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May-June 2020 • Vol. 29/No. 3 145

Barbara B. Brewer, PhD, RN, MALS, MBA, FAAN, is Professor, The University of Arizona,
College of Nursing, Tucson, AZ.

Megan C. Quinn, PhD(c), RN, is Clinical Nurse, Neonatal Intensive Care Unit, Banner Health,
Phoenix, AZ.

Claire Bethel, MSN, RN-BC, is Doctoral Student, The University of Arizona, College of Nursing,
Tucson, AZ.

What Makes a Medical-Surgical Unit

Barbara B. Brewer
Megan C. Quinn

Claire Bethel

he Academy of Medical-
Surgical Nurses (AMSN) de –
veloped the Premier Recog –

nition In the Specialty of Med-surg
(PRISM) Award® to recognize med-
ical-surgical nursing units on which
exemplary professional practice and
care are delivered. The first PRISM
Award was made in 2013. As of July
2019, 41 medical-surgical units had
received PRISM designation (AMSN,
2019a). The award is based on a
written application addressing unit
characteristics in six areas: leader-
ship, recruitment and retention, evi-
dence-based practice, patient out-
comes, healthy practice environ-
ment, and lifelong learning. The
purpose of this article is to report
findings from a qualitative study
using content analysis and descrip-
tive statistics to describe PRISM
units based on responses to award
applications. The study was com-
missioned by the AMSN Board of
Directors to identify key characteris-
tics of medical-surgical units exem-
plifying healthy practice environ-
ments and excellence in nursing

Research Questions
The research questions were as

follows: Are there differences in
demographic characteristics of units
that did and did not achieve PRISM
status? What are the key characteris-
tics of each of the PRISM Award cri-
teria (effective leadership, recruit-
ment and retention of competent
nurses, evidence-based practice, pos-
itive patient outcomes, healthy
practice environment, lifelong
learn ing)?

Review of the Literature
Literature published 2013-2019

was searched using Google Scholar
and CINAHL databases. Search
terms were healthy work environments
for nurses, healthy practice environ-
ment for nurses, or nurse practice envi-
ronment. Seminal literature related
to Magnet® hospital recognition also
was included.

The beneficial effect of healthy
practice environments on nurse and
patient outcomes has been recog-
nized for several decades (McClure
& American Academy of Nursing
Task Force on Nursing Practice in
Hospitals, 1983; McClure et al.,
2002). Subsequent to early research
initiated by the American Academy
of Nursing, many researchers have
studied the effects of healthy work
environments in critical care units
(Ulrich et al., 2019), medical-surgi-
cal and specialty units (Kramer et al.,
2017; Kramer et al., 2014; Kramer et
al., 2013; Stimpfel et al., 2015), and
behavioral health units (