CARING FOR NURSES: A CRITICAL NEED The Well-Being Excellence framework offers a comprehensive and evidence-based approach to enhancing employee well-being. Identifying key elements of effective well-being programs and incorporating employee feedback ensure that initiatives are both relevant and impactful. Supported by extensive literature and expert recommendations, this framework provides organizations with a structured, tiered pathway to foster a healthier and more supportive work environment. The new credential criteria further solidify its foundation, making it a robust tool for promoting staff well-being. Additionally, the 2025 International Nurses Day theme, “Our Nurses. Our Future. Caring for nurses strengthens economies,” highlights the importance of focusing on the health and well-being of nurses.28 This theme underscores the critical role a healthy nursing workforce plays in strengthening economies, improving health systems, and ensuring better outcomes for communities worldwide. “Workplace conditions must continue to improve to support the needs of both our caregivers and our patients. Programs, Well-Being Excellence™, are critical for healthcare organizations to foster a work environment where their policies and practices reduce burnout, normalize help-seeking, and strengthen professional well-being.” —Corey Feist, CEO and cofounder Dr. Lorna Breen Heroes' Foundation (which leads the ALL IN: Wellbeing First for Healthcare coalition) “Well-being is not a nicety; it is a necessity. Being the first chief wellness officer in the nation at a university that includes an academic health center, I have experienced firsthand how creating a sustained wellness culture and taking an evidence-based, multicomponent, strategic approach from top leadership to the grassroots of the organization improves population health and well-being as well as providing a positive return on and value of investment for the organization. The new ANCC credential is a wonderful mechanism to recognize hospitals and healthcare systems' programs that are deeply committed to the health and well-being of their people.” —Bernadette Mazurek Melnyk, PhD, APRN-CNP, FAANP, FNAP, FAAN Vice President for Health Promotion, Chief Wellness Officer The Ohio State University