SHARED GOVERNANCE NURS 450Courtney List

INTRODUCTIONWhat is shared governance? Staff-leader partnership Promotes collaboration, shared decision making and accountability Improving quality of care, safety, and enhancing work life.

Decentralized and interpersonal relationships between staff and administrators https://www.youtube.com/watch?v=ZgJWenOIKpc

WHY IS SHARED GOVERNANCE IMPORTANT? Historical developmentEconomically Constrained Healthcare system- cost containment/reimbursementNursing shortage Improve work conditions, retain nurses and attract new nurses to profession

Shared Governance was introduced in 1980’sLed to increased job satisfaction and improved patient outcomes

Benefits of Shared Governance Improve quality patient careContain CostRetain nursing staffEnhance Nursing Profession

Empowerment-Autonomy

OBJECTIVES

Be able to define shared governance

State one way shared governance adds value to the nursing profession

Identify one thing an entry level nurse could bring to a shared governance council

ROY ADAPTATION MODEL

Core concept-AdaptationAssumes the person (organization) is an open system- able to respond to both internal and external

stimuli

Major ConceptsAdaption- Goal of nursingPerson(Organization) -Adaptive systemEnvironment- StimuliHealth-outcome of adaptationNursing-promoting adaptation and health

EMPOWERMENT THEORY Kanter’s theory of structural empowerment Structural empowerment- focus on structures within organization rather than individual’s qualities Empowerment is provided by

Access to information Access to support Opportunity for advancement Access to resources

Two sources of power exist Formal Power Informal Power

ASSESSMENT OF HEALTH CARE

Shared Governance at Munson (Traverse City) Unit Based Shared Governance

Chair Co-chair

Divisional Councils Evidence Based Practice Magnet Steering committee Nurse/Pharmacy Safe work environment Pain committee Relationship based care committee

ASSESSMENT OF HEALTH CARE ENVIRONMENT

Shared Governance at Mercy (Cadillac) Encouraged to participate- promote autonomy and

professional growth 18 Unit-Based Councils 7 Divisional Councils

Nursing Coordinating, Quality performance and Improvement, Nursing Research, Practice and standards, Nursing leadership, Work environment and Education

ASSESSMENT OF HEALTH CARE

Shared Governance at Spectrum (Fremont) Purpose

Improve Professional practice environment Advance nursing at all levels of the organization

Councils Include Nurse Executive Council Central Shared Leadership Council Nursing Quality and Safety council Education Council Patient Education Council Standards of Practice Council Nursing Research Council

CHALLENGES

STAFF SATISFACTION WORK CONDITIONS

Hostile environment

Communication with Management

Engagement

Physically Demanding

Emotionally Demanding

Mentally Exhausting

Poor Staff Retention

Scheduling conflicts

Little opportunity for advancement

Stepping stone position

OTHER ISSUES

Under staffed

ROOT CAUSE ANALYSIS

ACTIVITY

Hospital ATraditional Leadership

Hospital B Shared Governance Leadership

Options:Chocolate SkittlesMints

Who is satisfied with their candy?

Engagement of employees- the effects on a company https://www.youtube.com/watch?v=y4nwoZ02AJM

IMPLICATIONS

Unit Based Councils-Buy-in attitude Investing in the floor Increase patient satisfaction-Press Gainey Staff retention Increased Patient satisfaction

Evidence Based PracticeChallenging to implement-recruitmentNegative perception of researchUnclear of expectations

IMPLICATIONS

Staff satisfactionPositive view of Shared GovernanceViewed as a means of empowering

Staff retention Increased staff satisfaction and empowerment would lead to better staff retention Little research- connecting staff retention and shared governance

Framework for sustainable change

SUGGESTIONS THAT PROMOTE SAFETY Promote council involvement

Educate staff on use of shared governance

Encourage interdisciplinary collaboration

Encourage participation of new graduate nurses

SAFETY AND QUALITY

QSEN CompetenciesPatient-centered CareEvidence-based Practice(EBP)Quality Improvement SafetyTeamwork and Collaboration

ANA Standards Standard 9: Evidence-Based Practice and Research Standard 12: Leadership Standard 13: Collaboration

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

Bamford-Wade, A., & Moss, C. (2010). Transformation leadership and shared governance: an action study. Journal of Nurse Management, 18, 815-821. doi:10.1111/j.1365-2834.2010.01134.x

Bradbury-Jones, C., Sambrook, S., & Irvine, F. (2007). The meaning of empowerment for nursing students: a critical incident study. Journal of Advanced Nursing, 59(4), 342-351.

Bretschneider, J., Glenn-West, R., Green-Smolenski, J., & Richardson, C. (2010). Strengthening the voice of the clinical nurse.Nursing Administration Quarterly, 41-48.

Cronenwett, L., Sherwood, G., Barnsteiner J., Disch, J., Johnson, J., Mitchell, P., Sullivan, D., Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55(3)122-

131.

REFERENCES

French-Bravo, M., & Crow, G. (2015, March 19). Shared governance: the role of buy-in in bringing about change. The Online Journal of Issues in Nursing, 20(2). doi:10.3912/OJJN.Vol202PPT02

Gallagher, L. (2014). Leveraging shared governance councils to advance evidence-based practice: the EBP council journey. Evidence-Based Nursing, 12(1), 61-63. doi:10.1111/wvn.12062

Larkin, M. E., Ciepial, C. L., Stack, J. M., Morrison, V. J., & Griffith, C. A. (2008). Empowerment theory in action: the wisdom of collaborative governance. Online Journal of Issues in Nursing, 13(2). doi:10.3912/OJJN.Vol13No02PPT03

Model of care: shared decision making. (n.d.). In Mercy Health. Retrieved from http://mercyhealthcareers.com/nurses/saintmarys/model-of-care

Nantz, S. (2015). How to increase unit-based shared governance. American Nurse Today, 10(1), 52-54.

Nursing shared governance model. (n.d.). In Spectrum Health. Retrieved from http://www.spectrumhealth.org/nursingsharedgovernancemodel

Pre-Licensure KSAS. (2014). In QSEN Institute. Retrieved from http://qsen.org/competencies/pre-licensure-ksas/

Roy's Adaptation Model. (2013). In Nursing Theories: a Companion to Nursing Theories and Models. Retrieved from http://currentnursing.com/nursing_theory/Roy_adaptation_model.html