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(Zhang baozhi-2022t0852)SHARED GOVERNANCE(605).pptx

  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!

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