Shared Goverance

royhanosn · Feb 15, 2012

What do you think about Shared Goverance in hospital settings? Has anyone attempted to try Shared Goverance at their hosptial? Does it work or is it just a way to keep nurses from forming unions?

the MORE beaucracy in a hospital, the more things slow down, because of politics, and people afraid of getting their butts fired.

futurenurse BScN RN · Feb 15, 2012

We are starting at shared governance at our hospital. I live in Alberta Canada and you can not nurse in any of our acute care hospitals without belonging to the union. Our shared governance teams do not deal with issues that they do not have the authority to change outright. Rather they develop new processes and practices for those issues that they are the experts on.

As well our shared governance councils are not silo'd in their discipline but are all multidisiplinary teams and represent all levels of leadership both informal and formal. We have also made clear expectations that these councils are for solutions not problems. Anyone who brings a concern must be willing to share possible solutions and actively engage in the change.

We have a accronym for out councils it is META- mobilizing energy and taking action. We also strongly believe in nothing about you without you- this means that decisions about a group of people will never be made without them as part of the discussion and solution. As we strive to be patient centered the nothing about you without you pushed us to have patient advisors at the table. These groups have helped us make better decisions as a group.

We have used this to improve the engagement and highlight and support creative innovative solutions to our new healthcare enviroment.

I would love to hear what made your shared governace structure successful.

rnpatrick · Feb 15, 2012

Shared governance is controversial because some hospitals make a good faith effort to engage nurses while it is window dressing in others. The fact is most nurses are complacent due to a feeling of powerlessness secondary to fear of retaliation. Or, having attempted to be involved with no results, remain cynical. The route to true power is for all nurses to unite on one thing: that our services should be reflected in billing. If we can show we contribute to a hospitals bottom line we will have power. We all know that a doctor gets what they want because they can go to administration and threaten to take their business elsewhere. They can show that their practice brought x number of dollars to the hospital. Often, they get what they want. For years they have been protected because of the cash cow they are. It is now time for nurses to say we want equal time at the table. There are billing codes for this and studies have been done to prove payers will reimburse for this. Aren't you tired of being referred to as an FTE. Tired of hearing administrators moan about the cost of nurse salaries? We are revenue producers! Demand that hospitals start billing for nursing services.

cdsga · Feb 15, 2012

Interesting take on this subject. I was at the hospital where Tim Porter-O'Grady wrote the concept. It worked very well there because I'm sure the hospital was the beneficiary of the notoriety that was gained by having him in their employ. But besides all that, I was a participant and thoroughly enjoyed it because it was fully supported by management and administration. Key things that are needed for governance to work is a fearless/courageous nursing leadership team. It is much easier to hide information, not involve staff and play a top down dictatorial role, but that leads to a less than stellar workforce, with much turn-over. It has been proven that when given the opportunity, staff can handle many of their own issues without management weight. I do know that managers seem somewhat lacking in the ability to handle big issues that should be their concern, not spend time putting out fires that staff can handle. What does that mean? If managers actually delegated some of the fireman duties, they would be exposed as "in over their heads" and not qualified to be in that position, they would actually have to do some work that was substantive, and they might even have to seek employment elsewhere. When you see the cycle go round and round with no resolution, it means that you have a dysfunctional administration /nursing leadership team. Most are not willing to put in the time up front to reap the rewards in the future. For Shared Governance to work, it takes all components of strong leadership, involved staff nurses who want a quality workplace, innovative solutions, clear communication back to staff members, and results that are shared with staff as a team effort, not one individuals idea. Insecure management will throw staff a bone now and then, but true leadership will give credit to staff as proud participants in growth professionally, increased quality of care, system fixes, and longer tenured employees. It's a shame they can't see the great benefit.

Chaya, ASN, RN · Feb 15, 2012

Shared governance is controversial because some hospitals make a good faith effort to engage nurses while it is window dressing in others. The fact is most nurses are complacent due to a feeling of powerlessness secondary to fear of retaliation. Or, having attempted to be involved with no results, remain cynical. The route to true power is for all nurses to unite on one thing: that our services should be reflected in billing. If we can show we contribute to a hospitals bottom line we will have power. We all know that a doctor gets what they want because they can go to administration and threaten to take their business elsewhere. They can show that their practice brought x number of dollars to the hospital. Often, they get what they want. For years they have been protected because of the cash cow they are. It is now time for nurses to say we want equal time at the table. There are billing codes for this and studies have been done to prove payers will reimburse for this. Aren't you tired of being referred to as an FTE. Tired of hearing administrators moan about the cost of nurse salaries? We are revenue producers! Demand that hospitals start billing for nursing services.

I think you hit the nail on the head.

riw1 · Feb 16, 2012

at the hospital I work at the administration kept changing the way the commitiees were organized every time the nurses got organized enough to make changes. when that stopped working they started making excuses or blocking what the commitees wanted done. in december there were so few nurses involved that the administration felt justified in disbanding the shared government.

cdsga · Feb 16, 2012

Makes you wonder doesn't it? What is so scary about people changing their own workplace for the better? Is it that they don't want cohesiveness, teamwork, positive work relationships inter departmentally? Sad situation. If leadership does not support then there can be no SHARED governance. That's the whole literal meaning of the concept.

wooh, BSN, RN · Feb 16, 2012

The problem is, for there to be SHARED governance, the leadership has to SHARE and give up some of the power. That rarely happens. Lots of places like to SAY they have shared governance, far fewer actually do...

rnpatrick · Feb 16, 2012

These stretegies often come in different forms. One is called Communities of Practice. When I heard it was in the pipeline I read the whitepaper written by the designer. Unfortunately, It was in name only as my institution used it to roll out its own agenda. There were rules that precluded nurses from introducing concerns related to management. Seeing it for what it was staff became disengaged. I saw it as another exercise on paper that would look good to surveyors. Sad that if it kept to the authors original intent it could have energized staff.

PeaceonearthRN · Feb 17, 2012

What do you think about Shared Goverance in hospital settings? Has anyone attempted to try Shared Goverance at their hosptial? Does it work or is it just a way to keep nurses from forming unions?

Currently our hospital is in the process 'OF' forming a union which was caused by

multiple issues that effected committed and serious nurses. We saw multiple lay offs,

corporate aquisitions, cut backs, bare bone staffing and obvious fear over job security, etc.

The hospital had a policy of immediate firing if someone made a mistake; the support was minimal.

Although committees were formed upon a new group/corporate ownership and structure,

the staff still revolted; trust is gone and all heck has broken loose.

A result of what happens when you suppress people's needs , lack support in the workplace and suppress the human spirit.

OCNRN63, RN · Feb 17, 2012

I think this is something that gets bandied about to make nurses feel like they have some degree of control regarding their work environments, when, in fact, they really don't. "We don't need a silly union. We've got shared governance."

(And the crowd goes "Oooh!")

Wickeddiaz · Feb 25, 2012

thank you for a positive reply to this question. I was so sad after reading some of the comments to this posting. Ideas such as shared governance take commitment and time. As nurses we really need to own our profession and this is a great way to achieve that. :w00t: