On 2017 Mar 23, University of Kansas School of Nursing Journal Club commented:

Team Members: Jason Tracy, Abigail Spare, Julia Damman, Laura Thompson, Sophie Bono, Maeve Markey. [Class of 2017]

Background

In our class, we took time to study shared governance in acute care organizations and looked at the importance of shared governance in regards to all nursing positions. This article not only touches on the importance of shared governance, but also explores the processes needed to help direct patient care nurses transition their knowledge, skills, and attitudes into the leadership role that would facilitate shared governance. Our team was especially interested in the idea of shared governance, and liked how this particular article discussed an intervention to increase shared governance by empowering nurses with leadership. This is an interesting, practical intervention that could be implemented with nurses.

Methods

This was a descriptive qualitative study that took place at a university medical center hospital with 300 adult beds in southeastern U.S. Through partnership, the CNO and CON faculty developed a Frontline Innovations (FI) group that help mentor frontline nurses with leadership skills, problem solving strategies, and evidence based to fix identified operational failures. The group included 12 frontline nurses from 4 different medical surgical units chosen by the CNO based on their leadership potential. Frontline nurses are extremely important to include in change process because they have direct impact to patients outcomes.

Interviews were conducted to reveal the steps of process improvement, and analysis of interviews determine recurring themes which were divided into process and outcome measures describing staff, administration, and faculty interaction. Engagement was identified as a component of the process theme and was observed through both verbal and nonverbal communication with the CNO, as well as focused role playing activities with interprofessional groups. The nurses that engaged in these group activities were then responsible for sharing what they learned with their peers on the unit (Dearmon et al. 2015).

The study ultimately affected nursing administration and executives as well because of their influence in the structures and processes of various units. This influence carried over to the care delivery of frontline nurses give. Shared governance distributes power, resources, and information as equally as possible, so it is important that both administration and frontline nurses work together (Dearmon et al. 2015).

Findings

Outcome measures included collaboration, empowerment, confidence, and lifelong learning. Collaboration was found to be important for the creation of the organization’s new shared governance model. It allowed members to work together to achieve a common goal, strengthen group morale, and improve the credibility of decisions making process. Nurses began to feel empowered when they felt their voices were heard by the CNO and changes were made. Nurses who were given the opportunity to visit other facilities that has shared governance model returned to their own organization feeling empowered to brought back shared governance model in their unit. In order to instill confidence that the new shared governance model would work for the organization, Frontline Innovations group members coached nurses through the new project and allowed them to use the process to see success for themselves (Dearmon et al. 2015).

Creating the Frontline Innovations group proved to be an effective way to influence change at the bedside through the implementation of a shared governance model. All disciplines involved learned to trust each other and this transferred to practice, improving collaboration in patient care. Nurses became more enthusiastic about the care they provided because they felt their voices were being heard and thus began to realize they had the ability to change practice when gaps were seen. The transition from a culture of administrative decision-making to one of staff engagement and shared decision-making forged an organization with all members willing to take responsibility for workplace obstacles (Dearmon et al. 2015).

Nursing Implications

The healthcare industry continues to become more complex as new discoveries are made. As these complexities expand the nursing practice becomes more specialized, making it more difficult for the executives in charge to understand the needs of the individual environments. Only by including the nurses that work in direct patient care areas can executives get a full picture of the operations and needs of the units. The literature shows that although both executive and front line nurses desire to collaborate, there is a gap to be filled before this can occur. The literature shows that there are means by which this gap can be bridged by developing mentorship programs, from which front line nurses can gain the knowledge needed to participate in counsels that effect change within the organization. This also helps nurses find their voice and the desire to work independently with their executive mentors to make quality improvements within their units. The end result was better working relationships between the two groups and more productive initiatives in providing better patient care (Dearmon et al. 2015). This means the healthcare industry is able to provide more efficient services and better patient outcomes due to changes made by the people involved in doing the work. As new nurses getting ready to enter the healthcare system, it is reassuring to know that our point of view is just as important as that of a nurse executive. Stepping into a new organization, we bring a fresh set of eyes that can see things to which others have become accustomed to. Being able to affect change within an organization is an important factor when choosing a career, and this article helps support this initiative. The section that discussed nurses being able to work independently gave rise to the idea of working and improving within specific system. Individually both systems can do a certain amount of work, but without collaboration they can ultimately fail. However, this also requires leadership to be in place in both systems. This means that although the executive officers may be the faces of the organization, nurse leaders in each system are called to step up to the task of effecting change.

If the literature is found to be valid and reliable, then many changes are sure to come. There is already a push for hospitals to obtain Magnet status. The evidence found in this article supports the Magnet program and the need for more nurses stepping into leadership roles. This may also change how nurses are integrated into an organization by mandating new employees to be trained in the organization's leadership development program. The end product would include more staff educated in how to effectively work within their unit’s structure and how their unit collaborates best with other units. This alone can provide a multitude of solutions to decrease expenses and the amount of waste, provide more efficient care, and increase employee morale.

Reference

Dearmon, V., Riley, H., Mestas, G., & Buckner, B. (2015). Bridge to shared governance: Developing leadership of frontline nurses. Nursing Administration Quarterly, 39(1), 69-77. doi: 10.1097/NAQ.0000000000000082

On 2017 Mar 23, University of Kansas School of Nursing Journal Club commented:

Team Members: Jason Tracy, Abigail Spare, Julia Damman, Laura Thompson, Sophie Bono, Maeve Markey. [Class of 2017]

Background

In our class, we took time to study shared governance in acute care organizations and looked at the importance of shared governance in regards to all nursing positions. This article not only touches on the importance of shared governance, but also explores the processes needed to help direct patient care nurses transition their knowledge, skills, and attitudes into the leadership role that would facilitate shared governance. Our team was especially interested in the idea of shared governance, and liked how this particular article discussed an intervention to increase shared governance by empowering nurses with leadership. This is an interesting, practical intervention that could be implemented with nurses.

Methods

This was a descriptive qualitative study that took place at a university medical center hospital with 300 adult beds in southeastern U.S. Through partnership, the CNO and CON faculty developed a Frontline Innovations (FI) group that help mentor frontline nurses with leadership skills, problem solving strategies, and evidence based to fix identified operational failures. The group included 12 frontline nurses from 4 different medical surgical units chosen by the CNO based on their leadership potential. Frontline nurses are extremely important to include in change process because they have direct impact to patients outcomes.

Interviews were conducted to reveal the steps of process improvement, and analysis of interviews determine recurring themes which were divided into process and outcome measures describing staff, administration, and faculty interaction. Engagement was identified as a component of the process theme and was observed through both verbal and nonverbal communication with the CNO, as well as focused role playing activities with interprofessional groups. The nurses that engaged in these group activities were then responsible for sharing what they learned with their peers on the unit (Dearmon et al. 2015).

The study ultimately affected nursing administration and executives as well because of their influence in the structures and processes of various units. This influence carried over to the care delivery of frontline nurses give. Shared governance distributes power, resources, and information as equally as possible, so it is important that both administration and frontline nurses work together (Dearmon et al. 2015).

Findings

Outcome measures included collaboration, empowerment, confidence, and lifelong learning. Collaboration was found to be important for the creation of the organization’s new shared governance model. It allowed members to work together to achieve a common goal, strengthen group morale, and improve the credibility of decisions making process. Nurses began to feel empowered when they felt their voices were heard by the CNO and changes were made. Nurses who were given the opportunity to visit other facilities that has shared governance model returned to their own organization feeling empowered to brought back shared governance model in their unit. In order to instill confidence that the new shared governance model would work for the organization, Frontline Innovations group members coached nurses through the new project and allowed them to use the process to see success for themselves (Dearmon et al. 2015).

Creating the Frontline Innovations group proved to be an effective way to influence change at the bedside through the implementation of a shared governance model. All disciplines involved learned to trust each other and this transferred to practice, improving collaboration in patient care. Nurses became more enthusiastic about the care they provided because they felt their voices were being heard and thus began to realize they had the ability to change practice when gaps were seen. The transition from a culture of administrative decision-making to one of staff engagement and shared decision-making forged an organization with all members willing to take responsibility for workplace obstacles (Dearmon et al. 2015).

Nursing Implications

The healthcare industry continues to become more complex as new discoveries are made. As these complexities expand the nursing practice becomes more specialized, making it more difficult for the executives in charge to understand the needs of the individual environments. Only by including the nurses that work in direct patient care areas can executives get a full picture of the operations and needs of the units. The literature shows that although both executive and front line nurses desire to collaborate, there is a gap to be filled before this can occur. The literature shows that there are means by which this gap can be bridged by developing mentorship programs, from which front line nurses can gain the knowledge needed to participate in counsels that effect change within the organization. This also helps nurses find their voice and the desire to work independently with their executive mentors to make quality improvements within their units. The end result was better working relationships between the two groups and more productive initiatives in providing better patient care (Dearmon et al. 2015). This means the healthcare industry is able to provide more efficient services and better patient outcomes due to changes made by the people involved in doing the work. As new nurses getting ready to enter the healthcare system, it is reassuring to know that our point of view is just as important as that of a nurse executive. Stepping into a new organization, we bring a fresh set of eyes that can see things to which others have become accustomed to. Being able to affect change within an organization is an important factor when choosing a career, and this article helps support this initiative. The section that discussed nurses being able to work independently gave rise to the idea of working and improving within specific system. Individually both systems can do a certain amount of work, but without collaboration they can ultimately fail. However, this also requires leadership to be in place in both systems. This means that although the executive officers may be the faces of the organization, nurse leaders in each system are called to step up to the task of effecting change.

If the literature is found to be valid and reliable, then many changes are sure to come. There is already a push for hospitals to obtain Magnet status. The evidence found in this article supports the Magnet program and the need for more nurses stepping into leadership roles. This may also change how nurses are integrated into an organization by mandating new employees to be trained in the organization's leadership development program. The end product would include more staff educated in how to effectively work within their unit’s structure and how their unit collaborates best with other units. This alone can provide a multitude of solutions to decrease expenses and the amount of waste, provide more efficient care, and increase employee morale.

Reference

Dearmon, V., Riley, H., Mestas, G., & Buckner, B. (2015). Bridge to shared governance: Developing leadership of frontline nurses. Nursing Administration Quarterly, 39(1), 69-77. doi: 10.1097/NAQ.0000000000000082