Shared Governance

The ELEVATE Study: Evaluating the Impact of Educational Professional Governance Workshop on Nurses' Perceptions of Shared Decision-Making

OBJECTIVE

The ELEVATE study evaluated whether an educational workshop would improve the perceptions of shared decision-making of nurses in an organization as demonstrated by an increase in Index of Professional Nursing Governance (IPNG) score.

BACKGROUND

Available literature insufficiently links educational interventions to improvements in shared professional governance.

METHODS

Six hundred ninety-one participants' IPNG scores were analyzed before and after an educational workshop was administered to formal administrative leaders and registered nurse (RN) RN council leaders every 6 months during a 2-year research study.

RESULTS

Index of Professional Nursing Governance scores were higher for RNs participating in nursing councils than scores for those who did not. The organization's IPNG scores remained stable from 2019 to 2021. Secondary analysis may suggest that council members were more resilient during crisis.

CONCLUSIONS

Further investigation is needed researching the relationship between professional governance education and RNs' perception of shared decision making.

Nursing roles for in-hospital cardiac arrest response: higher versus lower performing hospitals

BACKGROUND

Good outcomes for in-hospital cardiac arrest (IHCA) depend on a skilled resuscitation team, prompt initiation of high-quality cardiopulmonary resuscitation and defibrillation, and organisational structures to support IHCA response. We examined the role of nurses in resuscitation, contrasting higher versus lower performing hospitals in IHCA survival.

METHODS

We conducted a descriptive qualitative study at nine hospitals in the American Heart Association's Get With The Guidelines-Resuscitation registry, purposefully sampling hospitals that varied in geography, academic status, and risk-standardised IHCA survival. We conducted 158 semistructured interviews with nurses, physicians, respiratory therapists, pharmacists, quality improvement staff, and administrators. Qualitative thematic text analysis followed by type-building text analysis identified distinct nursing roles in IHCA care and support for roles.

RESULTS

Nurses played three major roles in IHCA response: bedside first responder, resuscitation team member, and clinical or administrative leader. We found distinctions between higher and lower performing hospitals in support for nurses. Higher performing hospitals emphasised training and competency of nurses at all levels; provided organisational flexibility and responsiveness with nursing roles; and empowered nurses to operate at a higher scope of clinical practice (eg, bedside defibrillation). Higher performing hospitals promoted nurses as leaders-administrators supporting nurses in resuscitation care at the institution, resuscitation team leaders during resuscitation and clinical champions for resuscitation care. Lower performing hospitals had more restrictive nurse roles with less emphasis on systematically identifying improvement needs.

CONCLUSION

Hospitals that excelled in IHCA survival emphasised mentoring and empowering front-line nurses and ensured clinical competency and adequate nursing training for IHCA care. Though not proof of causation, nurses appear to be critical to effective IHCA response, and how to support their role to optimise outcomes warrants further investigation.

Community- and hospital-based nurses' implementation of evidence-based practice: are there any differences?

The aim of this paper is to discuss the effect of nurses' beliefs, knowledge, and skills on the implementation of evidence-based practice (EBP) in hospital and community settings. EBP refers to the implementation of the most up-to-date robust research into clinical practice. Barriers have been well documented and traditionally include the negative beliefs of nurses as well as a lack of time, knowledge, and skills. However, with degree entry nursing and a focus on community health care provision, what has changed? A comprehensive search of contemporary literature (2010-2015) was completed. The findings of this review show that the traditionally acknowledged barriers of a lack of time, knowledge, and skills remained; however, nurses' beliefs toward EBP were more positive, but positive beliefs did not affect the intentions to implement EBP or the knowledge and skills of EBP. Nurses in hospital and community settings reported similar barriers and facilitators.

Impact of professional nursing practice environment and psychological empowerment on nurses' work engagement: test of structural equation modelling

AIM

This study aimed to investigate the influence of professional nursing practice environment and psychological empowerment on nurses' work engagement.

BACKGROUND

Previous researchers have acknowledged the positive influence that nurse work environment and psychological empowerment have on engagement. However, less is known about the mechanisms that explain the links between them.

METHOD

A predictive, non-experimental design was used to test the model in a random sample of 300 clinical nurses from two tertiary first class hospitals of Tianjin, China. The Utrecht Work Engagement Scale, the Practice Environment Scale of the Nursing Work Index and the Psychological Empowerment Scale were used to measure the study variables.

RESULT

Structural equation modelling revealed a good fit of the model to the data based on various fit indices (P = 0.371, χ(2) /df = 1.056, goodness of fit index = 0.967), which indicated that both professional practice environment and psychological empowerment could positively influence work engagement directly, and professional practice environment could also indirectly influence work engagement through the mediation of psychological empowerment.

CONCLUSION

The study hypotheses were supported. Psychological empowerment was found to mediate the relationship between practice environments and work engagement.

IMPLICATIONS FOR NURSING MANAGEMENT

Administrators should provide a professional nursing practice environment and empower nurses psychologically to increase nurse engagement.

Perceptions of shared governance among nurses at a midwestern hospital

Shared governance is a model of nursing leadership that drives practice. The purpose of this project was to determine whether nursing education, work experience, certification, employment position, setting (inpatient/ambulatory), participation in shared governance, and age were related and predictive of scores on the Index of Professional Nursing Governance (IPNG). The significance was to provide a basis on which to enhance a nursing shared governance model resulting in enhanced patient care. This prospective, cross-sectional study included nurses in any type of nursing role and with any level of educational preparation. An analysis of variance was employed to identify strength of relationships among the categorical or ordinal variables and regression models for the continuous variables. General linear models were used to identify the variables most predictive of IPNG scores. Of the 98 participants, most (96%) were women, 58% were bachelor's prepared, and 80% were staff nurses. The mean IPNG score was 186.5. No significant relationships were found among demographic measures and IPNG scores. A reported role in shared governance, when combined with work setting (inpatient or ambulatory), was predictive of IPNG scores. Nurses who worked in the inpatient setting reported higher mean IPNG scores.

Our VOICE: an interdisciplinary approach to shared governance

The authors' purpose was to make public to other healthcare executives the demonstrated success of an interdisciplinary shared governance process benefiting any healthcare organization. Main components of a successful model include a conducive work environment free of distractions, available resources in order to gather information to complete a project, and committees chosen focused on high priority for patient and staff satisfaction, quality, and safety. An essential piece of the puzzle is that grassroots staff needs to own the process. The authors share the current model and discuss outcomes, success, and lessons learned throughout their decade-long journey.

Enhancing shared governance for interdisciplinary practice

Cincinnati Children's Hospital Medical Center has a strong history of embracing staff empowerment and shared decision making. Shared governance for nursing was implemented in 1989; a separate allied health structure was created in 1999. The two operated in parallel with few occasions for interface, and with little collaboration. With the beginning of the medical center's efforts to pursue perfect patient care in 2002, there was a marked increase in the frequency of interprofessional initiatives and collaborations in the organization. By 2005, this increase in collaborative practice precipitated discussions questioning the purpose and efficiency of two separate structures. Over the next two years, planning ensued to merge these structures to better reflect the current interprofessional reality. The enhanced shared governance structure at Cincinnati Children's was launched in 2008. Each discipline now governs its own practice, but as patient care issues overlap, there is a structure in place to resolve patient issues that cross disciplines. The new Patient Care Governance Council includes physician and family representatives.

Factors associated with success and breakdown of shared governance

Shared governance (SG), a process for empowering nurses in practice settings, has been widely used for decades. However, despite enthusiasm for the concept, the process is not always successful or falters after successful initiation. To assist nursing leaders trying to implement or maintain SG processes, the author summarizes literature on both human and structural factors that contribute to the success or breakdown of SG practice models. Barriers to implementation and strategies to support implementation, as well as enculturation of SG, are discussed.

Decisional Involvement: Staff Nurse and Nurse Manager Perceptions

Enhancing involvement in organizational decisions is one strategy to improve the work environment of registered nurses and to increase their recruitment and retention. Little is known about the type of decision making and the level of involvement nurses desire. This was a descriptive study exploring staff nurse and nurse manager ratings of actual and preferred decisional involvement and differences between staff nurses and nurse managers. A sample of 320 RNs from a Midwestern health care network was surveyed using the Decisional Involvement Scale. Nurse managers and staff nurses had statistically significant differences in their perceptions of who was involved in actual decision making in the areas of unit governance and leadership and collaboration or liaison activities. There were statistically significant differences in preferred decisional involvement between staff nurses and nurse managers in the overall DIS scale and the subscales of unit governance and leadership and quality of support staff practice.

Development of a reliable and valid organization-specific professional practice assessment tool

PURPOSE

This article describes a study to devise an organization-specific professional practice model (PPM) assessment that reflects actual unit involvement. A secondary study goal is the development of a unit-based index that can be used to conduct comparative analyses in an efficient way.

DESIGN

Each of the 5 elements of the organization's PPM was represented by 1 or more items on an author-developed instrument. The tool was structured so that item scores could be summed to achieve a single subscale for each PPM element and further aggregated into a total score.

METHODS

The instrument was administered to a 40% random sample of all regularly scheduled, full- and part-time registered nurses in an academic, community Magnet hospital in 2003 and 2005. Descriptive statistics were calculated for items, subscales, and summary scores for each patient care unit and overall. A weighted, unit-based index was developed to reflect each unit's score on a scale of 100.

FINDINGS

The 2003 assessment response rate was 51% (n = 200); the 2005 response rate was 48% (n = 193). Subscale scores and a total PPM score were calculated by summing the values of each individual item. Submissions enabled calculations of total scores by unit, mean scores by item, and the development of a unit-specific PPM index of performance.

CONCLUSIONS

Beyond shared principles of empowerment, the specifics of each organization's PPM may differ in those key components of care delivery nurses are empowered to effect. Thus, fidelity to the organization-specific PPM is not well tested with generic decisional-involvement instruments. An organization-specific assessment such as this one can provide evidence of not only organizational PPM fidelity but a quantitative method to ensure that staff nurse decisional involvement is continuously evolving to an ever higher state.

Evolutionary emergent: chief nurse executive as chief vision officer

Barrett's power theory provides a theoretical framework that can be applied to the practice of nursing administration. From this perspective, the role of the system chief nurse executive can be seen as an evolutionary emergent, that of chief vision officer. Various organizational initiatives relevant to this role are discussed as exemplars of practice informed by the Barrett's power theory.

Achieving magnet redesignation: a framework for cultural change

Magnet recognition is the highest award that the ANCC bestows on an institution and exemplifies a hospital's accomplishments in providing commitment, support, and resources for nursing excellence throughout the organization. Magnet hospitals attain their status based on structure and outcome criteria known as the 14 Forces of Magnetism. The authors discuss one hospital's journey and the outstanding models integrated in their organization that paved the way for their first award, followed by their journey toward redesignation.

An interdisciplinary team approach to evidence-based improvement in family-centered care

Family-centered care has become an integral part of total patient care in today's healthcare setting. Meeting family needs can be challenging for staff nurses already overwhelmed with escalating patient acuity and ever-increasing technical and documentation burdens. In the year 2000, an Interdisciplinary team in a tertiary hospital in the midwest employed a collaborative process to design and pioneer an award-winning nursing role in family-centered care. This article describes the methods used by this hospital to meet the ever-increasing challenge of family needs integrated into holistic patient care.