Theory and Measures for Advancing Nursing Shared Governance
Midwest Nursing Research Society ● Chicago, IL ● March 7-10, 2013THEORY AND MEASURES FOR ACCELERATING THEPRACTICE OF NURSING SHARED GOVERNANCE:GEMSM. Lindell Joseph, PhD, RNRichard J. Bogue, PhD, FACHEUNIVERSITY OF IOWACOLLEGE OF NURSINGIOWA CITY, IOWA
Midwest Nursing Research Society ● Chicago, IL ● March 7-10, 2013ObjectivesAfter this presentation, participants will be able to…1. Discuss inputs, processes, and outcomes of nursingshared governance2. Conceive empirical tests of GEMS a formal theoryof nursing shared governance3. Critique and advance theory, measurement andpractice in nursing shared governance
Midwest Nursing Research Society ● Chicago, IL ● March 7-10, 2013State of Evidence on Shared Governance1. What about effectiveness?2. Seen as a pathway to excellence3. Yet ‘cannot be researched directly’a. Variations in definitions, measures and unitsb. Lack of clarity about processc. Inconsistent findings on outcomes4. Field needs a stronger theory-practice link5. NPCs are a concrete expression of nursingshared governance
Midwest Nursing Research Society ● Chicago, IL ● March 7-10, 2013Study 1. Defining Empowerment for TeamsNPCes: Initial Evidence on Reliability
Midwest Nursing Research Society ● Chicago, IL ● March 7-10, 2013Study 1. Defining Empowerment for Teams…in a Multi-Level Organizational ContextMoreEmpoweredNurses(67%)ORGANIZATIONALVALUESInformation & Extra-Unit Collaboration(23.90% of variance)PERSONAL GROWTHVALUESOpportunity & Support(23.82% of variance)UNIT LEVELVALUESResources(19.33 % of variance)
Midwest Nursing Research Society ● Chicago, IL ● March 7-10, 2013Study 2. Defining Empowerment for Leadership• Group power within organizations Sieloff-King (2003)– Specific to nursing– Adds clarity and richness to measurement of empowerment atorganization & department levels– Group power is the nursing group’s capacity to achieve itsgoals. Dimensions of nursing group power include:• Ability to control environmental forces• Power from position• Power from resources• Power from roles• Power perspective• Power competence, and• CNE communication competency
Midwest Nursing Research Society ● Chicago, IL ● March 7-10, 2013Study 2. Examining Vertical Power & Personality• Phase I– Online surveys of factors that may enhance or impedeshared governance at three levels• Unit Teams: NPC members• Unit Managers: Nurse Managers & Asst Nurse Managers• Department & Organization: Nursing Directors and CNOs• Phase II– Delphi study with top organizational executives (n=22)
Attributions Acting Understanding FeelingLeadership 3% 30% 9%Workers 36% 9% 12%Study 2. Executive Empowerment PhilosophyExecutive leadership expected workers to act empowered.Executive leadership expected of themselves, not action, but understanding.Midwest Nursing Research Society ● Chicago, IL ● March 7-10, 2013
Midwest Nursing Research Society ● Chicago, IL ● March 7-10, 2013Table 1: External Validation and Outcome Measures Associated with the NPC Effectiveness Scaler† p‡ St±ORGANIZATIONAL LEVEL MEASURESResources for Goal Attainment (SKAGOAO, Sieloff) 0.562 <0.001 2,3Organizational Support (POS) 0.563 <0.001 3Role (nursing central to the organization’s work, SKAGOAO) 0.430 <0.001 2,3DEPARTMENT LEVEL MEASURESPosition (nursing central in communication network, SKAGOAO) 0.584 <0.001 2,3CNO Communication Competency (SKAGOAO) 0.435 <0.001 2,3Nursing Department Group Power (SKAGOAO) 0.505 <0.001 2,3Control of Environmental Forces (SKAGOAO) 0.599 <0.001 2,3UNIT LEVEL MEASURESStructural Empowerment (CWEQ-II) 0.736 <0.001 1Co-Worker Support (JCQ) 0.431 <0.001 3Manager Support (JCQ) 0.588 <0.001 3Pressure Ulcers (NDNQI) ∆ 0.106 3INDIVIDUAL LEVEL MEASURESJob Satisfaction (RN Survey) 0.234 0.017 1Extroversion (40-item Mini Marker Personality Inventory, Saucier) 0.239 0.002 2Agreeableness (Mini Marker) 0.229 0.003 2Intellectual Openness (Mini Marker) 0.165 0.037 2Conscientiousness (Mini Marker) 0.139 0.079 2Emotional Stability (Mini Marker) 0.114 0.149 2Self Efficacy (IPIP) 0.200 <0.006 3†r = Pearson correlation.‡p = Probability of result, statistical significance±St refers to Study1, Study2 or Study3.
Midwest Nursing Research Society ● Chicago, IL ● March 7-10, 2013Turnkey tools and processes for Nursing Practice Council Effectiveness andOrganizational Shared Governance1. NPCs assess themselves and on nine competencies of effectivenursing practice councils2. Managers and others on the unit also assess NPC3. Leadership and Teams examine unit & roll-up results for• performance on the nine competencies• team dynamics (within a team & vertically)• vertical alignment in the organization4. Teams identify one or two competencies to improve5. Teams use provided evidence-based strategies to support NPCeffectiveness, or invent their own strategies6. Repeat assessment every six monthsDesigning & Testing a Process for Empowerment
Midwest Nursing Research Society ● Chicago, IL ● March 7-10, 2013Developing a Theory for Shared Governance• Identify requiredtheoretical attributesfor NPCeffectiveness, nursinggroup power, andvertical alignment.Step 1• Define each attributeas an observableintervention (CriticalInputs)Step 2 • Identify the activeingredients for eachcritical input.Step 3• Identify expectedoutcomes.Step 4General EffectivenessTheory for Multilevel Shared Governance(GEMTheory)
Midwest Nursing Research Society ● Chicago, IL ● March 7-10, 2013
Nursing LeadershipTeamNursing UnitWork TeamUse roles & resources expertlyManage external forcesCommunicate goalsInfluence decisionsSelf-directAlign performanceEmpower relationshipsEmpower practicesBuild on team foundationsEstablish team foundationsGEMS EffectiveShared GovernanceInputsInputsProcessOrganization LevelDepartment LevelUnit LevelPersonal LevelOutcomesNursing Influence/Power (SKAGO)Resources for Goals(SKAGO)Mgr Support (JCQ)Pressure UlcersSelf Efficacy (IPIP)Job Sat (NDNQI)
Midwest Nursing Research Society ● Chicago, IL ● March 7-10, 2013Summary and Testable Propositions• GEMS is process theory for engaging nurses at all levels to strive towardexcellence at their level of competencies and aspirations.• Maximizing & aligning nurses’ decision-making authority at all levelsreflects true nursing shared governance.1. Teams rating higher on NPCes will…a. More quickly and more widely adopt patient safety protocolsb. Achieve higher rates of quality performance improvementc. Have more satisfied people and less turnover2. Where leadership rates NPCes higher than care team members do,shared governance will be more marketing than empowering3. Where both leadership and teams rate low on NPCes, there will be anopportunity for a genuine journey forward together4. Where both leadership and teams rate high on NPCes, there will beexcellence in patient care and nurse engagement
Midwest Nursing Research Society ● Chicago, IL ● March 7-10, 2013General Effectiveness Multilevel Shared GovernanceFormalized GEMS, a practical,measurable, testable multilevel theoryExamined outcomes at individual, unit,department, organizational levelsNeeded a measure of leadershipcompetencies for empowermentNeeded a process for multilevelempowermentNeeded a practical, competency-based measure of team effectiveness
Midwest Nursing Research Society ● Chicago, IL ● March 7-10, 2013References• Anderson, E., Faye. (2011). A case for measuring governance. Nursing AdministrationQuarterly, 35(3), 197-203.• Anthony, M. K. (2004). Shared governance models: The theory, practice, and evidence.Online Journal of Issues in Nursing, 9(1). 3.• Argyris, C. (2004). Reasons and rationalizations: The limits to organizational knowledge.Oxford: University Press.• Bogue RJ, Joseph ML & Sieloff CL. (2009). Vertical Alignment of Nursing Group Powerand Nurse Practice Council Effectiveness. Journal of Nursing Management, 17:4-14.• Hess, R., J. (2004). From bedside to boardroom -- nursing shared governance. OnlineJournal of Issues in Nursing, 9(1), 10p.• Joseph, R., Bogue, R., & Thompson, J. (2006). Nursing practice councils: A FormativeAssessment. Research Report. Florida Hospital.• Kanter, R. (1977). Men and Women of the Corporation. New York: Basic Books.• Porter-OGrady, T. (2004). Shared governance: Is it a model for nurses to gain controlover their practice? Online Journal of Issues in Nursing, 9(1), 1.• Sieloff, C. L. (1995). Development of a theory of departmental power in advancing King’ssystems framework and theory of goal attainment. Sage Publications.• Saucier, G. (1994). Mini-Markers: A brief version of Goldbergs unipolar Big-Fivemarkers. Journal of Personality Assessment, 63, 506-516.• Sieloff, C. L. (2004). Leadership behaviors that foster nursing group power. Journal ofNursing Management. 12, 246-251.• Wright, T. A. (2003). What Every Manager Should Know: Does Personality Help DriveEmployee Motivation? The Academy of Management Executive. 17(2). 131.
M. Lindell Joseph, PhD, RNEmail: Maria-Joseph@uiowa.eduRichard J. Bogue, PhD, FACHEEmail: Richard-Bogue@uiowa.edu
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