1. Shared Governance
NURS 450
Courtney List

2. 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
Youtube- 3:05

3. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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.”

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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.

17. 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), doi: /NAQ.0b013e3181ff3845
Bamford-Wade, A., & Moss, C. (2010). Transformation leadership and shared governance: an action study. Journal of Nurse Management, 18, doi: /j 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),
Bretschneider, J., Glenn-West, R., Green-Smolenski, J., & Richardson, C. (2010). Strengthening the voice of the clinical nurse.Nursing Administration Quarterly,
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.

18. 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: /OJJN.Vol202PPT02
Gallagher, L. (2014). Leveraging shared governance councils to advance evidence-based practice: the EBP council journey. Evidence-Based Nursing, 12(1), doi: /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: /OJJN.Vol13No02PPT03
Model of care: shared decision making. (n.d.). In Mercy Health. Retrieved from
Nantz, S. (2015). How to increase unit-based shared governance. American Nurse Today, 10(1),
Nursing shared governance model. (n.d.). In Spectrum Health. Retrieved from
Pre-Licensure KSAS. (2014). In QSEN Institute. Retrieved from
Roy's Adaptation Model. (2013). In Nursing Theories: a Companion to Nursing Theories and Models. Retrieved from