Shared Governance In Nursing

Joseph, M. L., & Bogue, R. (2016, July-August). A theory-based approach to nursing shared governance. Nursing Outlook, 64(4), 339-351. http://dx.doi.org/10.1016/J.OUTLOOK.2016.01.004

The objective function of the program implementation is to yield better patient experiences/outcomes. When patients had a good hospital stay, a numerical value can be associated with out HCAHPS scores and reimbursement to the organization. Shared governance will afford clinical staff nurses to deliver better care through their practice. The result will be shown in decrease in our NDNQI nurse-sensitive indicators. The organization will see less/no falls, CLABSI’s, CAUTI’s, and HAPU’s. Decreasing or eliminating the cost of hospital associated conditions will be a secondary reflection on the development of shared governance at the unit

ABSTRACT: Delegation refers to the practice of a registered nurse assigning certain tasks and activities to other people while still maintaining responsibility for the actions of the others to whom responsibility has been delegated. The act of delegating assumes that the delegator has a certain amount of trust in the person to whom they delegate. Additionally, quality communication is paramount in maintaining superior patient care when delegating tasks to others. One signifigant obstacle to delegation is ensuring that the proper tasks are delegated to the appropriate individuals. The organizational structure and leadership

Caramanica, L. (2004). Shared Governance: Hartford Hospital’s Experience. The Online Journal of Issues in Nursing, Vol. 9. Retrieved from http://www.nursingworld.org/mainmenucatefories/ANAmarketplace/ANAperiodicals/OJIN/tableofcontents/volume92004/No1Jan04/HartfordHospitalsExperience.aspx

Many hospitals and some healthcare facilities have attempted to research how the nursing practice model correlates with patient outcomes. “Hospital studies frequently consider attributes of medical staff but neglect attributes of nursing staff.” (Weisman). Some of the factors to consider when looking the nursing practice model are structural dimensions such as nurses’ individual level of practice and education, management per unit rather than traditional supervisors, case management, and the degree to which nursing or multidisciplinary teams are employed. The National Center for Nursing Research (NCNR) and the Division of Nursing, have funded two research projects in Arizona and New York. “The University of Rochester School of Nursing is implementing and evaluating an Enhanced Professional Practice Model for Nursing, designed to increase nurses’ control over practice at the unit level and to provide professional compensation.” (Weisman). The experiment will include five hospitals and the patient outcomes being studied include morbidity and mortality, patients’ perceptions of the hospital experience, and unplanned hospital readmission up to 30 days after discharge. “The University of Arizona College of Nursing is implementing and evaluating a unit-based Differentiated Group Professional Practice Model that includes three components: group governance (including participative management, staff bylaws, peer

Nursing is hierarchical hence should engage in different types of leadership activities in their routine care delivery

effectiveness (Cioffi & Ferguson, 2009). Therefore, it is important to ensure that nurses who assume leader roles have the skills to manage and delegate tasks as required. There must be clearly defined roles and responsibilities for each team member that take into account the levels of expertise among the members. It can be troublesome when team members do not carry their share of the work. When this occurs, other team members take on an additional work burden to address the shortfalls in patient care. If the team leader is unable to provide clarity and direction for the team, the model will not be effective.

The organization obtains the input of direct care nurses (DCN) prior to the implementation of changes that affect care delivery or and work flow. Shared governance is incorporated into the professional practice model by DCN’s at the Providence Veterans Administration Medical Center (PVAMC). Shared governance promotes critical thinking, decision-making, and a just culture at the PVAMC. DCN’s are empowered to develop and direct professional practice based on their knowledge and expertise. According to the “Medical Center Plan for Nursing Practice” Policy Memorandum 118-1: the shared governance model “reflects the high professional stature of nurses at the medical center”.

She said that it has not changed to this yet. There are thirty-five staff members under the department manager, thirty-three registered nurses and three licensed practical nurses. Fifteen of the registered nurses are charge nurses, Leigh-Ann being on of them. Her nurse manager rules autocratically. There is not a sharing of leadership with organizations and councils. She said there aren’t councils that participate in decision making and coordination of the department of nursing, as shared governance is described in Marquis & Houston’s Leadership Roles and Management Functions in Nursing Theory and

Shared governance is a professional model for nurse management which leads to nurse autonomy, empowerment, job satisfaction and improved patient outcomes. Research show nurses want a professional, autonomous environment for practice that recognizes the value of its nurses, and allow greater control over the practice environment. Proximity to job and monetary gain was listed as less important.

Additionally, the growth in group participation allows for feedback from various healthcare personnel on how they could have perceived the errors in their hospital and how they could prevent future errors. Awareness is a very important component of this group feedback, it permits the manager to obtain a clear perspective of what others are undertaking within the organization which could enlighten or help clarify an area where there was general conflict. Group behavior based feedback is also an important means of motivation to improving and using the assessment of others ideas and knowledge as a learning tool. Improving the groups effectiveness should suggest that for every four beds there are two nurses assigned to monitor and oversee each

The authors of "Traditional Models of Care Delivery: What Have we Learned?" offer an in-depth analysis and critic of the care delivery models so as to provide further insight. The hallmark of the team nursing model is "care through others" and its goal is to improve patient satisfaction (Yoder-Wise, 2015). The structural organization of team nursing consists of several teams or groups in which each group has a team leader who is responsible for coordinating the group throughout the daily assignment. Figure 13-4 'Team nursing ' in "Leading and Managing in Nursing" illustrates the chain of command as the charge nurse RN, team leader RN, and RN, LPN/NA, respectively (Yoder-Wise, 2015, p. 237). The nurse manager, whose minimal educational requirement is a baccalaureate degree, is skilled in critical-thinking and leadership concepts. These skills enable the nurse manager to carry out the duties of determining which person to select as charge nurse or the team leader. It is also the responsibility of the nurse manager to "provide adequate staff mix and orient the team members to the team nursing system by providing continuing education about leadership, management techniques, delegation, and team interactions (Yoder-Wise, 2015, p.238).

Buy-in is very difficult in nursing today because of all the changes required in response to internal and external threats and opportunities. As we know if our nurses are a part of the decision making when creating the change, they are more likely to support the change. This will in turn lead to successful and sustainable outcomes. This is not easy to do even in a culture of shared governance which allows our nurses to have greater control and autonomy over their practice. Our facility promotes a culture of shared governance but unfortunately some nurses are satisfied with sitting back and playing a passive role. This makes it very difficult. Achieving buy-in does require time, accurate and credible communication and an understanding of what

Total patient care is the oldest method of patient care organization and within this system, each nurse assumes total responsibility for patient care. As cited in Fernandez et al. (2010), this model is best suited to a workplace consisting of all registered nurses and as a result, its use is slowly declining. This study identifies the advantages of this model as the potential for patients to be involved in decisions regarding their care, and that patients’ progress can be easily evaluated. Additional responsibilities, including being a mentor, preceptor, and supporter of new nurses, are generally avoided. While these decreased responsibilities could mean less stress in the workplace, it could potentially lead to new graduates receiving patients for care that

The division of nursing is in the early stages of implementing shared governance, which has resulted in a more formal staff communication through the various councils. In addition, departmental meetings and house wide town hall meetings take place. Email is the main form of daily leadership communication and is at times utilized with staff. However, accessibility has been difficult especially for the non-licensed staff. A monthly newsletter is published through a shared governance task force which includes a message from the CNO.