Factors associated with success and breakdown of shared governance

A Road Map for the Development of a Decisional Authority Framework for Professional Governance Using Accountability Grids

Although resources are available to guide structures and processes for professional governance, limited information exists about defining and legitimizing the decisional authority needed to support direct care nurses' ownership of clinical practice as well as the role of nursing leaders. This article presents a road map for creating and implementing clinical nurse, nurse leader, and nurse executive accountability grids with clearly delineated authority to provide a decisional authority framework for professional governance in one organization.

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.

A systematic review of implementation frameworks of innovations in healthcare and resulting generic implementation framework

BACKGROUND

Implementation science and knowledge translation have developed across multiple disciplines with the common aim of bringing innovations to practice. Numerous implementation frameworks, models, and theories have been developed to target a diverse array of innovations. As such, it is plausible that not all frameworks include the full range of concepts now thought to be involved in implementation. Users face the decision of selecting a single or combining multiple implementation frameworks. To aid this decision, the aim of this review was to assess the comprehensiveness of existing frameworks.

METHODS

A systematic search was undertaken in PubMed to identify implementation frameworks of innovations in healthcare published from 2004 to May 2013. Additionally, titles and abstracts from Implementation Science journal and references from identified papers were reviewed. The orientation, type, and presence of stages and domains, along with the degree of inclusion and depth of analysis of factors, strategies, and evaluations of implementation of included frameworks were analysed.

RESULTS

Frameworks were assessed individually and grouped according to their targeted innovation. Frameworks for particular innovations had similar settings, end-users, and 'type' (descriptive, prescriptive, explanatory, or predictive). On the whole, frameworks were descriptive and explanatory more often than prescriptive and predictive. A small number of the reviewed frameworks covered an implementation concept(s) in detail, however, overall, there was limited degree and depth of analysis of implementation concepts. The core implementation concepts across the frameworks were collated to form a Generic Implementation Framework, which includes the process of implementation (often portrayed as a series of stages and/or steps), the innovation to be implemented, the context in which the implementation is to occur (divided into a range of domains), and influencing factors, strategies, and evaluations.

CONCLUSIONS

The selection of implementation framework(s) should be based not solely on the healthcare innovation to be implemented, but include other aspects of the framework's orientation, e.g., the setting and end-user, as well as the degree of inclusion and depth of analysis of the implementation concepts. The resulting generic structure provides researchers, policy-makers, health administrators, and practitioners a base that can be used as guidance for their implementation efforts.

Governanca em enfermagem: revisao integrativa da literatura

O objetivo deste estudo foi identificar e caracterizar os tipos de governança em enfermagem, destacando seu impacto na prática dos enfermeiros e no cuidado em saúde. Trata-se de revisão integrativa a partir das bases de dados MEDLINE, CINAHL, LILACS e na biblioteca eletrônica SciELO, de 2007 a 2011, com os descritores Governança /Governance e Enfermagem/ Nursing, totalizando 25 artigos. Foram identificados três modelos de governança, estudados principalmente nos Estados Unidos e Inglaterra: governança compartilhada, governança clínica e governança pública. Entre os impactos desses modelos, destacam-se: melhoria da qualidade assistencial, maior autonomia profissional dos enfermeiros, melhoria da articulação entre os serviços de saúde e maior satisfação profissional entre enfermeiros. Pontua-se a necessidade da realização de estudos sobre a temática na América Latina, com o intuito de avaliar sua aplicabilidade em diferentes contextos.

Decisional Involvement

Enhancing nurse involvement in decision-making is a starting point in addressing the nursing shortage, recruitment, and retention. The purpose of this descriptive comparative secondary data analysis was to describe the level of registered nurses’ actual and preferred decisional involvement (DI) in two studies carried out during 2004 and 2010 and to describe the difference in the levels of actual and preferred DI between the 2004 study ( N = 290) and the 2010 ( N = 111) study in a Midwestern medical center after a new shared governance structure was implemented. In the 2004 and 2010 studies, there were statistically significant differences between actual and preferred levels of DI. A statistically significant decrease in means occurred in actual and preferred DI in 2010 as compared with that in 2004. A concerted effort must be made by nursing leaders to enhance DI, offer adequate resources, promote learning and growth, and recognize nursing contributions within a shared governance.

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.