Nursing Shared Governance

Nursing Shared GovernanceSofia WarrenFerris State University

Shared governance is a model to promote nursing leadership through shared decision making, collaboration and a commitment for excellence.1ObjectivesTo identify the four basic elements of shared governanceTo identify the structure model in support of shared governanceTo identify the correlation between shared governance and relationship based careTo identify the relationship between shared governance and Magnet recognitionTo identify perceptions of how and if shared governance improves quality and safety outcomes for patients

2What is nursing shared governance?Please click on link below and copy and paste into address bar or right click and click on hyperlink.http://www.youtube.com/watch?v=2WpqOHZDPUY&feature=player_detailpage

3Shared GovernancePartnershipEquityAccountabilityOwnership

SG establishes a mechanism for greater nurse participation in clinical and institutional structure, actively engaging the clinical nurse in decision making processes. SG process moves the decision making from a hierarchical form of management to a unit based form of management, with a collaboration and redesign of goals and processes. Empowerment of the bedside nurse to participate in control of process related to clinical nursing practice leads to better patient outcomes. 4Shared governance model

Shared governance will look different from institution based on mission and values as well staff. Here you have one image of what shared governance might look like. Most importantly the is at the center of any structure then councils are developed from the inside out . 5PartnershipBuilds relationshipsLinks the health care provider to the patient throughout the health care systemCreates professional empowerment through the collaborative relationships of all the stakeholdersImplies the key value of each member in fulfilling the mission and purpose of the organization

6EquityMaintains a focus on servicesIs the foundation and measure of valueIntegrates roles and relationships into the establishment of the structures and processes needed to achieve positive patient outcomes

Equity does not mean equality in scope of practice, knowledge, responsibility or authority. It does imply that each member has a vital role in the delivery of safe effective care.7Accountability Investment in decision-makingAccepting ownership of decisions

Accountability is the core of share governance, allowing for evaluation, supporting partnerships and is affirmed as positive patient outcomes are recognized8OwnershipRecognition and acceptance of the importance of each roleRecognition that success is determined by how well each individual does their job.

Those that are happy in their jobs take greater ownership and are more vested in patient outcomes. All stakeholders benefit from SG.9Self governance vs. Share governanceCentralized interactions(Self governance)Position-basedDistant from point of careHierarchical communicationLimited staff inputSeparates responsibility to managersWe-they work environmentDivided goals/purposeIndependent activities/tasks

Decentralized interactions(Shared governance)Knowledge-basedOccurs at point of careDirect communicationHigh staff inputIntegrates equity, accountability and authority for staff and managersSynergistic work environmentCohesive goals/purpose ownershipCollegiality, collaboration, partnership

The SG lends itself to an increased perception of control over professional nursing practice as well as increased autonomy in practice. The SG model supports greater clinical nurse participation in clinical and operational affairs. The stakeholders in this model would be administrative leadership, nrsg leadership, staff nurse, interdisciplinary team members, patients and community members.10Empowerment When staff members are clear about their roles, responsibilities, authority, and accountability they have a greater confidence in their own judgments and are more willing to take ownership for decision making at the point of care (Koloroutis, 2004).

Decentralized decision-making is most successful clearly delineated responsibility, authority, accountability.11TheoryJean Watsons Theory of CaringRelationship Based Care: Mary KoloroutisKanters Theory of Structural Empowerment

12Theory of Human CaringCare and relationship-centered care is a foundational ethic for healing practicesCreates a healing environmentDelineates the art of nursing through caring-healing modalities

Caring vs. curing delineates nursing from medicine with and attention to quality of life and inner healing which affect patient outcomes. Much of what we understand and communicate in practice related to caring is a result of the decades of research done by Jean Watson. For our purposes, I would like to focus on the importance of self-care and our ability to first care for self and promote our own personal value and sense of empowerment. Through which we are better able to provide care to our patients. Caring is integral to the concepts of shared governance and relationship based care in that the foundations of caring are demonstrated in how we do what we do, and how we project how we feel. Furthermore our level of caring is evaluated continually by our patients and their perceptions of care.13Relationship Based Care

Health care is provided through relationships. Activities are prioritized around the care needs of the patient and their family. Care practices should clearly demonstrate the mission and values of the organization. A caring and healing Environment is depicted in this diagram. With the family and the patient at its core. Leadership, teamwork, professional practice, care delivery, resources and outcomes. The RBC model illustrates how nursing services are provided through relationships in a caring and healing culture that embodies the concepts of partnership, equity, accountability and ownership.

14Relational Partnerships in the health care settingInterdependenceCollegial relationshipsTeam work/collaborationPatient centered and leadLeading changePartnershipsDirect communication

Relational partnerships are meant to create a culture of respect and compassion. Interdisciplinary shared decision promotes cohesiveness and professional collaboration. With the goal of promoting a safety culture, honest communication and collaboration are key.15Kanters Theory of Structural Empowermentpower as an ability to mobilize resources and achieve goals.We feel empowered when we have access to information, support, access to resources and opportunities to learn and growStrong networks with peers, patients and other organizational members increase perception of empowerment

Empowerment is linked to Magnet characteristics. Magnet-designated hospitals espouse the tenets of shared governance and embrace the empowerment of staff16Assessment of the Health Care EnvironmentInstitutional frameworkQuality and safety issuesSatisfaction and engagementObstacles

17Shared governance frameworkGrounded in clinical practiceNursing is responsible, accountable and has authority over all decisions related to practice, quality and competenceStaff nurses are elected to positions by peersNeeds to be implemented organization wideManagement provides the support, encouragement, resources, training and boundaries for successResponsibility and accountability basedComposed of a coordinating group of staff and management.Is bylaws and rules driven

SG will look different in every organization. Nursing practice, process and leadership will vary based on the staffing mix and the organizations mission. It is defined by what nurses do, how they do it and the expected outcomes at point of care. An effective SG transforms, empowers, shifts accountability of management, it affects the institution as a whole and means that shared decision making makes each role essential and accountable.18Basic requirement for shared governanceCommitted nurse executiveStrong management teamEmployees must have a clear basic understanding of shared governance. Must be able to chart progress with a plan and timeline for implementation

There must be a clear destination and a willingness to undertake the process needed to implement SG19American Nursing Credentialing Center Magnet designationTransformational leadershipStructural empowermentExemplary professional nursing practiceNew knowledge, innovations, and improvementsEmpirical quality outcomes

Magnet focuses on 5 components: Magnet credentialing serves as the standard for knowledge and expertise for the delivery of nursing care. The Principles of the SG model and Magnet designation are meant to promote nursing excellence at point of service by creating an infrastructure that is based on evidence based practice thus promoting safety and best patient outcomes20Magnet RecognitionSupports nursing practice, identifying nursing excellenceFocuses on professional nursing developmentSupports nursing autonomy in practice and decision makingSupports nursing involvement in decisions related to bedside care, education and nursing leadership

MR lends itself to organizational reform which shapes patient care quality. Alignment with this model of care supports the empowerment of nurses at the point of care and helps provide the mechanism for best practices21Benefits of designation reflected in shared governance for the patient Reduced mortalityReduced patient morbidityIncreased patient satisfaction

22Nursing Leaders must continue to identify and sustain new strategies to empower nurses so that nurses can continue to be an integral component in the health care delivery team

Improved job satisfactionIncreased engagementIncreased retention

Reference:Barden, A. M., Quinn Griffin, M. T., Donahue, M., & Fitzpatrick, J. J. (2011). Shared governance and empowerment in registered nurses working in a hospital setting. Nursing Administration Quarterly, 35(3), 212-218. doi:10.1097/NAQ.0b013e3181ff3845

Sg provides an environment where nurses are involved in decision making processes and the hope is that this model will lead to improved job satisfaction and retention. Empowerment, information and support are key.23Root Cause AnalysisProblem: Poor nursing engagementData Collection: Lack of participation in council meetings and unit decisions, low safety and engagement scores, decreased moral.Possible Causal Factors: Breakdown in communication, disinterest, lack of knowledge lack of resources, lack of support.Root cause: Perceived lack of value and empowerment.Recommended Solution: Provide unit support to participate, improve available resources, support opportunities for growth and promote autonomy in practice.

24Obstacles to shared governancePoor collaborationPoor communicationResistance to change and implementation of changeLack of interest Lack of concern to effect changeLack of consensusLack of clarity related to roles and responsibilities

Differing unit goals can be a problematic with implementation. Staff resistant to investing efforts and time for meetings25Please cut and past to address bar or right click and click on hyperlinkhttp://www.youtube.com/watch?feature=player_detailpage&v=XowMzXDko1I

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ANA StandardsStandard 10: Quality of Practice

Standard 11: Communication

Standard 12: Leadership

Standard 13: Collaboration

Quality: is demonstrated through a commitment to participate in departmental and organizational efforts to improve quality and safety in clinical care through continual development and study of best processes and practices. Communication: is vital to any system for the SG process model to be effective communication must be continually evaluated and improved. Leadership: through empowerment in practice all nurses are leaders, leadership is demonstrated through participation, mentorships communication, development in a respectful, honest and collegial manner. Collaboration: Nursing is vested in the continual collaboration of the healthcare team in team building processes in effecting an promoting positive patient outcomes.27Quality and Safety Education for NursesQSEN competenciesPatient Centered CareTeamwork and CollaborationEvidence Based PracticeQuality ImprovementInformaticsSafety

SG model promotes the nurse patient relationship, QSEN competency for patient centered care: identifies the patient as the lead in the decision about care, defining needs, values, and preferences. The nurse is able to seek out, respect and practice in a way that is individual and respectful of the patient. Teamwork and collaboration: With the goal being quality patient care the nurse works within the health care team as an honest, collaborative, respectful health care partner. Evidence Based Practice: delivering care that is patient/family centered valuing beliefs and preference with the integration of best practices Quality improvement: The nurse will always seek to monitor care outcomes and seek out methods and data to improve patient outcomes. Informatics The nurse will always seek to use technology in the dissemination of information and data to communicate and aid in decision making and decrease error in patient care. Safety: the nurse continually works to minimize potential hazards and improve safety through observations, participating in the perhaps a SG committee to improve safety protocols or processes to improve safety outcomes.28SummaryIncreased nursing retention related to increased job satisfactionImproved patient care and safety outcomes.Improved financial viabilityEmpowerment of nurses through promotion of nursing excellenceNursing excellence and Magnet recognition

29ClosingResearch implies that shared governance can have a positive impact on nursing satisfaction and potentially patient outcomes.More research needs to be doneShared governance empowers nurses to develop practiceAllows nurses to network and collaborate among units and departments

Through the empowerment of nursing, practices and process are being developed based on bedside nursing care with the collaboration and input of all point of care nurses. It stands to reason that with a sense of power and autonomy a nurse would have a vested interest in practice a quality issues in their unit and in an organization as a whole working to improve patient outcomes. Research indicates support of nursing empowerment creates a positive safety climate and supports high quality patient care.30ReferencesAlligood, M., & Tomey, A. (2010). Nursing Theorists and Their Work (7th ed.). Maryland Heights, MO: Mosby.

American Nurses Association (2010). Nursing Scope and Standards of Practice (2nd ed.). Silver Springs, MD. American Nurse Association.

Armstrong, K., & Laschinger, H. (2006). Structural empowerment, magnet hospital characteristics, and patient safety culture: making the link. Journal of Nursing Care Quality, 21(2), 124-134.

Barden, A.M., Quinn Griffin, M. T., Donahue, M., & Fitzpatrick,J. (2011). Shared governance and empowerment in registered nurses working in a hospital setting. Nursing Administration Quarterly, 35(3). 212-218. doi: 10.1097/NAQ.0b013e3181ff3845

Brewton, C., Eppling, J., & Hobley, M. (2012) Our voice: an interdisciplinary approach to shared governance. Hospital Topics 90(2), 39-46. doi: 10.1080/00185868.2012.679910

Burkman, K., Sellers, D., & Batcheller, J. (2012). An integrated systems nursing share governance model: a system chief nursing officers synergistic vehicle for a leading a complex health care system. Nursing Administration Quarterly 36(4), 353-361. doi: 10.109/NAQ.0b013e31826692ea

Koloroutis, M. (Ed.). (2004) Relationship-Based Care: A model for Transforming Practice. Minneapolis, MN: Creative Healthcare Management.

31References Larkin, M.E., Cierpial, C.L., Stack, J.M, Morrison, V.J., Griffith, C.A. (2008). Empowerment Theory in action: the wisdom of collaborative governance. OJIN: The Online Journal of Issues in Nursing. 13(2) doi:10.3912/OJIN.Vol13No02PPT03

Nursing Theories (2012). Jean Watsons philosophy of nursing. Retrieved October1, 2012 from http://currentnursing .com/nursing_theory/Watson.html

Porter-OGrady, T., Finnigan, S. (1984). Shared Governance for Nursing: a Creative Approach to Professional Accountability. Aspen Publication. Rockville , Maryland.

Quality and Safety Education for Nurses (2012). Pre-licensure knowledge, safety and attitude competencies. Retrieved October1, 2012 from http://www.qsen.org/overview.php

Swihart, Diana (2006). Shared Governance: A Practical Approach to Reshaping Professional Nursing practice. HCPr o, Inc. Marblehead, MA

Yoder-Wise, P. (2011). Leading and Managing in Nursing (5th ed.). Elsevier. St. Louis, MO.

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