Nurse manager perspective of staff participation in unit level shared governance

Why Shared Decision Making Matters

Shared decision making is a hallmark of Magnet® organizations. Although the terminology can vary, the essence is the same: nurses at all levels, and in all settings, need to be a part of the decision making structure and process. Their voices, along with those of their interprofessional colleagues, ensure a culture of accountability. During times of financial challenges, trimming shared decision making councils may seem an easy place to save money. However, eliminating the councils may lead to increased unintentional costs. This month's Magnet Perspectives takes a closer look at the benefits of shared decision making and its enduring value.

Organisational support for healthcare innovation in hospitals: Towards a commitment framework

The article investigates organisational drivers and restrainers of innovation in hospitals on the background of different institutional logics. It presents evidence from a multiple case study in Polish hospitals, which reveals different dynamics on the micro-, meso- and macro-level of organisations in enabling and implementing new procedures and technologies. In particular, the study documents an ambiguous influence of medical professionalism as a specific logic in the healthcare sector, which can affect innovation positively as well as negatively. The article therefore proposes a managerial framework based in innovation action commitment to control the effects of professionalism in healthcare.

Factors Facilitating or Inhibiting the Capacity for Effective Leadership Among Front-Line Nurse Managers: A Scoping Review

AIMS

The purpose of this scoping review is to map and synthesize research studies addressing the factors that impact leadership behaviors of Front-Line Nurse Managers.

BACKGROUND

Leadership is a fundamental component of the role of Front-Line Nurse Managers. Ineffective leadership is associated with costly outcomes; thus, organizations seek effective strategies to facilitate consistent demonstration of leadership behaviors.

EVALUATION

Using a scoping review methodology, findings from 26 empirical studies were mapped to identify barriers and facilitators of leadership among Front-Line Nurse Managers. Major categories included personal and environmental factors with subthemes of personal characteristics, competencies, and social support.

KEY ISSUES

Available evidence captures the influence of personal characteristics, education, competency, and formal social support on leadership capacity. The role of informal social support was not captured.

CONCLUSIONS

Multiple personal and environmental factors influence the capacity for leadership behaviors among Front-Line Nurse Managers. Strategies such as leadership development programs, mentorship and peer support programs, and work environments that support relational and structural support may increase leadership capacity for Front-Line Nurse Managers IMPLICATIONS FOR NURSING MANAGEMENT: Senior nurse leaders can use the results of this review to guide implementation of evidence-based strategies to recruit and retain Front-Line Nurse Managers.

Expanding nurses' authority - Physicians' and nurses' attitudes

AIM

To examine and compare the attitudes of physicians and registered nurses regarding extending nurses' authority.

DESIGN

This was a comparative quantitative study, which used a questionnaire that examined the attitudes of nurses and physicians regarding expanding nurses' authority.

METHODS

The study comprised a sample of 134 nurses (62.7%) and physicians (37.3%), who filled out the self-report questionnaire that included sociodemographic data and questions designed to examine the participants' attitudes and perceptions on expanding nurses' authority. The general reliability of the questionnaire was Cronbach's α = 0.931. Participants were sampled through the convenience-snowball method.

RESULTS

Differences were found between the attitudes of physicians and nurses to expanding nurses' authority. Nurses tended to be in favor, whereas physicians tended to be against (t(86.29) = 7.713; p < 0.05). Nurses' attitudes are also more positive specifically to procedures related to drug administration (t(132) = 6.894; p < 0.05) and resuscitation (t(132) = 2.974; p < 0.05), compared to physicians.

CONCLUSIONS

Nurses have more positive attitudes toward expanding nurses' authority than physicians do, specifically toward drug administration and resuscitation. Further study is proposed to identify factors which affect the physician-nurse relationship and attitudes on a large scale through a qualitative study.

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.

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.

Evaluation of Nursing Service Management Model applied in hospitals managed by social health organization

OBJECTIVE

Evaluate the Hospital Nursing Service Management Model from the perspective of nurses from hospitals managed by social health organization, considering the type and dimensions of the model.

METHODS

This is an exploratory, cross-sectional study with a quantitative approach; census population. The evaluation was conducted in 15 hospitals based on the Index of Professional Nursing Governance, including the descriptive analysis of the k-means method and multiple linear regression to score the instrument. Data collection was performed online, stored in REDCap®.

RESULTS

Of 1,523 invited, 680 (44.6%) accepted and 518 (34.1%) completed the questionnaire. With a general average of 184.3 points, 12 hospitals indicated shared; and 3 (20%), traditional governance (average of 165.7 points).

CONCLUSION

Managers presented a lower perception of shared governance with professionals without a management function. The type of function and time of activity at the institution influenced the results. The present model is hybrid, in the transition process from the traditional to corporate.

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.

Comparing nurse leader and manager perceptions of and strategies for nurse engagement using a positive deviance approach: A qualitative analysis

AIMS

To understand nurse leader and manager perspectives on employee engagement and their own role to foster engagement. To examine differences between managers of units with high versus low engagement.

BACKGROUND

Health systems recognize the impact of employee engagement, yet alignment of leader and frontline-manager perspectives remains unclear.

METHODS

A qualitative study at the Veteran Affairs New England Healthcare System. Leaders at five facilities (N = 13) and managers of units with high and low nurse engagement (N = 31) were interviewed.

RESULTS

Nurse leaders almost universally conceptualized staff engagement as involvement in quality improvement service, while managers defined engagement as either commitment to excellence in direct patient care or involvement in quality improvement efforts. Intra- and interprofessional attitude contagion, and organisational factors of staffing-time-workload and senior leadership support were most common to support or detract from nurse engagement. A variety of strategies were identified, including protecting nurses as people and professionals. Differences in perceived roles and constraints to engaging nurse staff exist between managers of units with high versus low engagement.

CONCLUSION

Nurse managers and leaders perceive engagement differently; strategies exist to facilitate engagement.

IMPLICATIONS FOR NURSING MANAGEMENT

Leader and manager partnerships are needed to provide clarity on and resources for engagement.

Exploring the governance practices of nurse managers in the Greater Accra Region of Ghana

AIM

The study aim was to examine governance practices of nurse managers at the unit level in the Greater Accra Region of Ghana.

BACKGROUND

Health care managers are encouraging authorities of hospitals to appoint knowledgeable and experienced nurse managers to better coordinate and carry out the delivery of health care services. Nurse managers' governance practices have been identified as essential in ensuring quality health care delivery. This study investigated nurse managers' governance practices at the unit level.

METHODS

The study employed a quantitative cross-sectional design to gather data from 522 nurses in 19 selected hospitals in the Greater Accra Region of Ghana. Data were analysed using descriptive statistics and linear regression analyses.

RESULTS

The study findings showed that nurse managers exhibited a moderate level of governance practices. Qualification, training in management, experience as a nurse and experience as nurse manager together had no significant influence on governance practice (R²  = .012, p = .180). The only experience as a nurse manager was a significant predictor in the model (B = 0.037, p = .023).

CONCLUSION

Nurse managers' roles and responsibilities continue to evolve within the complex health care system. It is important to empower nurse managers to enhance their governance practices through a well-structured programme such as coaching and mentorship to improve efficiency and effectiveness at the unit level.

IMPLICATION FOR NURSING MANAGEMENT

Governance practices of nurse managers to create a favourable environment is essential to ensure efficiency, quality and unit outcomes. Experience as a nurse manager predicted governance practices, this implies that nurse managers should be assisted to enable them to gain experiences in governance practices.

Professional pride: A qualitative descriptive study of nursing home staff's experiences of how a quality development project influenced their work

AIMS AND OBJECTIVES

To explore and describe how daily work at a nursing home had been influenced by a quality improvement project, from the perspective of direct care staff.

BACKGROUND

Deficiencies in nursing home care are widely reported, often with a focus on lack of competence among direct care staff. The present trend in quality development in nursing homes brings direct care staff's perspectives into focus through participatory action research approaches. Still, little is known about how staff experience the impact of such projects on their everyday work.

DESIGN

The study was designed as an interpretive descriptive study, based on interviews with nursing home staff. The methods were conducted in accordance with the SRQR guidelines.

RESULTS

The analysis revealed that the participants reasoned on whether the improvement project contributed to their possibilities perform their work at the unit for the benefit of the residents. This was strongly connected to their professional pride. The participants reflected on this through three changes generated by the project: (a) participating in project activities-supporting or threatening daily work at the unit, (b) from performing individual duties towards a shared responsibility and (c) confirming and strengthening competence that brings the everyday situation of residents into focus.

CONCLUSION

The importance of professional pride identified in this study points towards a need for reducing barriers for direct care staff to express and develop competences they regard as part of their professional identity. The findings also shed some light on competence that brings the everyday situation of residents into focus as a driving force behind lack of compliance and resistance to change.

RELEVANCE TO CLINICAL PRACTICE

The findings indicate a call for quality development designs to reduce barriers for care staff to express and develop knowledge that they regard as part of their professional identity.