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Importance of nursing professional development specialists to implementing shared decision-making


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Shared governance

After reading this article, you will be able to:

  • Describe a professional development strategy to strengthen nurse leaders’ involvement in shared governance

by Debbie Buchwach, MSN, RN-BC

Author’s note: I am a learning consultant/nurse educator in learning and change management at the Oregon Health & Science University in Portland. I started my journey in staff development in 2003. In my current role, I develop curriculum for preceptor training, new graduate nurse transitions, leadership training, conflict resolution/effective communication, and change management. I am a member of the National Nursing Staff Development Organization (NNSDO), president of the newly formed NNSDO affiliate Northwest Staff Development Organization, author of Quick-E Pro! Time Management: A Guide for Nurses, and coauthor of Nursing Orientation Program Builder: Tools for a Successful New Hire Program.

My professional commitment to patient safety, quality care, and performance improvement is the focus of my work. I hope to share some of what I have learned along the way with you as a member of the editorial advisory board for Briefings on Evidence-Based Staff Development.

Whether your organization is new to shared governance or is trying to revitalize a current program, nursing professional development specialists play an integral role in an organization’s shared governance structure.  

R.G. Hess wrote that “Nursing shared governance  is a managerial innovation that legitimizes nurses’ control over practice, while extending their influence into administrative areas previously controlled only by  managers” (1998). Shared governance in the healthcare  setting consists of formal organizational structures, such as committees or councils, that address issues such as practice, management, quality, and education (Hess, 2004). 

In this article, I will share with you my organization’s professional development strategy designed to strengthen the nurse leaders serving in our shared governance model.

In the spring of 2010, Oregon Health & Science University (OHSU) launched a new workshop for managers and staff nurses participating in unit-based nursing practice committees (UBNPC). At OHSU, these committees consist of staff chairs and cochairs, managers, professional practice leaders, and unit-based council representatives. UBNPCs serve as the foundation for shared governance at the unit level. Members of the committees are responsible for making decisions related to planning, improving, and maintaining quality care. They are also accountable for identifying and resolving practice-related issues on their unit. 

Because committee members have been replaced over time through elections and normal turnover, nursing leaders realized that not all committee members possess the knowledge and skills required to be effective leaders. So we decided to offer a training workshop for new managers and staff nurses. After I conducted a review of literature to identify essential education required by members serving in a shared governance model, I developed and conducted a learning needs assessment. Findings from the needs assessment determined the content for the workshop. (See the agenda on p. 3.) UBNPC chairs and cochairs, along with unit managers, were invited to attend. Curricula were developed to introduce key concepts, frameworks, tools, and strategies for effective unit-based leadership. 

Workshop content

I began the day by reviewing the concept and structure of shared governance at OSHU. In a shared governance model, nurses share in the responsibility to make decisions that affect the unit. Although managers and staff nurses work together to make informed decisions, each is accountable for a different set of outcomes. 

For example, managers are accountable for resource allocation, rewards and recognition, and performance appraisal; staff nurses are accountable for standards of practice, professional development, and quality outcomes. Using Manion, Lorimer, and Leander’s (1996) four levels of authority, participants identified the scope of the work that they are being asked to do. 

The four levels of authority are:

1. Gather data and report back

2. Gather data and recommend potential solutions

3. Gather data, identify a solution, and validate before implementing

4. Gather data, determine a solution, implement the solution, and report back

This framework set the foundation for the remainder of the day.

Working in teams, participants examined each other’s annual goals, agenda and minutes, action plans, and staffing plans to apply what they were learning. Activities included:

  • A crosswalk activity to align unit goals to nursing division and organization goals. (A crosswalk is a table that aligns corresponding information. See the crosswalk example below in the left column.)
  • Critique of meeting agenda and minutes against the principles for effective meeting management. 
  • Evaluation of unit goals against SMART (Specific, Measurable, Attainable, Realistic, Timely) goal criteria to assess goal-setting effectiveness. 
  • A SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis for one of the newly revised SMART goals.
  • Development of a basic action plan using Felgen’s I2E2 framework (see p. 5) for leading lasting change. 

In the end, participants left the workshop with practical, relevant tools they could use right away. 

Conclusion

In addition to establishing a structure for shared governance, organizations need to make a commitment to the professional development of the members serving in the structure. 

Hess argues, “The number, titles, and arrangements of committees are not as important as the people who make up the membership … [it’s] their expertise and knowledge that guide their actions ... and [is the] more likely predictor of success” (2004). 

To this end, OHSU will be offering the workshop again in the fall for the newly elected members of UBNPCs and annually thereafter. The next order of business is to develop content-specific workshops for the members of the practice, quality and safety, education, research, and nursing technology councils.

References

Felgen, J. (2007). I2E2: Leading Lasting Change. Minneapolis:  Creative Health Care Management, Inc. 

Forum for Shared Governance. Essential education for shared  governance. Accessed May 8, 2010, at www.sharedgovernance.org.

Hess, R.G. (2004). “From Bedside to Boardroom: Nursing Shared Governance.” Online Journal of Issues in Nursing 9 (1).

Hess, R.G. (1998). “Measuring Nursing Governance.” Nursing  Research 47 (1): 35–42.

Manion, J., Lorimer, W. & Leander, W.J. (1996). Team-Based  Healthcare Organizations: Blueprint for Success. Sudbury, MA:  Jones & Bartlett.