Shared Governance NURS 450 Courtney List

Introduction What 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 Youtube- 3:05

Why is shared Governance important? Historical development Economically Constrained Healthcare system- cost containment/reimbursement Nursing shortage Improve work conditions, retain nurses and attract new nurses to profession Shared Governance was introduced in 1980’s Led to increased job satisfaction and improved patient outcomes Benefits of Shared Governance Improve quality patient care Contain Cost Retain nursing staff Enhance 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-Adaptation Major Concepts Assumes the person (organization) is an open system- able to respond to both internal and external stimuli Major Concepts Adaption- Goal of nursing Person(Organization) -Adaptive system Environment- Stimuli Health-outcome of adaptation Nursing-promoting adaptation and health The concept of adaptation assumes that a person is an open system who responds to stimuli from both internal and external aspects of the person. Adaptation -Responding positively to environmental changes -Process and outcome of indviduals and groups who use conscious awareness, self refelction and choice to create human and environmental integration Person -Constant interaction with changing environment -Includes groups, families, organizations, communities or society as a whole -uses innate and acquired mechanisms to adapt Environment -All conditions, circumstances, and influences surrounding and affecting  Health -To promote adaptation for individuals and groups in the four adaptive modes -Contributing to health, quality of life, and dying with dignity by assessing behaviors and factors that influence adaptive abilities and by intervening to enhance environmental

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 Interdisciplinary collaboration with many different department. Specifically with management- decentralized team management approach

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 In assessing the Healthcare environment I worked backwards. I researched ways in which our clinical sites are using shared governance. By looking at the structure of each shared governance and the different divisional councils you can assess where the need was the greatest for Shared governance UNIT BASED- largest, most common EBP Quality and Safety

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 Central focus between all councils-making patient-centered decisions

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 Advance nursing at all levels of the organization by encouraging input from staff FROM website “Shared decision making among leadership and bedside practitioners ensures staff nurse involvement in organizational and clinical issues. The Shared Governance Model empowers nurses with the authority to govern nursing practice, policies and the environment.”

ROOT CAUSE ANALYSIS Poor Staff Retention STAFF SATISFACTION WORK CONDITIONS Under staffed Engagement Hostile environment Communication with Management Poor Staff Retention Physically Demanding Scheduling conflicts Little opportunity for advancement Emotionally Demanding Stepping stone position Mentally Exhausting OTHER ISSUES CHALLENGES

Activity Hospital A Hospital B Options: Traditional Leadership Hospital B Shared Governance Leadership Options: Chocolate Skittles Mints 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 Practice Challenging to implement-recruitment Negative perception of research Unclear of expectations How has theory lead to real results? How do these councils play out in practice

Implications Staff satisfaction Staff retention Positive view of Shared Governance Viewed 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 New graduates are equipped with the most up-to-date information

Safety and Quality QSEN Competencies ANA Standards Patient-centered Care Evidence-based Practice(EBP) Quality Improvement Safety Teamwork and Collaboration ANA Standards Standard 9: Evidence-Based Practice and Research Standard 12: Leadership Standard 13: Collaboration Standard 9: Evidence-Based Practice and Research The registered nurse integrates research findings into practice. Standard 12: Leadership The registered nurse demonstrates leadership in the professional practice setting and the profession. Standard 13: Collaboration The registered nurse collaborates with healthcare consumer, family, and others in the conduct of nursing practice.

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