Nursing Shared Governance

1. Nursing Shared Governance Sofia Warren Ferris State University

2. Objectives • To identify the four basic elements of shared governance • To identify the structure model in support of shared governance • To identify the correlation between shared governance and relationship based care • To identify the relationship between shared governance and Magnet recognition • To identify perceptions of how and if shared governance improves quality and safety outcomes for patients

3. What 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

4. Shared Governance • Partnership • Equity • Accountability • Ownership

5. Shared governance model

6. Partnership • Builds relationships • Links the health care provider to the patient throughout the health care system • Creates professional empowerment through the collaborative relationships of all the stakeholders • Implies the key value of each member in fulfilling the mission and purpose of the organization

7. Equity • Maintains a focus on services • Is the foundation and measure of value • Integrates roles and relationships into the establishment of the structures and processes needed to achieve positive patient outcomes

8. Accountability • Investment in decision-making • Accepting ownership of decisions

9. Ownership • Recognition and acceptance of the importance of each role • Recognition that success is determined by how well each individual does their job.

10. Self governance vs. Share governance Centralized interactions (Self governance) • Position-based • Distant from point of care • Hierarchical communication • Limited staff input • Separates responsibility to managers • We-they work environment • Divided goals/purpose • Independent activities/tasks Decentralized interactions (Shared governance) • Knowledge-based • Occurs at point of care • Direct communication • High staff input • Integrates equity, accountability and authority for staff and managers • Synergistic work environment • Cohesive goals/purpose ownership • Collegiality, collaboration, partnership

11. Empowerment “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).

12. Theory • Jean Watson’s Theory of Caring • Relationship Based Care: Mary Koloroutis • Kanter’s Theory of Structural Empowerment

13. Theory of Human Caring • Care and relationship-centered care is a foundational ethic for healing practices • Creates a healing environment • Delineates the art of nursing through caring-healing modalities

14. Relationship Based Care

15. Relational Partnerships in the health care setting • Interdependence • Collegial relationships • Team work/collaboration • Patient centered and lead • Leading change • Partnerships • Direct communication

16. Kanter’s Theory of Structural Empowerment “power 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 grow • Strong networks with peers, patients and other organizational members increase perception of empowerment

17. Assessment of the Health Care Environment • Institutional framework • Quality and safety issues • Satisfaction and engagement • Obstacles

18. Shared governance framework • Grounded in clinical practice • Nursing is responsible, accountable and has authority over all decisions related to practice, quality and competence • Staff nurses are elected to positions by peers • Needs to be implemented organization wide • Management provides the support, encouragement, resources, training and boundaries for success • Responsibility and accountability based • Composed of a coordinating group of staff and management. • Is bylaws and rules driven

19. Basic requirement for shared governance • Committed nurse executive • Strong management team • Employees must have a clear basic understanding of shared governance. • Must be able to chart progress with a plan and timeline for implementation

20. American Nursing Credentialing Center Magnet designation • Transformational leadership • Structural empowerment • Exemplary professional nursing practice • New knowledge, innovations, and improvements • Empirical quality outcomes

21. Magnet Recognition • Supports nursing practice, identifying nursing excellence • Focuses on professional nursing development • Supports nursing autonomy in practice and decision making • Supports nursing involvement in decisions related to bedside care, education and nursing leadership

22. Benefits of designation reflected in shared governance for the patient • Reduced mortality • Reduced patient morbidity • Increased patient satisfaction

23. “Nursing 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 satisfaction • Increased engagement • Increased 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

24. Root Cause Analysis • Problem: Poor nursing engagement • Data 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.

25. Obstacles to shared governance • Poor collaboration • Poor communication • Resistance to change and implementation of change • Lack of interest • Lack of concern to effect change • Lack of consensus • Lack of clarity related to roles and responsibilities

26. Please cut and past to address bar or right click and click on hyperlink http://www.youtube.com/watch?feature=player_detailpage&v=XowMzXDko1I

27. ANA Standards • Standard 10: Quality of Practice • Standard 11: Communication • Standard 12: Leadership • Standard 13: Collaboration

28. Quality and Safety Education for Nurses QSEN competencies • Patient Centered Care • Teamwork and Collaboration • Evidence Based Practice • Quality Improvement • Informatics • Safety

29. Summary • Increased nursing retention related to increased job satisfaction • Improved patient care and safety outcomes. • Improved financial viability • Empowerment of nurses through promotion of nursing excellence • Nursing excellence and Magnet recognition

30. Closing… • Research implies that shared governance can have a positive impact on nursing satisfaction and potentially patient outcomes. • More research needs to be done • Shared governance empowers nurses to develop practice • Allows nurses to network and collaborate among units and departments

31. References Alligood, 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 system’s nursing share governance model: a system chief nursing officer’s 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.

32. References 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-O’Grady, 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.