It is noted that most “nurses love their work and hate their work” (Berliner and Ginzberg 2742). Given the current quality of the nursing environment, this is not surprising. The biggest factor affecting hospital quality is staff stress levels. While it is inevitable to eliminate stressors in all medical centers, how stress is perceived is a controllable factor. The idea of ​​controlled stress highlights the need for CISM programs in all U.S. healthcare settings to address critical incidents and stress that occur on a daily basis. CISM, as defined by Tracy, is a "comprehensive, multi-component program based on counseling principles and peer support processes, designed to help emergency health professionals effectively manage the stressors of their work” (28). The program is considered the most effective type of counseling in hospitals for critical incidents and stress, due to its detailed step-by-step guidelines. CISM is expected to increase nursing staffing, patient satisfaction, and overall create more efficient healthcare facilities. by alleviating negative reactions to stress among hospital staff. The program will provide a safer and healthier environment for both nurses and patients at medical centers. One study found that hospitals with a more positive work environment for their nurses had higher patient satisfaction (Greenslade and Jimmieson 1189). Higher patient satisfaction is likely because nurses are more emotionally prepared to care for their patients in a thriving environment. CISM programs provide a healthier environment and better working conditions in the hospital. CISM was initially created by Jeffrey Mitchell to reduce the ...... middle of paper ...... (2003). Crisis intervention and CISM: a research summary. Ellicott City, Maryland, International Critical Incident Stress Foundation. Retrieved from http://cism.cap.gov/files/articles/CISM%20Research%20Summary.pdfParsley, Lee Ann, Conditions and Strategies Affecting Interagency Collaboration in the Development of Critical Incident Stress Management Programs. Diss. Ohio University, 2003.UMI, 3093687. Print.Sieben, Laura. Staff debriefing after a critical incident in the emergency department. Diss.College of Scholastica, 2009, UMI, 14738626. Print.Tracy, Scott. How cumulative stress affected emergency medical services workers' experiences after a horrific natural disaster: Implications for professional counselors. Diss. Duquesne University, 2007. UMI, 3292249. Print.