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Nursing Shared Governance: GEMS, the Next Generation
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Nursing Shared Governance: GEMS, the Next Generation


GEMS accelerates the effectiveness of nursing practice councils. It helps patient care teams become more effective as engines of innovation and excellence. …

GEMS accelerates the effectiveness of nursing practice councils. It helps patient care teams become more effective as engines of innovation and excellence.

GEMS refers to the General Theory for Effective Multilevel Shared Governance. It includes a process, a self-assessment tool, a manual, and live and distance support. Contact us to learn more at at www.courageoushealthcare.com.

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  • 1. A GENERAL THEORY FOR EFFECTIVE MULTILEVEL SHARED GOVERNANCE (GEMS): A MODEL FOR DRIVING CHANGE IN NURSING PRACTICERichard J. Bogue, PhD M. Lindell Joseph, PhD, RNrjb@courageoushealthcare.com mlj@courageoushealthcare.com (407) 376-3740 www.courageoushealthcare.com
  • 2. Session Objectives• Review Nursing Shared Governance• Describe Development of an operational Theory for Nursing Shared Governance (GEMS)• Review Initial Results from GEMS• Describe Practice Guidance for GEMS 1. Self-Assessment 2. Process 3. Guide 4. Workshops
  • 3. Shared Governance• In academia: • Formal statement by the American Association of University Professors in 1920 • Asserted the importance of faculty involvement “in personnel decisions, selection of administrators, preparation of the budget, and determination of educational policies.”• In nursing: • First introduced by Christman in1976 • Asserted the idea that nurses should have decision making power within their scope of practice equal to that of physicians within theirs. • A component of “magnet hospital recognition” in 1988
  • 4. State of Evidence on Shared Governance• Shared governance is empowerment and any means of empowerment. O’Grady (2001, 2003), and widely accepted• It cannot be measured because it is a concept that can take on many different expressions. O’Grady (2003)• Consequently, no clear guidance for… • Method of measuring shared governance • Testing theoretical inputs and outcomes of shared governance • Practical, actionable processes based on theory• However, nursing practice councils are a definitive expression of shared governance. (eg, O’May and Buchan,1999, and many others)
  • 5. Building Theory for Shared Governance• Sine qua non of SG = More Effective NPCs• Based on multiple studies and using program theory (Lipsey, 1996), we have developed a theory driven approach to shared governance• Theory Development Steps 1. What does “effective” mean for NPCs? 2. How can “effective” be measured? 3. What are the inputs to effectiveness? 4. What are theorized outcomes of effectiveness? 5. How can this theory be demonstrated and tested in practice?
  • 6. Our Starting Place: Nurse Empowerment Draws onOrganizational,Team, and Personal Values ORGANIZATIONAL VALUES Information & Extra-Unit Collaboration (23.90% of variance) More Empowered UNIT LEVEL VALUES Nurses Resources (67%) (19.33 % of variance) PERSONAL GROWTH VALUES Opportunity & Support (23.82% of variance)
  • 7. Series of Subsequent Studies# Focus Methods & Measures Initial1 Survey: Empowerment, Job Satisfaction Validation Power & Survey, Interviews & Delphi: Leadership2 Personality Competencies of Goal Attainment, Nurse Personality Inputs & Survey: Leadership Competencies (GA), Sources of3 Outcomes Support, Self-Efficacy, Clinical Measures Theory4 Lipsey Implementation Theory Development Formalization Field Tests of5 Survey & Interviews: Usefulness and Value of Tools Tools Revision &6 Survey: Job Satisfaction Validation
  • 8. Nursing Leadership Team OUTCOMES of Effective NPCs Nurse retention•Ensuring goal clarity & communication Nurse recruitment •Controlling environmental forces Needed skill sets for service lines •Influencing decision making Organizational Level •Using roles and resources expertly Needed resources Nursing goal attainment Respect from other disciplines Nursing Department Level Critical INPUTS for Effective Nursing Practice Councils Care quality Patient safety Supervisor supportiveness Nursing Work Unit Level Self efficacy •Working toward Job satisfaction empowering and aligning goals Psychological empowerment •Using foundational practices Individual Level for effective nursing team work Nursing Unit Work Team INPUTS and OUTCOMES for Effective Multilevel Shared Governance
  • 9. The Staged Competencies of Effective NPCs Self-Directing Nursing Teams AdvancingAscending Steps Personal Proficiencies,To Excellence… Professional Practices and Organizational Goals Advancing Professional 9 Nursing Practice Aligning Demonstrating Leadership for 8 Nursing in Practice Excellence Self-Defining and Directing a Local 7 Patient Care Improvement Agenda 6 Enabling Excellence in Patient Safety Initiatives Empowering Working toward outcomes that help the 5 organization face challenging trends. 4 Achieving the Active Support of Management 3 Focusing on Driving Change in Nursing Practice Foundations Team 2 Establishing Group Identity and Normative Expectations 1 Skillfully Managing Group Formation and Tasks® GEMS is a trademark of Courageous Healthcare, Inc.
  • 10. Table 1: Summary of Associations with Nursing Practice Council Effectiveness r† p‡ St±ORGANIZATIONAL LEVEL MEASURESResources for Goal Attainment (SKAGOAO) 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 (NDNQI) 0.234 0.017 1Extroversion (Mini Marker) 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 Study 1: 2006 (n=119); Study 2: 2008 (n=248); Study 3: 2009-2010 (n=336)∆ NPCes predicted Pressure Ulcer rates at this significance in regression modeling.
  • 11. Translating GEMS to Practice• GEMS Self-Assessment • Use a tested, reliable and valid measure• GEMS Process • Ensure leadership commitment to principles • Embed purpose-driven practices• GEMS Guide • Facilitate reflection and self-improvement with the aim of increasing nursing practice council effectiveness• Courageous Leadership Workshops • Setting the Stage for Excellence…Top to Bottom & Bottom to Top
  • 12. Summary• GEMS is a theory- and purpose-driven approach to shared governance, by which work team empowerment leads to vertical alignment and better outcomes.• Translations for evidence-based practice: • GEMS Self-Assessment • GEMS Process • GEMS Guide • GEMS Leadership Workshops
  • 13. ReferencesAAUP. Governance of Colleges & Universities. 1920. Web. 1 September 2011. [http://www.aaup.org/AAUP/issues/governance/]American Nurses Association (2003-2011), National Database of Nursing Quality Indicators. (NDNQI).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 Power and Nurse Practice Council Effectiveness. Journal of Nursing Management, 17:4-14. (NPCes)Christman L. (1976). The autonomous nursing staff in the hospital. Nursing Administrative Quarterly, 1, 37-4Eisenberger R., Huntington R., Hutchison S, Sowa D. (1986). Perceived organizational support. Journal of Applied Psychology, 71, 500-507. (POS)Flor R. (2004). Organizational development readiness: Six conditions. Paper presented at the 2005 Capella University Residency. Abstract retrieved June 13, 2006, from http://www.capellauniversity.edu.International Personality Item Pool: A Scientific Collaboratory for the Development of Advanced Measures of Personality Traits and Other Individual Differences (http://ipip.ori.org/). Internet Web Site.Joseph ML, Bogue RJ, Thompson J. (2006). Nursing practice councils: A Formative Assessment. Research Report. Florida Hospital.Kanter R. (1977). Men and Women of the Corporation. New York: Basic Books.Karasek R, Brisson C, Kawakami N, Houtman I, Bongers P, Amick B. J Occup. (1998). The Job Content Questionnaire (JCQ): an instrument for internationally comparative assessments of psychosocial job characteristics. Health Psychol. Oct;3(4):322-55. (JCQ)Laschinger HKS, Finegan J, Shamian J, Wilk P, (2001). Impact of struclural and psychological empowerment on job strain in nursing work settings: expanding Kanters moiicl. J Nurs Adm. 2O01:3U5):26O-272. (CWEQ-II)Lipsey MW. (1993). Theory as a Method: Small Theories of Treatments. San Francisco: Josey Bass;. New Directions for Program Evaluation, No. 57.O’May F, Buchan J. (1999). Shared governance: A literature review. International Journal of NursingStudies, 36(4), 281-300.Porter-O’Grady T. (2001). Is shared governance still relevant? JONA, 31:468–473.Porter-OGrady T. (2003). Research on shared governance: a futility of focus. JONA, 33:251–252.Sieloff CL. (1995). Development of a theory of departmental power in advancing King’s systems framework and theory of goal attainment. Sage Publications. (SKAGOAO)Saucier G. (1994). Mini-Markers: A brief version of Goldbergs unipolar Big-Five markers. Journal of Personality Assessment, 63, 506-516. (MINI MARKER)Sieloff CL. (2004). Leadership behaviors that foster nursing group power. Journal of Nursing Management. 12, 246-251.Wright TA. (2003). What Every Manager Should Know: Does Personality Help Drive Employee Motivation? The Academy of Management Executive. 17(2). 131.
  • 14. A GENERAL THEORY FOR EFFECTIVE MULTILEVEL SHARED GOVERNANCE (GEMS): A MODEL FOR DRIVING CHANGE IN NURSING PRACTICERichard J. Bogue, PhD M. Lindell Joseph, PhD, RNrjb@courageoushealthcare.com mlj@courageoushealthcare.com (407) 376-3740 www.courageoushealthcare.com