Perceptions of shared governance among nurses at a midwestern hospital

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.

A descriptive study of factors that facilitate nurses' participation in shared governance and attendance at unit meetings

AIM

To identify factors that facilitate participation in shared governance and attendance at unit meetings.

BACKGROUND

Shared governance and unit meetings are crucial for education and communication. Current literature explores barriers to participation and attendance; however, removal of barriers may be insufficient to bring about behaviour change in nurses.

METHOD

Secondary analysis of data from 511 clinical nurses, who worked at one of nine facilities within one large health care system in the Midwest United States, was used to address our aim.

RESULTS

Shared governance participants and unit meeting attendees were most satisfied with nursing as a career and more likely to be optimistic that nurses could change things, than non-participants and non-attendees, and this difference was statistically significant (p < .05). The organizational variable most associated with participation and attendance dealt with paid time-off to attend meetings. Personal reasons for participation and attendance were the opportunity to express opinions and to hear opinions of others.

CONCLUSION

Organizations should encourage nurses to express their opinions and ensure that nurses are paid for the time spent participating in meetings.

IMPLICATIONS FOR NURSING MANAGEMENT

While some variables cannot be controlled by organizations, nursing leadership can provide opportunities for nurses to become more active and participate in decision-making.

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.

Shared governance in a clinic system

Shared governance in health care empowers nurses to share in the decision-making process, which results in decentralized management and collective accountability. Share governance practices have been present in hospitals since the late 1970s. However, shared governance in ambulatory care clinics has not been well established. The subjects of this quality project included staff and administrative nurses in a clinic system. The stakeholder committee chose what model of shared governance to implement and educated clinic staff. The Index of Professional Nursing Governance measured a shared governance score pre- and postimplementation of the Clinic Nursing Council. The Clinic Nursing Council met bimonthly for 3 months during this project to discuss issues and make decisions related to nursing staff. The Index of Professional Nursing Governance scores indicated traditional governance pre- and postimplementation of the Clinic Nursing Council, which is to be expected. The stakeholder committee was beneficial to the initial implementation process and facilitated staff nurse involvement. Shared governance is an evolutionary process that develops empowered nurses and nurse leaders.

[Intervening conditions on governance of the nursing practice at an obstetrics centre]

Governance refers to all processes that grant nurses autonomy, control and authority over the nursing practice. The aim of this study was to identify intervening conditions on governance of nursing practice at an obstetrics centre. This is a qualitative study based on the grounded theory method. Data were collected between January and May 2013 by means of semi-structured interviews with 27 participants of a university hospital in southern Brazil, divided into four sampling groups. Data were analysed using open, axial and selective coding. Governance is reinforced by experience and professional autonomy, coordination of the care and management dimension, interpersonal communication, satisfaction and engagement with the profession. It is limited by difficulties with interpersonal relationships, work overload and precarious physical structure of the maternity units. This study provides arguments for the discussion on improvements in healthcare and the professional satisfaction of nurses and nursing teams.

Decisional Involvement Among Staff Nurses Based on Educational Level and Certification Status

Mechanisms to enhance the work environment are nurse decisional involvement (DI), obtainment of a baccalaureate or higher degree, and specialty certification. The purpose of this descriptive comparative study was to determine the difference between actual and preferred DI of staff nurses on the overall Decisional Involvement Scale (DIS), the differences based on its subscales, and those based on education level and certification. The sample included 163 staff nurses from a Midwestern health care organization. A statistically significant difference was found between actual and preferred DI, but no difference was found based on educational level and certification. There is a need to focus on nurses with a BSN/master’s degree or specialty certification and to conduct comprehensive studies to address the effects of education and certification on DI. An additional strategy that can be useful for organizations is to provide nurses with the empowerment structures, expectations, and mentoring/coaching to become involved in the process of decision making.

Barriers to participation in governance and professional advancement: a comparison of internationally educated nurses and registered nurses educated in the United States

OBJECTIVE

This study compared the perspectives of internationally educated nurses (IENs) and registered nurses (RNs) educated in the United States regarding participation in hospital governance structures and professional advancement.

BACKGROUND

Nurses' participation in hospital governance is reported to contribute to empowerment. No research has examined how IENs' perceptions about participation in governance compared with those of U.S. RNs.

METHODS

Semistructured interviews were held with 82 nurses in 2 urban hospitals. Forty nurses were reinterviewed to follow up on themes.

RESULTS

Internationally educated nurses and US RNs shared similar perspectives. Nurses in both samples did not value participation in governance, lacked guidance about how to advance, and preferred to at the bedside.

CONCLUSIONS

Strategies to encourage nurses to participate in and value governance and professional advancement opportunities should be explored and adopted.