Objectives

1. The Role of Nursing Leadership in Shared GovernanceMarch 25, 2011Vilma Ortiz, MSN, BSN, RN Director of Patient Care Services Medical Surgical Hospital Center

3. Objectives • Identify best practices of the leadership team in Shared Governance. • Identify the governance functions of the professional nursing staff and leadership. • Discuss the effects of personal strength and conviction in leading a team effectively. • Explain factors that supports shared governance practice model.

4. Shared Governance • Share: participate, partake, implies having or taking part in an undertaking or activity • Governance:exertion of a determining or guiding influence over; government; direct control; having the authority to determine basic policy Source: Merriam Webster’s English Dictionary

5. Total Commitment: Shared Governance History: Un-named concept first introduced in nursing literature (1976) by Christman; “autonomous nursing organizations giving nursing an equal voice with physicians” Source: http://www.nursingworld.org, accessed Jan. 26, 2009. Cleland later published it in nursing literature in 1978 – a university model, reconciling the interests of different organizational groups through the distribution of power; “faculty, administration and students coming together to try to come to decisions,” hence Shared Governance Source: Shared Governance: A Working Definition, St. Louis University News, 2004. Today: Management empowering frontline staff to make changes in their work environments Source:O’Grady, T. P (2004). Overview: Shared Governance: Is It a Model for Nurses to Gain Control Over Their Practice? (http://www.nursingworld.org, accessed Jan. 26, 2009).

6. Shared Governance Defined “An evidence-based management process model of shared decision-making based on the principles of partnership, equity, accountability, and ownership at the point of service.” Source: Church, Baker & Berry (2008) Nursing Management, April 2008, Shared Governance: A journey with continual mile markers

8. Concept of Shared Governance • Rooted in business • Integrally related to Magnet Designation • Involves frontline staff • Includes management • What does it mean?

9. Shared Governance • Frontline staff know best what the customer needs so let them take care of it, within certain limitations • Management from the bottom up • Empowering staff to fix certain problems that they know exist • Allowing staff to evaluate their practice and change it to make it better • Involves patient care improvement

10. Who is the Nurse Manager/Manager/Supervisor? • The nurse/person who has the responsibility, authority and accountability for the overall clinical and operational functions on the unit. • Includes:a) Staffingb) Budgetc) Disciplinary action, and so forth

11. How is Shared Governance Manifested at JHS? • The Unit Practice Councils & Practice Councils • What are the Unit Practice Councils?

12. Definition • Unit Practice Council (UPC) is: unit-based aspect of Shared Governance • Function outlined in handout entitled, “Unit Practice Council, the way Forward”

13. Role of Nursing Leadership in Shared Governance Increase your knowledge:a) Become familiar with the intricacies of the UPCb) Assist the UPC in establishing Communication Network/Tree c) Clarify expectations with UPCd) Assist in the development of UPC meeting schedule

14. Know the Charter • Outlines UPC: 1) Philosophy 2) Responsibility3) Authority4) Accountability5) Membership • In essence, Charter is the Constitution of the UPC

15. Communication • Maintain open communication with the UPC:a) Ask to attend a meeting b) Give advice to the UPC c) Do not tell them what to dod) Discuss your expectations clearly (e.g. minutes)Remember: Your UPC is a reflection of you

16. UPC Projects • Ensure that they are: a) unit-needs-drivenb) data ladenc) outcome-oriented i.e. decrease cost, improve system/process d) first presented to the divisional Steering Councile) bases of practice change (P&P)

17. Data Sharing • Share unit-specific data with staff and let them know the implications Examples:a) NDNQI (National Database for Nursing Quality Indicators)b) PRC (Professional Research Consultants, Inc.) Scores – Patient satisfaction scoresc) Outcome dataAny data that staff can impact, share!

18. Why Share Data? • Gives staff ownership of the data • Instills feelings of responsibility • May be an impetus for change • Your UPC should be that instrument for practice change

19. Staff Meetings • Most common complaints from staff:a) lack of open, respectful communication b) lack of staff meetings c) mode of communicating information – they are left out

20. Staff Meetings • Bridge the communication gap by having regular staff meetings with an update from the UPC at each meeting! • Have the UPC organize the meeting if you do not have the time Gem: This will engender empowerment and trust!

21. Motivate Staff UPC Membership means:a) Trust by peersb) Professional growth and developmentc) Leadership Examples:a) Many UPC members have been promotedb) Some UPCs have presented at research conferences

22. Be Involved Our best practices at JHS reveal the following:a) Nurse leadership/leadership involvement = successful UPCb) If staff perceives and believes leader is supportive, UPC = strongerc) Leadership involvement = sustainability of the UPC & Shared Governance structure

24. Reasons for UPC Failure/Struggles per ANMs

25. Leadership Detachment Results in:a) Failure of UPCb) Demoralization of staffc) Lack of trustd) Frustratione) Fear of trying f) Erosion of the Shared Governance Structure g) Denial of Magnet Designation

26. Top 6 Causes of UPC Struggle/Failure per NMs

27. Conclusions/Implications Nurse leadership: • Is integral to the success of the Shared Governance • Must be involved but not controlling • Is necessary to sustain the UPCs • Is a great source to tap into for facilitators

28. Group Practice Impact(Results from Focus Group Conducted by UPC Coordinator, 2008) • “It has made me more aware of our responsibility as caregivers and true advocates for patients.” • “Still working on the model; it’s going to take time to work.” • “Can’t wait to participate….!” • “More continuity of care, improving quality of care, more accountability.”

29. How has involvement in the UPC changed your image of Professional Nursing?(Focus Group 2008)

30. PRC Patient Satisfaction Scores 2008“Describe the overall quality of care provided” Units with high performing UPCs Units that do not have established UPCs

31. Pressure Ulcers: Improvement Trends

32. Job Enjoyment Trends Upward

33. UPCs & PRESSURE ULCERS 2009

34. Tim Porter O’Grady (father of Shared Governance in Nursing) • “It is a format for all nurses to own their practice and join in a collective effort to advance the value and quality of health care for all. That’s what it means to be a nurse. It is clear, we simply can’t do the work alone. Shared Governance isn’t an option; it’s an expectation.” • Source: OJIN article: Overview: Shared Governance: Is it a model for nurses to gain control over their practice? (Jan. 2004)

35. Accomplishments for 2010 Patient Satisfaction Exceeds National Standard for Likelihood to Recommend and Quality of Care North Wing 3 Medical Adult South Wing 5 Medical Adult

36. Surgical Transplant Recipient of Silver Award – KidneyBronze Award for Pancreas - Liver

37. Thank You!!! • QUESTIONS? • COMMENTS?