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

Team Members: Miranda Hanchett, Katie Bolin, Lizzy Lothamer, Molly Meagher, Kathryn Noble, Alisa Schemmel, Amy Toth. [Class of 2017]

Background

In class, we learned that shared governance encompasses four main principles for nurses and other professionals. These principles include partnership, accountability, equity, and ownership. Each of these are necessary for team-based decision making in the realms of research, clinical matters, quality improvement, and others. However, one topic we did not explore in class was the impact that the level of nurse engagement in shared governance has on patient outcomes. Kutney-Lee et al’s (2016) article explored the different levels of nurse engagement across a variety of hospitals and how these levels affected patient satisfaction through appraisal of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data. This information is valuable to our knowledge as new graduate registered nurse (RN) professionals in order to understand that nurse involvement within the organization (beyond patient care) is vital to improving patient outcomes. This study also adds another dimension to our understanding of the four principles of shared governance and whom they affect.

Methods

Our team decided to select this article because it described the effects shared governance has on our patients in addition to how it affects nurses. Knowing these effects enables nurses to understand that involvement in hospital affairs can influence the quality of care and outcomes of our patients. The purpose of this study is to, “examine differences in nurse engagement in shared governance across hospitals and to determine the relationship between nurse engagement and patient and nurse outcomes” (Kutney-Lee et al., 2016, p. 605). This article is a cross-sectional observational study of three secondary data sources: the 2006-2007 Penn Multi-State Nursing Care and Patient Safety Survey of RNs from four states (California, New Jersey, Pennsylvania, and Florida), the 2007 American Hospital Association (AHA) Annual Survey of Hospitals, and the HCAHPS patient survey data from October 2006 to June 2007. The nurse survey was collected from large, random samples of RNs that were licensed in the four previously mentioned states. The AHA survey provided information about hospital characteristics and the HCAHPS survey provided information about overall patient experiences during hospitalization. Shared governance was measured using three items from the, “Participation in Hospital Affairs,” subscale of the Practice Environment Scale of the Nursing Work Index (PES-NWI). Nurse job outcomes and quality of care was measured using the Penn Multi-State Nursing Care and Patient Safety Survey of RNs. The HCAHPS survey provided information on patient measures while the AHA Annual Survey provided information about hospital characteristics, such as population density, teaching status, ownership, technology status, and size. Magnet recognition status was acquired from the American Nurses Credentialing Center (ANCC) website.

Findings

Shared governance has a large impact on patient outcomes. This study found that not only did shared governance contribute to more positive patient outcomes, but they also received a higher level of quality of care from their nurses. Nurses are in direct contact with the patients for the most amount of time and thus, are intimately in touch with patients’ wants and needs. They forge a personal relationship with the patient that no other health care provider can or will. Nurses are a valuable asset to hospital administration to improve the direction of resources and strategies to increase flow efficiency.

With the inclusion of floor nurses within the shared governance model, it has been shown that the reporting of poor patient outcomes, safety, and quality of care has declined. In effect, this has lowered the costs of penalties against the hospital for patient care problems, mismanaged discharge instructions and subsequent homecare, and readmission, and has increased reimbursement for quality of care. Hospitals have also saved millions of dollars by lowering their rate of nurse turnover (Kutney-Lee et al. 2016). In addition, the shared governance model has been shown to increase nurse satisfaction and reduce nurse burnout and the intent to leave. By incorporating floor nurses into the shared governance model, they feel more invested to contribute towards the system-level approach to improving both patient and nurse outcomes (Kutney-Lee et al. 2016).

Nursing Implications

Shared governance is extremely important to the nursing profession because it has been shown to increase employee engagement, which is related to an increase in job satisfaction, retention, profitability, and performance (Kutney-Lee et al. 2016). This study shows that nurses who worked at institutions where they had a greater opportunity to be engaged in shared governance were more likely to report better patient experiences and superior quality of care (Kutney-Lee et al. 2016). In our program, professionalism has been emphasized as a key factor in being a BSN-prepared nurse. A huge factor that relates to being a professional nurse is being actively involved in nursing boards, policies, and interprofessional teams, along with being leaders at the bedside. These factors help hospitals attain Magnet Recognition because they lead to structural empowerment for nurses in the workplace (American Nurses Credentialing Center, 2017). Through improving patient outcomes and satisfaction, the nursing satisfaction and reimbursement rates increase as well. From a micro- and macrosystem level, this is important because nurse turnover and low patient satisfactions scores tends to increase hospital cost. Hiring and training new staff is expensive and time consuming and can lower patient outcomes. These lower patient outcomes and satisfaction levels can result in lower HCAHPS scores, which reduces reimbursement amounts to the hospital. The study shows that nurses at hospitals where shared governance was promoted were less likely to report, “poor confidence in their patients’ ability to manage their care after discharge,” thus reducing readmission cost on the hospital (Kutney-Lee et al. 2016, p. 610). By increasing shared governance in hospitals, it is more fiscally responsible for the hospital and the nursing profession as a whole.

This information can benefit us as future nurses by helping us realize the importance of shared governance when looking at future employers. Being able to have a say and make decision in how we are allowed to practice gives us greater autonomy. This ability to practice autonomously and feel empowered to practice in a meaningful way leads to structural empowerment and greater job satisfaction (Laschinger, Finegan, Shamian, & Wilk, 2001). It will be important as new graduate nurses and as future nurse leaders to keep this information in mind for the well-being of our patients, employees, and self.

References

American Nurses Credentialing Center (2009). Announcing a new model for ANCC’s magnet recognition program. Retrieved from http://www.nursecredentialing.org/Magnet/NewMagnetModel.aspx

Kutney-Lee, A., Germack, H., Hatfield, L., Kelly, S., Maguire, P., Dierkes, A. Del Guidice, M., & Aiken, L. H. (2016). Nurse engagement in shared governance and patient and nurse outcomes. The Journal of Nursing Administration, 46(11), 605-612. doi:10.1097/nna.0000000000000412

Laschinger, H.K.S., Finegan, J., Shamian, J., & Wilk, P. (2001). Impact of structural and psychological empowerment on job strain in nursing work settings: Expanding Kanter’s model. The Journal of Nursing Administration, 31(5), 260-272. doi: 10.1097/NNA.0000000000000080

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

Team Members: Miranda Hanchett, Katie Bolin, Lizzy Lothamer, Molly Meagher, Kathryn Noble, Alisa Schemmel, Amy Toth. [Class of 2017]

Background

In class, we learned that shared governance encompasses four main principles for nurses and other professionals. These principles include partnership, accountability, equity, and ownership. Each of these are necessary for team-based decision making in the realms of research, clinical matters, quality improvement, and others. However, one topic we did not explore in class was the impact that the level of nurse engagement in shared governance has on patient outcomes. Kutney-Lee et al’s (2016) article explored the different levels of nurse engagement across a variety of hospitals and how these levels affected patient satisfaction through appraisal of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data. This information is valuable to our knowledge as new graduate registered nurse (RN) professionals in order to understand that nurse involvement within the organization (beyond patient care) is vital to improving patient outcomes. This study also adds another dimension to our understanding of the four principles of shared governance and whom they affect.

Methods

Our team decided to select this article because it described the effects shared governance has on our patients in addition to how it affects nurses. Knowing these effects enables nurses to understand that involvement in hospital affairs can influence the quality of care and outcomes of our patients. The purpose of this study is to, “examine differences in nurse engagement in shared governance across hospitals and to determine the relationship between nurse engagement and patient and nurse outcomes” (Kutney-Lee et al., 2016, p. 605). This article is a cross-sectional observational study of three secondary data sources: the 2006-2007 Penn Multi-State Nursing Care and Patient Safety Survey of RNs from four states (California, New Jersey, Pennsylvania, and Florida), the 2007 American Hospital Association (AHA) Annual Survey of Hospitals, and the HCAHPS patient survey data from October 2006 to June 2007. The nurse survey was collected from large, random samples of RNs that were licensed in the four previously mentioned states. The AHA survey provided information about hospital characteristics and the HCAHPS survey provided information about overall patient experiences during hospitalization. Shared governance was measured using three items from the, “Participation in Hospital Affairs,” subscale of the Practice Environment Scale of the Nursing Work Index (PES-NWI). Nurse job outcomes and quality of care was measured using the Penn Multi-State Nursing Care and Patient Safety Survey of RNs. The HCAHPS survey provided information on patient measures while the AHA Annual Survey provided information about hospital characteristics, such as population density, teaching status, ownership, technology status, and size. Magnet recognition status was acquired from the American Nurses Credentialing Center (ANCC) website.

Findings

Shared governance has a large impact on patient outcomes. This study found that not only did shared governance contribute to more positive patient outcomes, but they also received a higher level of quality of care from their nurses. Nurses are in direct contact with the patients for the most amount of time and thus, are intimately in touch with patients’ wants and needs. They forge a personal relationship with the patient that no other health care provider can or will. Nurses are a valuable asset to hospital administration to improve the direction of resources and strategies to increase flow efficiency.

With the inclusion of floor nurses within the shared governance model, it has been shown that the reporting of poor patient outcomes, safety, and quality of care has declined. In effect, this has lowered the costs of penalties against the hospital for patient care problems, mismanaged discharge instructions and subsequent homecare, and readmission, and has increased reimbursement for quality of care. Hospitals have also saved millions of dollars by lowering their rate of nurse turnover (Kutney-Lee et al. 2016). In addition, the shared governance model has been shown to increase nurse satisfaction and reduce nurse burnout and the intent to leave. By incorporating floor nurses into the shared governance model, they feel more invested to contribute towards the system-level approach to improving both patient and nurse outcomes (Kutney-Lee et al. 2016).

Nursing Implications

Shared governance is extremely important to the nursing profession because it has been shown to increase employee engagement, which is related to an increase in job satisfaction, retention, profitability, and performance (Kutney-Lee et al. 2016). This study shows that nurses who worked at institutions where they had a greater opportunity to be engaged in shared governance were more likely to report better patient experiences and superior quality of care (Kutney-Lee et al. 2016). In our program, professionalism has been emphasized as a key factor in being a BSN-prepared nurse. A huge factor that relates to being a professional nurse is being actively involved in nursing boards, policies, and interprofessional teams, along with being leaders at the bedside. These factors help hospitals attain Magnet Recognition because they lead to structural empowerment for nurses in the workplace (American Nurses Credentialing Center, 2017). Through improving patient outcomes and satisfaction, the nursing satisfaction and reimbursement rates increase as well. From a micro- and macrosystem level, this is important because nurse turnover and low patient satisfactions scores tends to increase hospital cost. Hiring and training new staff is expensive and time consuming and can lower patient outcomes. These lower patient outcomes and satisfaction levels can result in lower HCAHPS scores, which reduces reimbursement amounts to the hospital. The study shows that nurses at hospitals where shared governance was promoted were less likely to report, “poor confidence in their patients’ ability to manage their care after discharge,” thus reducing readmission cost on the hospital (Kutney-Lee et al. 2016, p. 610). By increasing shared governance in hospitals, it is more fiscally responsible for the hospital and the nursing profession as a whole.

This information can benefit us as future nurses by helping us realize the importance of shared governance when looking at future employers. Being able to have a say and make decision in how we are allowed to practice gives us greater autonomy. This ability to practice autonomously and feel empowered to practice in a meaningful way leads to structural empowerment and greater job satisfaction (Laschinger, Finegan, Shamian, & Wilk, 2001). It will be important as new graduate nurses and as future nurse leaders to keep this information in mind for the well-being of our patients, employees, and self.

References

American Nurses Credentialing Center (2009). Announcing a new model for ANCC’s magnet recognition program. Retrieved from http://www.nursecredentialing.org/Magnet/NewMagnetModel.aspx

Kutney-Lee, A., Germack, H., Hatfield, L., Kelly, S., Maguire, P., Dierkes, A. Del Guidice, M., & Aiken, L. H. (2016). Nurse engagement in shared governance and patient and nurse outcomes. The Journal of Nursing Administration, 46(11), 605-612. doi:10.1097/nna.0000000000000412

Laschinger, H.K.S., Finegan, J., Shamian, J., & Wilk, P. (2001). Impact of structural and psychological empowerment on job strain in nursing work settings: Expanding Kanter’s model. The Journal of Nursing Administration, 31(5), 260-272. doi: 10.1097/NNA.0000000000000080