Slicing and dicing shared governance: in and around the numbers

Understanding strategies that foster nurses to act as clinical leaders in hospitals: A realist review

AIM

To identify strategies that develop clinical nursing leadership competencies among staff nurses, and to explain the contextual elements and mechanisms that underpin the development of clinical nursing leadership competencies.

DESIGN

Realist review according to the Realist and Meta-narrative Evidence Syntheses-Evolving Standards (RAMESES).

DATA SOURCES

PubMed, Embase, CINAHL, Web of Science, Wiley Online Library, PsycInfo and ProQuest were searched from January 2000 until October 2022.

REVIEW METHODS

Three iterative phases: (1) development of initial programme theory, (2) structured searches for relevant published and grey literature and (3) data synthesis and interpretation by researchers and theory triangulation, and discussions within the research group.

RESULTS

Multiple context-mechanism-outcome configurations were extracted from 10 reports that explain how, under what circumstances and why strategies can facilitate (or discourage) staff nurses to act as clinical leaders. Reports were both quantitative and qualitative in design, originating from English-speaking countries only.

CONCLUSIONS

A logic model was developed and suggests four contexts and five mechanisms underlying the development of clinical nursing leadership. Growth in clinical nursing leadership was mainly experienced through experiential learning, which was enhanced by a supportive relationship with a coach or mentor, the use of reflective practices and modelling from other leaders. Furthermore, a supportive work environment triggers ownership, confidence and motivation, and thereby growth in clinical nursing leadership competencies.

IMPACT

Fostering competencies for clinical leadership among staff nurses requires multifaceted strategies. Strategies are successful if, and only if, they combine learning by doing, by knowing and by observing, and establish a responsive work environment. Hospital policy should ensure that staff nurses have access to reciprocal relationships with role models or a coach. In order to grow as clinical nurse leader, ownership and self-reflection on own leadership behaviour need to be facilitated.

NO PATIENT OR PUBLIC CONTRIBUTION

Prospero ID CRD42021292290.

Associations and Predictive Pathways Between Shared Governance, Autonomy, Magnet Status, Nurse-Sensitive Indicators, and Nurse Satisfaction: A Multisite Study

BACKGROUND

Evidence is limited to the effects of shared governance (SG) and autonomy on nurse-sensitive indicators (NSIs).

PURPOSE

To explore the effects of SG, autonomy, and Magnet status on nurse and patient outcomes.

METHODS

A cross-sectional survey study was conducted using a convenience sample of 404 nurses from 4 hospitals. Descriptive analyses of variance (ANOVAs), and path analysis were conducted to identify hypothesized associations and predictive pathways among study variables.

RESULTS

Nurse managers reported higher perceptions of SG, autonomy, and satisfaction than staff nurses. SG and autonomy were significant predictors of patient falls and hospital-acquired pressure injuries. Nurses' autonomy, SG, and Magnet accreditation were significant predictors of nurse satisfaction.

CONCLUSIONS

Leadership support of SG and autonomous practice are key strategies to improve nurse satisfaction and NSI outcomes.

The predicting effects of professional governance and structural empowerment on job satisfaction among Jordanian nurses: A cross-sectional study

AIM

This study aimed to investigate the role of professional governance and empowerment in predicting nurses' job satisfaction.

BACKGROUND

Nurses can lead the way to enhance health care quality for all if they work in safe, satisfying and empowering environments. Professional governance and structural empowerment are associated with favourable work conditions and environments. However, studies addressing the predicting effects of professional governance and structural empowerment on job satisfaction are still limited.

METHODS

A cross-sectional design was applied. Online self-reported questionnaires were completed by 126 nurses. The analysis consisted of descriptive statistics, Pearson r correlation and hierarchical multiple regression to address the research aim.

RESULTS

Job satisfaction moderately correlated with structural empowerment (r = .40, p < .001) and professional governance (r = .30, p < .001). The final regression model revealed that 30% of the variation in job performance scores can be predicted by professional governance, structural empowerment and some demographic characteristics (R²  = .30, F = 8.67, p < .001).

CONCLUSIONS

Working in an environment that incorporates empowerment conditions, genuine support and valuable opportunities will increase the nurse's job satisfaction. Additionally, nurses will have higher job satisfaction if they have their voices heard.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers should properly assess the existing situation in each institution, implement already-tested-for-effectiveness and efficiency interventions and create new ones based on nurses'-specific needs.

Survey Research: Do All RN Types Have the Same Perceptions Regarding Professional Nursing Governance?

OBJECTIVE

Researchers examined professional nursing governance perception differences by RN type (clinical, manager, and other RNs), and nurse-related outcome associations.

BACKGROUND

Shared governance is associated with improved nurse-related outcomes. Understanding differences in RN types regarding shared governance perceptions is important and not well studied.

METHODS

Mean Index of Professional Nursing Governance (IPNG) scores from 3 hospitals' 502 RNs were used to evaluate associations by RN type and unit-based nurse-related outcomes. Descriptive and inferential statistical methods were used.

RESULTS

Shared governance was the predominant finding (overall score and 4 of 6 subscale scores) with no significant differences by RN type. Traditional governance was scored for 1 subscale (control over personnel), which was not significant. There were no significant differences in the IPNG score associations with outcomes data by RN type.

CONCLUSIONS

Clinical nurses, managers, and other RN types perceived their governance as shared, without significant difference in the nurses' perceptions based on role.

Nurses' critical reflections of working in unit practice councils-A qualitative interview study

AIM

This study aimed to describe nurses' experiences of working as members of unit practice councils.

BACKGROUND

Health care organisations worldwide want personnel to participate in decision-making. Unit practice councils promote unit-level decision-making over unit-specific issues. Despite extensive research on shared decision-making, few studies have examined the experiences of nurses serving as members of these councils.

METHODS

A descriptive qualitative study design was used with semi-structured interviews of 16 nurses in two clinics of a Finnish university hospital. Interviews were analysed using thematic analysis.

RESULTS

The analysis revealed two themes describing nurses' experiences as members of unit practice councils: (i) inchoate unit practice councils with insufficient allocated working time and (ii) partial empowerment of nurses through the organisation's evolving Magnet project.

CONCLUSIONS

Unit practice councils in the studied organisations are inchoate and unable to effectively advance shared decision-making or support nurses' professional autonomy. In the future, the councils require constant support from all leadership levels of the organisation.

IMPLICATIONS FOR NURSING MANAGEMENT

Sharing decision-making power could be a win-win situation where nurse leaders relinquishing power over certain matters gain time to immerse in wider issues. While acknowledging different organisational roles, there is room for trusting each other's professionality and respecting autonomous work.

Effect of Shared Governance on Nurse-Sensitive Indicator and Satisfaction Outcomes by Magnet® Recognition Status

OBJECTIVE

Researchers examined associations between Index for Professional Nursing Governance (IPNG) types and outcomes.

BACKGROUND

Effects of professional nursing governance on nurse-related outcomes by Magnet® status are not well studied.

METHODS

Associations were evaluated between average IPNG scores from 2170 RNs, and nurse-sensitive indicators (NSIs) as well as patient and RN satisfaction outcomes (N = 205 study units; 20 hospitals), following Magnet requirements.

RESULTS

Magnet hospitals had significantly better IPNG shared governance scores than non-Magnet hospitals (Magnet, 106.7; non-Magnet, 101.3). For Magnet hospitals, units scoring as shared governance outperformed traditional governance for 9 of 19 outcomes (47.4%) (NSI, 2; patient satisfaction, 3; RN satisfaction, 4). Self-governance outperformed shared governance for 8 of 15 outcomes (53.3%) (NSI, 2; patient satisfaction, 6; RN satisfaction, 0). For non-Magnet hospitals, shared governance significantly outperformed traditional governance for 1 of 15 outcomes (6.7%) (patient satisfaction).

CONCLUSIONS

Having shared or self-governance is a strategy that can be considered by nurse leaders to improve select nurse-related outcomes.

Nurse managers' perception of governance among Korean nurses

AIM

This study aims to ascertain nurse managers' perception of nurses' governance and explore their perception of facilitating and hindering factors of shared governance.

BACKGROUND

Shared governance has been introduced in nursing as a plan to improve nursing service quality. There is limited understanding about how governance is implemented.

METHODS

A mixed-methods design was used to elicit Korean nurse managers' views.

RESULTS

Quantitative data revealed the level of nurses' governance perceived by nurse managers as shared governance. However, among the subdomains, 'control over personnel' and 'participation in committee structures' indicate traditional governance. Analysis of qualitative data identified the factors that facilitate or hinder the subdomains: 'stifled atmosphere', 'nurse manager's encouragement', 'lack of opportunity and perception of the given authority' and 'flexible organisational structure'.

CONCLUSION

Findings from the study can be used to inform shared governance programmes for hospitals.

IMPLICATIONS FOR NURSING MANAGEMENT

Health care organisations, nurse managers and nurses must take action at each level to improve the current nurse governance situation. A flexible organisational culture with opinion windows for participation by nurses is important for shared governance. Supportive leadership of nurse managers and nurse-directed implementation could advance shared governance.

An integrative review on interventions for strengthening professional governance in nursing

AIM

To identify the interventions for strengthening professional nursing governance and describe their outcomes.

BACKGROUND

The ever-changing health care environment requires empowering governance structures and shared decision-making. The costly nature of reshaping governance makes the identification of effective interventions vital.

EVALUATION

An integrative review was carried out between January 2007 and May 2020 in the CINAHL, PubMed, Scopus, PsycINFO, Business source, Cochrane and Medic databases. The quality of the 12 included studies was evaluated with the Joanna Briggs Institute critical appraisal tools.

KEY ISSUES

Eight studies reported that the implemented interventions had positively influenced organisation regarding creating positive work environments, building new leadership competencies and increasing personnel's ability to take part in decision-making. The overall quality of the evidence was judged to be moderate.

CONCLUSION

Comprehensive decision-making structures, efficient teamwork and transformational leadership competencies among nurse leaders enable personnel to participate in decision-making. Further research is needed to identify the most effective interventions for improving professional governance.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse leaders have to ensure that personnel have adequate opportunities to congregate and decide over matters concerning their work. Positive organisational climate and relational leadership style, along with highly functioning teams, are important prerequisites to nursing councils producing the desired outcomes.

Professional governance in Finnish nursing - measured by the Index of Professional Nursing Governance

AIM

To translate and validate the Index of Professional Nursing Governance (IPNG) 2.0 and assess the state of professional nursing governance in Finland.

BACKGROUND

Raising and maintaining quality of care while retaining staff are common problems in healthcare globally. Professional governance is a modern way to tackle them, but a reliable instrument is needed to measure the state of nursing governance in Finland, and elsewhere.

METHODS

The IPNG that was translated into Finnish by forward-backward translation, culturally adapted and pilot tested with 20 nurses. A sample of 419 nurses was utilised in a cross-sectional study to assess the state of professional governance in Finland 2018.

RESULTS

Principal component analysis yielded six components with good Cronbach's α values. The results clearly indicate that the IPNG version developed and evaluated in this study has suitable psychometric properties for use in Finnish healthcare settings. The validated IPNG scores indicate that nursing governance in Finland is in the professional governance range. The staff have some input in the governance of Finnish healthcare organisations. However, this perception is strongest among the nurse leaders and experts; other groups do not perceive much change yet.

CONCLUSION

Participants, particularly nurse leaders in Finland, had self-reported impact in decision-making. The translated IPNG has acceptable internal consistency and can be used to assess healthcare organisations' governance models in Finland and broader in Nordic countries and Europe.

Transforming Shared Governance: Toward Professional Governance for Nursing

For more than 40 years, shared governance has supported structural empowerment and engaged nurses in their practice. Although progress has been made in advancing nursing ownership of practice through shared governance, mature nursing autonomy has yet to be achieved. It is time to evolve to professional governance, emphasizing accountability, professional obligation, collateral relationships, and decision making. Nurse leaders are provided with historical context and recommendations for effectively leading professional governance in an empowering work culture.

An Exploration of Factors Associated With Nurses' Perceptions of Decisional Involvement

OBJECTIVE

The purpose of this study was to evaluate nurses' perceptions of decisional involvement (DI).

BACKGROUND

Decisional involvement is a measure or gauge of nurses' perceived shared leadership. There has been limited research examining factors associated with actual and preferred DI.

METHODS

A descriptive, observational study design was used. A total of 189 RNs completed the Decisional Involvement Scale and Evidence-Based Practice Implementation Scale. Nurses' preferred DI (DI-P) and actual DI (DI-A) were analyzed, and DI total and subscale scores were compared based on nurses' demographic and clinical practice characteristics.

RESULTS

The DI-A and DI-P total scores were significantly different, including subscales for DI-A compared with DI-P score. Dissonance scores by subscale were highest for recruitment, governance, and support. Unit-based council (UBC) participants had significantly higher actual DI, compared with non-UBC participants. Nurses' perceptions of implementing evidence-based practice (EBP) was not significantly different by low versus high EBP implementation; nor were the scores significantly correlated with their DI-A or DI-P scores.

CONCLUSIONS

Findings indicate nurses' perceptions of DI-A and DI-P. This study provided further examination of the differences and interrelationships between DI and nurses' demographic and clinical practice characteristics. Dissonance DI scores provide opportunities for targeting interventions to engage nurses in shared leadership.

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.

Shared governance: a children's hospital journey to clinical nursing excellence

BACKGROUND

Shared governance is examined through a framework for developing independent decision making in professional nursing practice and improving patient care outcomes.

AIMS

This study is designed to obtain a baseline measurement of the degree of shared governance in a selected children's hospital in Saudi Arabia.

METHODS

The study was guided by the Donabedian model. The Professional Nursing Governance Index was used. A total of 400 questionnaires were distributed to nurses working at the hospital, with a response rate of 77% (n = 307). Descriptive and inferential statistics were used for analysis.

RESULTS

The results corresponded with those from nurses and managers in most subscales of the Index of Professional Nursing Governance (information, goals, resources, participation and practice). However, nurses working in the operating theatre and surgical unit have a perceived higher level of shared governance than those in critical care units and medical wards.

CONCLUSIONS

The results could encourage shareholders and leaders in the nursing field to develop the perception of shared governance by adopting a shared governance model, which in turn might improve the quality of nursing care.

Nursing shared governance at hospitals - it's Finnish future?

PURPOSE

The purpose of this study is to describe council structure, its benefits, supportive and obstructive factors and developmental needs as a part of shared governance in a university hospital.

DESIGN/METHODOLOGY/APPROACH

This is a descriptive study, where semi-structured interviews with 12 nurses was conducted in 2014 and documents from 75 council meetings from 2009 to 2014 were gathered and analyzed. Qualitative content analysis method was used on the data.

FINDINGS

The study hospital has been developing nursing shared governance with unique structure and processes of councils. Professors and university researchers act as chair and members are voluntary nursing staff. The factors supporting the councils are nurse managers' support, enthusiastic personnel and neighboring university. The factors obstructing the councils are lack of time, understanding and skills. The work of the councils benefits the organization by improving patient care, harmonizing nursing practices and informing decision-making. The council's developmental needs were more visibility, concentration into everyday problems and interprofessionality.

RESEARCH LIMITATIONS/IMPLICATIONS

Applying nursing shared governance structures into an organization improves the professional practice environment of nursing personnel.

PRACTICAL IMPLICATIONS

The study hospital has its own, unique council structure. It did not cover the whole hospital or all of the nursing personnel, but it is already producing promising results. It should be given an official status and more support from nurse managers, and it should be developed into an inter-professional discussion. The results presented here indicate that shared governance, even, in its early stage, contributes positively to the quality of care, harmonizes nursing practices and informs decision-making. Applying shared governance structures into an organization improves the professional practice environment of nursing personnel. The study showed concrete supporting and obstructing factors that should be notified in nursing leadership.

ORIGINALITY/VALUE

Despite the extensive empirical studies on nursing shared governance, there is very little research on councils in the Scandinavian countries.

Interdisciplinary Shared Governance in Ambulatory Care: One Health System's Journey

The implementation of shared governance structures in acute care has illustrated the positive relationship between shared decision making and nurse empowerment and positive nurse and patient outcomes. Little is known, however, about interdisciplinary shared governance, and even less is known about shared governance in ambulatory care. This article details one health system's experience with the implementation of an interdisciplinary shared governance structure in ambulatory care over a 4-year period. The authors report lessons learned, positive health system outcomes that resulted including improved communication, better preparedness for accreditation visits, improved assessment of fall risk, and a streamlined documentation system. Also discussed are mechanisms to enhance sustainability of the structure and discussion of future opportunities and challenges.

Comparing Clinical Nurse Specialist Students' Socialization Based on Magnet Employment

PURPOSE

The purpose of this study is to ascertain if clinical nurse specialist students differed on measures of professional socialization based on employment in a Magnet-oriented hospital.

DESIGN

A secondary analysis of data from a previous national study of the socialization of clinical nurse specialist students was used. Anticipatory socialization variables (nursing leadership, workplace exposure to the role, and preconceived impression of the role), mentorship by a clinical nurse specialist, and socialization outcomes (self-concept, perceived preparedness for practice, and nursing specialty certification) were explored.

METHODS

Data were divided into 2 groups: Magnet (n = 106) and non-Magnet (n = 119). Comparisons between the groups on researcher-designed items and the Professionalism and Work Ethic subscales of the Nurses Self-Description Form were analyzed.

RESULTS

The Magnet group was more likely to be exposed to the clinical nurse specialist role in the workplace. Overall, there were no group differences in socialization outcome measures; but in the subset of students with workplace exposure to the role, those with Magnet experience had higher professionalism self-concept scores.

CONCLUSIONS

Magnet employment was not a significant socializing factor for nurses pursuing clinical nurse specialist education. The graduate program is likely the primary socializing agent for these students.

Measuring perceptions of shared governance in clinical practice: psychometric testing of the RN-focused Index of Professional Governance (IPNG)

Shared governance is considered an innovative management process model that includes shared decision-making between all members of the healthcare workforce and focuses on nurses’ control over their practice and accountability of care. One specific tool that measures shared governance perceptions of nurses is the RN-focused Index of Professional Governance (IPNG). The objective of this study was to assess reliability and add to the validity of the IPNG by further establishing the construct validity and correlating the scale scores to measures of satisfaction obtained from the National Database of Nursing Quality Indicators (or NDNQI) survey. There were 76 respondents representing six units in one hospital. We reported high reliability for each one of the six subscale scores as well as for the total score (Cronbach alphas of 0.94 and higher). Construct validity was supported by the invariance of the scores across age groups along with schooling and experience levels. Concurrent validity was supported by a correlation of the IPNG score with job enjoyment ( r = 0.437, p = 0.002) and the desire to recommend the hospital as a place of employment ( r = 0.442, p = 0.001). The IPNG should also be tested in other healthcare professionals as its scoring ability can compare management, units and departments.

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.

Decisional involvement in Magnet®, magnet-aspiring, and non-magnet hospitals

BACKGROUND

Empowered decision making can help establish innovative work cultures. OJECTIVE: This study used the Decisional Involvement Scale to determine differences in actual and preferred decisional involvement among staff RNs and administrators in Magnet®, Magnet-aspiring, and non-Magnet hospitals.

METHODS

: Two facilities were Magnet designated, 3 were Magnet aspiring, and 9 were non-Magnet. A total of 5000 staff RNs and administrators were asked to participate in the nonexperimental descriptive survey. RESUTS: The difference observed in actual global scale score by Magnet status was statistically significant (P = .01). Respondents in Magnet hospitals had the highest actual global scale score on average, followed by Magnet-aspiring, then non-Magnet.

CONCLUSIONS

Decisional involvement is higher among Magnet-designated than non-Magnet facilities.

Reframing Knowledge Work: Shared Governance in the Postdigital Age

Shared governance is a structural model for framing professional practice within an organizational format. After 25 years of research and development, basic principles that undergird the appropriate and sustaining structures of shared governance have become well established. Understanding, translating, and applying these principles will help those implementing nursing shared governance to build a strong professional structure, which can serve as a framework for constructing and expressing professional practices, processes, and relationships.