Slide 1: Shared Governance
Creating and Sustaining Nursing System Excellence: Utilizing a Triad Approach – Shared Governance, Expertise, Evidence Based Practice
Patty Knecht 2009 PSU Grad Student
Slide 2: You Have To Be Willing To Learn New Things
Tim Porter O’Grady PhD
Tim Porter O"Grady PhD
Slide 3: Nurses Control Over their Practice
1988 Sample of 3,500 nurses
identified being "allowed" to exercise nursing judgment for patient care was one of the most important factors in their practice (Huey & Hartley, 1988).
Research area for Magnet hospitals (Kramer & Schmalenberg, 2003) and nurse investigators (Weston, 2006).
Reference Hess (2007)
Slide 4: Who Rules??
Governance relates to decisions that define expectations, grant power, or verify performance. (Wikipedia) Governance is about power, control, authority and influence (Hess, 2007)
Slide 5: History of Shared Governance
Christman (1976)
Introduced the autonomous nursing organization concept Equal voice with physicians within hospitals
Cleland (1978)
Introduced label of shared governance Model reconciled the interests of different organizational groups through the distribution of power to formulate policy
Soared in the 1980’s due to the infusion of humanizing models.
Original concepts morphed to fit institution
Slide 6: Three Models
Councilor Model
Coordinating council integrates decisions made by subcommittees
Administrative Model
More traditional bureaucratic model
Congressional Model
Democratic component
Slide 7: Key Points
Structure is Critical Defined Set of Bylaws Clinical Nurses have Control over their Practice
Decisions at the Unit Level Clinical Nurses involved in Policy/Administrative Decisions (Nursing Councils)
Evidence Based Practice
Slide 8: Measure of Success of Shared Governance
Control of Practice leading to Better Patient Outcomes Increased Nurse Retention/Job Satisfaction Development of Enhanced Critical Thinking Skills Development of Staff Conflict Resolution and Negotiating Skills Tearing Down of Silos and Creating Enhanced Opportunities for Collaboration
Slide 9: Disadvantages/Concerns
Cost ROI? Union/Labor Organization Concerns Staff concerns that they are burdened by management decisions
Slide 10: Key Steps to Implementing Shared Governance
www.sharedgovernance.org
Assessing the Individual’s Perceptions Assessing the Manager’s Perceptions Assessing the Staff’s Perceptions Beginning Implementation
The Index of Professional Nursing Governance (Hess, 1998)
Implementing the Governance Councils Unit Based Shared Governance Activities Implementing Changes
Reference: Porter O'Grady, T (2004) Shared Governance Implementation M
Slide 11: Leaders should be looking ahead……….
Tim Porter O’Grady PhD
Slide 12: Roger’s Diffusion Of Innovation Theory
“Identify a Champion”
Change is Difficult for Most!!
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Slide 13: EBP and Shared Governance
EBP is at the core of Shared Governance Councils utilize research to steer decisions related to policies, procedures and clinical pathways “That’s the “way we always do it” no longer is acceptable Efficient and reliable access to evidence
Slide 14: Expertise
Expertise versus Experience Benner’s Novice to Expert
Slide 15: Magnet & Shared Governance
Shared Governance is at the Core EBP Quality Outcomes www.ahrq.gov
Slide 16: What Magnet Has Taught Us
BSN produces better clinical outcomes Non-BSN have strong functional focus Experience alone is not sufficient Value-based practice requires synthesis Multi-lateral/complexity competence Chronicity requires different competence
Tim Porter O'Grady PhD
Slide 17: New Language Of the New Age
Accountability based processes Focus on evidence (outcomes) Integrating everything, (creating “flow”) “Users” drive the relationship Interdisciplinary TEAMS as unit of service Building structures from point-of-service No “MORE-based” solutions
Tim Porter O'Grady PhD
Slide 18: Nursing Excellence = Quality Patient Outcomes
Triad of Creating and Sustaining Nursing Excellence
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Slide 19: In the 21st Century Do We Really Have a Choice If we Want to Thrive?
Tim Porter O’Grady PhD
