Ripple effect: Shared governance and nurse engagement

Enhancing nursing education to bolster nurse governance: insights from nurse managers

Aim

In South Korea, the level of nursing governance is moving toward shared governance. This study sought to explore nursing education contents in undergraduate nursing programs necessary to improve the governance of nurses from the perspectives of nurse managers.

Methods

The study employs thematic analysis following the guidelines outlined in the Consolidated Criteria for Reporting Qualitative Research utilizing a qualitative research design. Our investigation involves general or tertiary hospital nurse managers intending to gain valuable insights and perspectives.

Results

Interview data from 14 nurse managers were analyzed. A total of one main and four sub-themes were derived from the qualitative data analysis. Analysis revealed the main theme, "occupational socialization." The four sub-themes were education on "nurse-patient and nurse-colleague communicative interaction," "humanity," "career development," and "nurses as politicians."

Conclusion

The findings are valuable in suggesting critically needed educational content in undergraduate nursing programs to improve nursing governance. Future research should investigate the effects of the abovementioned themes on nursing governance among clinical nurses or nursing students for several years of follow-up data collection.

The Nursing Practice Environment and Patients' Satisfaction with Nursing Care in a Hospital Context

Nursing, being a profession in health, aims to improve the quality of the response to patients' demands, which have repercussions on the attitudes, behaviors and performance of nurses.

BACKGROUND

The aim of the study was to evaluate the relationships among the nursing practice environment, nurse-patient interactions and patients' satisfaction with nursing care in a hospital context.

METHODS

The study applied a descriptive analysis. Based on the initial exploration of the data, we decided to perform a simple linear regression of the dimensions of the scales.

RESULTS

The latent variables and interactions between the different dimensions of the three constructs (the nursing practice environment (PES-NWI), nurse-patient interactions (NPIS-22-PT) and patients' satisfaction in the hospital context (SAPSNC-18)) were submitted to confirmatory analysis. The model was statistically significant, with a good fit with the data (χ2/gl = 128.6/41 (0.000); GFI = 0.900; AGFI = 0.831; TLI = 0.910; CFI = 0.907; RMSEA = 0.102).

CONCLUSIONS

The study showed favorable rates of overall satisfaction on the part of patients, such as the nurses' skills in dealing with their illness/health situation, ability to solve problems in a timely manner, responsiveness to patients' needs and technical competence.

Moving Shared Governance to the Next Level: Assessing Council Health and Training Council Chairs

The shared decision making professional practice model of shared governance supports positive nursing working environments and patient outcomes. Achieving and sustaining clinical nurse involvement with unit councils can be challenging. Nursing leaders of a large healthcare system with approximately 650 patient beds across 5 hospitals utilized the Council Health Survey to assess unit-based councils' health. Interventions for strengthening shared governance in the organization included enhancements of unit council structures and training for chairs and leaders based on the survey findings.

Evidence-Based Quality Improvement: a Scoping Review of the Literature

BACKGROUND

Quality improvement (QI) initiatives often reflect approaches based on anecdotal evidence, but it is unclear how initiatives can best incorporate scientific literature and methods into the QI process. Review of studies of QI initiatives that aim to systematically incorporate evidence review (termed evidence-based quality improvement (EBQI)) may provide a basis for further methodological development.

METHODS

In this scoping review (registration: https://osf.io/hr5bj ) of EBQI, we searched the databases PubMed, CINAHL, and SCOPUS. The review addressed three central questions: How is EBQI defined? How is evidence used to inform evidence-informed QI initiatives? What is the effectiveness of EBQI?

RESULTS

We identified 211 publications meeting inclusion criteria. In total, 170 publications explicitly used the term "EBQI." Published definitions emphasized relying on evidence throughout the QI process. We reviewed a subset of 67 evaluations of QI initiatives in primary care, including both studies that used the term "EBQI" with those that described an evidence-based initiative without using EBQI terminology. The most frequently reported EBQI components included use of evidence to identify previously tested effective QI interventions; engaging stakeholders; iterative intervention development; partnering with frontline clinicians; and data-driven evaluation of the QI intervention. Effectiveness estimates were positive but varied in size in ten studies that provided data on patient health outcomes.

CONCLUSIONS

EBQI is a promising strategy for integrating relevant prior scientific findings and methods systematically in the QI process, from the initial developmental phase of the IQ initiative through to its evaluation. Future QI researchers and practitioners can use these findings as the basis for further development of QI initiatives.

The perception of shared governance and engagement in decision-making among nurses

BACKGROUND

Shared governance is a structural framework for operationalizing nursing ownership and accountability for nursing practice. Healthcare institutions are striving to promote healthy and satisfactory work conditions to retain their qualified personnel and achieve organizational stability and high care quality. However, little is known about nurses' participation in governance in developing countries.

AIM

This study aims to evaluate the levels of shared governance, also known as professional governance, among nurses in Jordan. The demographics of the study participants will also be assessed.

METHODS

The current study used a cross-sectional design implementing an anonymous online survey technique to collect data from 111 nurses on the Index of Professional Nursing Governance (IPNG). Descriptive statistics were performed to evaluate the nurses' perception of the concept of shared governance in the domains of personnel, information, resources, participation goals and conflict resolution, and practice.

RESULTS

Among the 111 nurses, 55% of the participants were females, 45.5% were affiliated with governmental hospitals, and about half of them worked in critical care units. The analysis showed that the mean score for the total IPNG was 113 (SD = 26.28). The analyses of the mean scores of IPNG domains ranged from 11.5 (SD = 4.6) for goals and conflict resolution to 23.8 (SD = 5.7) for access to information.

DISCUSSION

The results revealed that nurses' average perception of professional governance demonstrated shared governance, and more specifically, in the lower level of shared governance where decisions are made primarily by management with some staff input. Analysis of the domains of governance revealed that participants' scores corresponded with shared governance in the areas of information, resources, goals and conflict, and practice, while traditional governance was prevalent in the governance of nursing personnel and participation.

CONCLUSION

There is an agreement on the need of moving the position of frontline nurses to the center of their organizations where equity, accountability, and ownership are the pillars of participative governance. Frontline nurses need further empowerment to be more actively engaged especially in the management of nursing staff and related structures and in the participation in structures connected to governance activities at different organizational levels such as in committees.

SOARING: A Residency Program for Unlicensed Assistive Personnel: Meeting the Demands While Retaining Highly Skilled, Engaged Clinical Technicians

A complex healthcare environment requires an optimal nursing skill mix at a reasonable cost to sustain safe, quality, and efficient patient care. An innovative, unlicensed assistive personnel residency program was developed to fill open positions with a skillful, confident, and engaged clinical technician workforce. The program resulted in highly skilled and confident clinical technicians, a 4% increase in engagement scores, and a 14% increase in retention rate.

Research on hospital-based shared governance: a scoping review

Purpose

The purpose of this study is to review research on hospital-based shared governance (SG), focussing on its core elements.

Design/methodology/approach

A scoping review was conducted by searching the Medline (Ovid), CINAHL (EBSCO), Medic, ABI/INFORM Collection (ProQuest) and SveMed+ databases using SG and related concepts in hospital settings as search terms (May 1998–February 2019). Only original research articles examining SG were included. The reference lists of the selected articles were reviewed. Data were extracted from the selected articles by charting and then subjected to a thematic analysis.

Findings

The review included 13 original research articles that examined SG in hospital settings. The studied organizations had implemented SG in different ways, and many struggled to obtain satisfactory results. SG was executed within individual professions or multiple professions and was typically implemented at both unit- and organization-levels. The thematic analysis revealed six core elements of SG as follows: professionalism, shared decision-making, evidence-based practice, continuous quality improvement, collaboration and empowerment.

Practical implications

An SG framework for hospital settings was developed based on the core elements of SG, the participants and the organizational levels involved. Hospitals considering SG should prepare for a time-consuming process that requires belief in the core elements of SG. The SG framework can be used as a tool to implement and strengthen SG in organizations.

Originality/value

The review resumes the tradition of systematically reviewing SG literature, which had not been done in the 21st century. General tendencies of the research scene and research gaps are pointed out.

Reconciling economic concepts and person-centred care of the older person with cognitive impairment in the acute care setting

Person-centred care is a relatively new orthodoxy being implemented by modern hospitals across developed nations. Research demonstrating the merits of this style of care for improving patient outcomes, staff morale and organizational efficiency is only just beginning to emerge. In contrast, a significant body of literature exists showing that attainment of person-centred care in the acute care sector particularly, remains largely aspirational, especially for older people with cognitive impairment. In previous articles, we argued that nurses work constantly to reconcile prevailing constructions of time, space, relationships, the body and ethics, to meet expectations that the care they provide is person-centred. In this article, we explore key concepts of neo-liberal thought which forms an important back-story to the articles. Economic concepts, "efficiency" and "freedom" are examined to illustrate how nurses work to reconcile both the repressive and productive effects of economic power. We conclude the article by proposing a new research agenda aimed at building a more nuanced understanding of the messy actualities of nursing practice under the influences of neo-liberalism, that illuminates the compromises and adaptations nurses have had to make in response to economic power.

Engagement in Nursing: One Organization's Success

Engagement in health care has gained in importance over time. It has become increasingly important in the work that nurses do to optimize patient involvement in the management of their health care activities. Nurse leaders are being called upon to build and sustain cultures of engagement for their employees and ultimately for patients. The purpose of this article is to share an engagement process that has proven successful at a community-based academic medical center that has received Magnet designation. While engagement remains a multifaceted process for all parties involved and requires a constant focus, the authors have focused on 3 key areas to increase registered nurse engagement. These areas include professional development, autonomy, and leadership access. Each area is addressed with specific strategies that were utilized to achieve success.