1.
PHDN 605 - GOVERNANCE IN HEALTH CARE PRACTICE
PHDN-K SY2022-2023 2nd Trimester
ZHANG BAOZHI /2022t0852
DR.NICOLO ANDREI AÑONUEVO
Shared Governance in Nursing

2.
目录
A Rich History of Shared Governance
Nursing Shared Governance
Shared Governance in Times of Crisis
Nursing Professional Governance
Summary

3.
A Rich History of
Shared Governance

4.
A Rich History of Shared Governance
In the 1970s to 1980s, a high point in social-cultural confrontation and
transformation in the United States, scholars most exemplified by Virginia
Cleveland and Luther Christman began to idealize the character, design, and
function of nursing as a profession within healthcare academic and service
settings.1Historically, nurses have not always operated or been organized or
managed as professionals.Unlike physicians, with their unilateral ownership of peer-
based competence, education, quality, and practice, nurses have often been treated
as a subordinate employee work group and subset of an organization's service
structure. Nursing education and practice often historically included large
components of indentured servitude to the institution as a part of the rite of passage
into the nursing profession.

5.
A Rich History of Shared Governance
The conceptual foundation of nursing as an independent profession required that
many of the structural considerations applied to like professions also be applied to
nursing. Issues of professional self-direction, decision making, standard-setting, and
professionalgovernance were explored through time.Initial efforts to define and
design governance structures began in a number of health settings across the United
States.Initial efforts considered the independence of nursing and operating models to
support this began in a highly decentralized manner.

6.
A Rich History of Shared Governance
In 1984, the 1st comprehensive text on nursing governance was published,
outlining an organizational and structural model for nursing professional
governance within any clinical structure.
This early work enumerated conceptual and structural foundations for nursing
shared governance in a way that did not challenge or threaten existing
hierarchical and bureaucratic infrastructures. Although both the concept and
the language were novel at the time, a number of enterprising hospitals and
health agencies began to embrace shared governance to transform their nursing
organizations (eg, Rush-Presbyterian Hospital–Chicago, St Joseph's Hospital–
Atlanta, Rose Medical Center– Denver, and St Michael's Hospital–
Milwaukee).

7.
A Rich History of Shared Governance
From these small tests of change to today, most healthcare organizations have
some elements of nursing shared governance and incorporate these elements in
their “journey to excellence” priorities . As a further stimulus to develop nursing
shared governance, the ANCCMagnet Recognition Program® has included
governance elements in its structural empowerment Magnet® model component
sources of evidence.

8.
A Rich History of Shared Governance
Today, it is embedded into nearly every healthcare setting. Robert Hess, founder
and chief executive officer of the Forum for Shared Governance,3 writes that the
model is now so widespread it impacts not only nurses but also all members of
the healthcare team, including patients and families. “In many settings, they are
all at the decisionmaking table,” Hess says.

9.
Nursing Shared
Governance

10.
Nursing Shared Governance
A strong shared governance framework gives nurses control over their practice.
Whether unit based or system wide, shared governance provides the
infrastructure to deliver high-quality patient care, especially in a crisis.
The critical concept of nursing shared governance is shared decision making
between the bedside nurses and nurse leaders, which includes areas such as
resources, nursing research/evidence-based practice projects, new equipment
purchases, and staffing.This type of shared process allows for active engagement
throughout the healthcare team to promote positive patient outcomes and also
creates a culture of positivity and inclusion, which benefits job satisfaction.

11.
Nursing Shared Governance
Nursing Shared Governance is a pillar of the ANCC Magnet culture. Utilizing
this approach in the hospital setting allows for better nurse satisfaction and
improved patient outcomes. The process of building this type of structure and
the related processes can be challenging among both nurse administrators and
bedside nurses. Open communication and collaboration among team members
are the best practices for overcoming these and other potential barriers. Shared
governance shifts the focus from a top-down management style to a
collaborative focus from the administrative team to the nurses providing care at
the bedside.

12.
Nursing Shared Governance
Nursing leadership must take time to provide education about the process, bring
bedside nurses to the table from the start, and instill trust. Training is necessary
to build a foundational knowledge of what shared governance is and how it will
benefit the nursing staff and patients within the healthcare system. Having these
nurses participate from the beginning will help build confidence in the process
and assist with buy-in. Nurses participating also helps to begin the trust-building
sooner, which will give the bedside nurses a greater sense of confidence and
ownership of the shared governance structure.

13.
Nursing Shared Governance
Robust processes and procedures to support growth are vital to the success of
any new program, but this is especially true of shared governance. Following the
PDSA improvement cycle will assist an organization with developing
sustainable policies and procedures during the shared governance planning,
implementation, and evaluation stages. Tracking and monitoring are vital
components to achieving and sustaining success.

14.
Nursing Shared Governance
Clinical Significance
Improved patient outcomes are the most significant clinical impacts associated
with a nursing shared governance structure within healthcare organizations.
Numerous studies have found improved results for nursing-sensitive indicators
such as catheter-associated urinary tract infections, hospital-acquired pressure
ulcers, falls with injuries, and central line-associated bloodstream infections
using shared governance structures and processes. Knowledge of this benefit
should aid in the desire for all nurses to be involved in this type of initiative.

15.
Nursing Shared Governance
Clinical Significance
Improved job satisfaction among nurses is also a positive clinical impact for
those implementing a shared governance structure. Nurses are more engaged in
policy development and revision, helping to give them a better overall picture of
the hospital environment. Nurses are also more satisfied when they see their
ideas at work within the various patient care improvement projects. Giving the
nurse a sense of belonging and loyalty to their healthcare organizations also
increases morale and performance.

16.
Nursing Shared Governance
Clinical Significance
Successfully shared governance programs and structures assist healthcare
organizations with internal succession planning. Bedside nurses become actively
engaged with decision making, policies, and procedures, which helps them to
see their leadership skills come to life. Nurses move from being members to the
chairperson of the shared governance councils. Active learning occurs during
this participatory process. Growth internally of nursing leaders helps healthcare
organizations promote from within, improve the culture through career ladder
plans, and allows for investing in the future of the organization.

17.
Shared Governance
in Times of Crisis

18.
Shared Governance in Times of Crisis
The COVID-19 pandemic has shed new light on the enduring role of shared
governance as a strategy to manage crisis situations. Hess et al5 note that a well-
established model enhances communication and can be used to quickly respond
to emergent issues, fast-track practice changes, create new workflows and
processes, reeducate staff, protect the safety of cliniciansand patients, and
facilitate the transition back to business as usual.

19.
Shared Governance in Times of Crisis
Magnet Recognition® from the American Nurses Credentialing Center
addresses many of the elements that contribute to successful shared governance
and an empowering work environment. Pursuing the credential helps shore up
factors that create an inclusive, supportive workplace, factors such as
appropriate resources; strong, supportive leadership; nurse engagement and
recognition; mutual respect; and a collaborative culture.Wei et al7 found a strong
link between a positive workplace and nurse outcomes such as psychological
health, emotional strain, job satisfaction, and retention.

20.
Shared Governance in Times of Crisis
When nurses perceived higher caring behaviors in the work setting, they had
significantly lower scores on compassion fatigue, stress, and burnout and higher
scores on work relationships, job satisfaction, and compassion satisfaction.
With these factors at the forefront, Magnet organizations are in a strong position
to give nurses direct involvement in decision-making processes that impact
every aspect of the care environment. In the chaotic early days of the COVID-19
pandemic, shared governance provided the structure for nurses to influence care
delivery, ultimately saving lives.

21.
Shared Governance in Times of Crisis
Magnet nurses at NewYork-Presbyterian/Columbia University Irvine Medical Center
put it best: “The Magnet framework that is in place helped lead us through this crisis,”
says Hollis George,MS, RN. “The paradigm shift of nurse autonomy, transformational
leadership, shared governance, and interprofessional collaboration all played a critical
role.”
“Our strength as an organization was a good combination of excellent leadership and an
empowered and engaged workforce,” says Patricia Punzalan, MA,RN, NE-BC. “The
principles of shared decisionmaking, interprofessional collaboration,front-line
engagement, and professional ownership and accountability that we built for 6 years in
our journey to Magnet brought us to a level of excellence and resilience in our efforts to
respond, recover, and thrive.”

22.
Shared Governance in Times of Crisis
Goals of shared governance include improved communication, heightened
relationships, increased professional growth, and feelings of satisfaction with
decisional involvement in nursing practice.Shared governance results in positive
practice environments that increase nurse retention and improve patient
outcomes.1In addition, shared governance has been found to be related to
empowerment, increased nurses’ perceptions of overall job satisfaction, and
decreased anticipated turnover scores.

23.
Shared Governance in Times of Crisis
Involvement in organizational and clinical decision making is the focus of
shared governance, decentralizing authority, and facilitation of shared decision
making, allowing nurses to make decisions that have a direct impact on their
practice.7It is a structural model founded on the principles of partnership, equity,
accountability, and ownership in which nurses can voice and manage their
practice with more professional autonomy.

24.
Shared Governance in Times of Crisis

25.
Shared Governance in Times of Crisis
Often, shared governance structures and processes have not enabled
participative deliberations and input on value-driven nursing practice.This can
remove nursing control of professional obligations: making decisions and taking
actions in the areas of professional nursing practice, quality, competence, and
knowledge. Practice standards driven through management mechanisms that
approve, sanction, promulgate, and drive them toward the role of practicing
nurses prevent them from originating these standards or weighing in on their
legitimacy or relevance.Enabling nurses to “participate” in decisions integral to
their practice falls short of them owning those decisions and actions with the
requisite accountability and authority fundamental to their role.

26.
Shared Governance in Times of Crisis

27.
Nursing Professional
Governance

28.
Nursing Professional Governance
Much has been written on the concept, implementation, operation, and practices
associated with nursing governance, yet the critical delineation of nurses as
independent practitioners, with ownership of their profession within governance,
has not been well outlined.
Much of the literature explores the impact of governance and management
structures upon nurse satisfaction, staffing, quality of professional life, quality of
care, and patient outcomes.Professional governance positions nurses within
legitimate structures that clearly affirm a nurse's control over practice,
competence, quality, and the generation of nursing knowledge.

29.
Nursing Professional Governance
These professional attributes are central to professional governance and assume
that related organizational structures and processes are in place to support the
nurse professional locus-of-control,promote nursing staff ownership
(professional obligation), and influence nurse practice behaviors to achieve
exemplary nursing, patient, and organizational empirical outcomes,with
structures that support engagement of the nurse in practice decisions while
measuring impact.

30.
Nursing Professional Governance
In a professional governance structure, all
deliberations, mechanics, processes, and
actions are derived from nurses,
specifically nurses in direct clinical
practice (Figure 3). The leader should
assume that the foundations established in
shared governance are built upon in our
understanding of professional governance.

31.
Nursing Professional Governance
professional governance enables a structure within which the exercise of
ownership and accountability for practice, competence, quality, and nursing
knowledge is demonstrated by nurses undertaking the clinical work of the
profession. We can assume that the role of professional governance is to foster
nursing. The quest for excellence. staff ownership of nursing professional
accountabilities, not clearly evident in governance structures today.

32.
Nursing Professional Governance
Leading a contemporary professional community and professional governance
in any organization requires engaging and aligning nurses in a way that
requires their full contribution and commitment. This requires a deeper look at
the expectations and privileges of a professional community as well as
intentionally planning, implementing, and evaluating a successful governance
framework that achieves an effective distribution of power.
Leading Professional Governance

33.
Nursing Professional Governance
Membership in a Professional Community

34.
Nursing Professional Governance
Professional Governance Councils

35.
Summary

36.
Summary
The shift to professional governance implies membership in a professional
community and the assurance that decisions and actions represent the standards of
the profession and positively impact intended outcomes. As the nursing profession
continues to mature, more emphasis on structuring for professional practices,
behaviors, and partnerships (professional governance) will demonstrate its value
and contribution to the health and quality of life of the communities and persons
that nurses serve. With the shift to professional nursing governance structures, the
work toward that preferred future is further advanced, providing a framework that
ultimately leads to more positive outcomes. In that effort, the original impetus for
nursing governance, advancing nursing practice and improving health for all, will
have been fulfilled.

37.
Thanks for your
attention!