2. Sofia Warren Ferris State University

3. Objectives To identify the four basic elements of shared governance To identify the structure model in support of shared governance To identify the correlation between shared governance and relationship based care To identify the relationship between shared governance and Magnet recognition To identify perceptions of how and if shared governance improves quality and safety outcomes for patients

4. What is nursing shared governance? Please click on link below and copy and paste into address bar or right click and click on hyperlink. http://www.youtube.com/watch?v=2WpqO HZDPUY&feature=player_detailpage

5. Shared Governance Partnership Equity Accountability Ownership

6. Shared governance model

7. Partnership Builds relationships Links the health care provider to the patient throughout the health care system Creates professional empowerment through the collaborative relationships of all the stakeholders Implies the key value of each member in fulfilling the mission and purpose of the organization

8. Equity Maintains a focus on services Is the foundation and measure of value Integrates roles and relationships into the establishment of the structures and processes needed to achieve positive patient outcomes

9. Accountability Investment in decision-making Accepting ownership of decisions

10. Ownership Recognition and acceptance of the importance of each role Recognition that success is determined by how well each individual does their job.

11. Self governance vs. Share governance Centralized interactions (Self governance) Position-based Distant from point of care Hierarchical communication Limited staff input Separates responsibility to managers We-they work environment Divided goals/purpose Independent activities/tasks Decentralized interactions (Shared governance) Knowledge-based Occurs at point of care Direct communication High staff input Integrates equity, accountability and authority for staff and managers Synergistic work environment Cohesive goals/purpose ownership Collegiality, collaboration, partnership

12. Empowerment “When staff members are clear about their roles, responsibilities, authority, and accountability they have a greater confidence in their own judgments and are more willing to take ownership for decision making at the point of care” (Koloroutis, 2004).

13. Theory Jean Watson’s Theory of Caring Relationship Based Care: Mary Koloroutis Kanter’s Theory of Structural Empowerment

14. Theory of Human Caring Care and relationship-centered care is a foundational ethic for healing practices Creates a healing environment Delineates the art of nursing through caring-healing modalities

15. Relationship Based Care

16. Relational Partnerships in the health care setting Interdependence Collegial relationships Team work/collaboration Patient centered and lead Leading change Partnerships Direct communication

17. Kanter’s Theory of Structural Empowerment “power as an ability to mobilize resources and achieve goals”. We feel empowered when we have access to information, support, access to resources and opportunities to learn and grow Strong networks with peers, patients and other organizational members increase perception of empowerment

18. Assessment of the Health Care Environment Institutional framework Quality and safety issues Satisfaction and engagement Obstacles

19. Shared governance framework Grounded in clinical practice Nursing is responsible, accountable and has authority over all decisions related to practice, quality and competence Staff nurses are elected to positions by peers Needs to be implemented organization wide Management provides the support, encouragement, resources, training and boundaries for success Responsibility and accountability based Composed of a coordinating group of staff and management. Is bylaws and rules driven

20. Basic requirement for shared governance Committed nurse executive Strong management team Employees must have a clear basic understanding of shared governance. Must be able to chart progress with a plan and timeline for implementation

21. American Nursing Credentialing Center Magnet designation Transformational leadership Structural empowerment Exemplary professional nursing practice New knowledge, innovations, and improvements Empirical quality outcomes

22. Magnet Recognition Supports nursing practice, identifying nursing excellence Focuses on professional nursing development Supports nursing autonomy in practice and decision making Supports nursing involvement in decisions related to bedside care, education and nursing leadership

23. Benefits of designation reflected in shared governance for the patient Reduced mortality Reduced patient morbidity Increased patient satisfaction

24. “Nursing Leaders must continue to identify and sustain new strategies to empower nurses so that nurses can continue to be an integral component in the health care delivery team” Improved job satisfaction Increased engagement Increased retention Reference: Barden, A. M., Quinn Griffin, M. T., Donahue, M., & Fitzpatrick, J. J. (2011). Shared governance and empowerment in registered nurses working in a hospital setting. Nursing Administration Quarterly, 35(3), 212-218. doi:10.1097/NAQ.0b013e3181ff3845

25. Root Cause Analysis Problem: Poor nursing engagement Data Collection: Lack of participation in council meetings and unit decisions, low safety and engagement scores, decreased moral. Possible Causal Factors: Breakdown in communication, disinterest, lack of knowledge lack of resources, lack of support. Root cause: Perceived lack of value and empowerment. Recommended Solution: Provide unit support to participate, improve available resources, support opportunities for growth and promote autonomy in practice.

26. Obstacles to shared governance Poor collaboration Poor communication Resistance to change and implementation of change Lack of interest Lack of concern to effect change Lack of consensus Lack of clarity related to roles and responsibilities

27. Please cut and past to address bar or right click and click on hyperlink http://www.youtube.com/watch?feature=player_detailp age&v=XowMzXDko1I

28. ANA Standards Standard 10: Quality of Practice Standard 11: Communication Standard 12: Leadership Standard 13: Collaboration

29. Quality and Safety Education for Nurses QSEN competencies Patient Centered Care Teamwork and Collaboration Evidence Based Practice Quality Improvement Informatics Safety

30. Summary Increased nursing retention related to increased job satisfaction Improved patient care and safety outcomes. Improved financial viability Empowerment of nurses through promotion of nursing excellence Nursing excellence and Magnet recognition

31. Closing… Research implies that shared governance can have a positive impact on nursing satisfaction and potentially patient outcomes. More research needs to be done Shared governance empowers nurses to develop practice Allows nurses to network and collaborate among units and departments

32. References Alligood, M., & Tomey, A. (2010). Nursing Theorists and Their Work (7 th ed.). Maryland Heights, MO: Mosby. American Nurses Association (2010). Nursing Scope and Standards of Practice (2 nd ed.). Silver Springs, MD. American Nurse Association. Armstrong, K., & Laschinger, H. (2006). Structural empowerment, magnet hospital characteristics, and patient safety culture: making the link. Journal of Nursing Care Quality, 21(2), 124-134. Barden, A.M., Quinn Griffin, M. T., Donahue, M., & Fitzpatrick,J. (2011). Shared governance and empowerment in registered nurses working in a hospital setting. Nursing Administration Quarterly, 35(3). 212-218. doi: 10.1097/NAQ.0b013e3181ff3845 Brewton, C., Eppling, J., & Hobley, M. (2012) Our voice: an interdisciplinary approach to shared governance. Hospital Topics 90(2), 39-46. doi: 10.1080/00185868.2012.679910 Burkman, K., Sellers, D., & Batcheller, J. (2012). An integrated system’s nursing share governance model: a system chief nursing officer’s synergistic vehicle for a leading a complex health care system. Nursing Administration Quarterly 36(4), 353-361. doi: 10.109/NAQ.0b013e31826692ea Koloroutis, M. (Ed.). (2004) Relationship-Based Care: A model for Transforming Practice. Minneapolis, MN: Creative Healthcare Management.

33. References Larkin, M.E., Cierpial, C.L., Stack, J.M, Morrison, V.J., Griffith, C.A. (2008). Empowerment Theory in action: the wisdom of collaborative governance. OJIN: The Online Journal of Issues in Nursing. 13(2) doi:10.3912/OJIN.Vol13No02PPT03 Nursing Theories (2012). Jean Watsons’ philosophy of nursing. Retrieved October1, 2012 from http://currentnursing.com/nursing_theory/Watson.html Porter-O’Grady, T., Finnigan, S. (1984). Shared Governance for Nursing: a Creative Approach to Professional Accountability. Aspen Publication. Rockville, Maryland. Quality and Safety Education for Nurses (2012). Pre-licensure knowledge, safety and attitude competencies. Retrieved October1, 2012 from http://www.qsen.org/overview.phphttp://www.qsen.org/overview.php Swihart, Diana (2006). Shared Governance: A Practical Approach to Reshaping Professional Nursing practice. HCPr o, Inc. Marblehead, MA Yoder-Wise, P. (2011). Leading and Managing in Nursing (5 th ed.). Elsevier. St. Louis, MO.