shared governance

vashtee, RN · Sep 28, 2011

Is "shared governance" another term for team nursing?

princessp · Sep 28, 2011

It's the use of staff nurses via committee to make decisions on how nurses do their jobs in your facility. Supposedly, the committees (education, professional practice, quality) handle problems proposed by the bedside nurse. At least that's how I think it works. I need more info.

LouisVRN, RN · Sep 28, 2011

I will give you some advice, and that is it will only work if you get a lot of support from management and the higher-ups. The bedside nurses get extremely frustrated putting their time and effort into something to have it go no where.

I think the best way to start would be divide it by floors/units not practices (education, skills, etc). At least on a floor level the bedside nurses can usually identify the problems their floor has and propose their own solutions. However bringing everyone together from different units together to try to work on something, for example how to manage NGTubes, some units may have tons of input if its something they do frequently, others may have very little/no buy-in, and the end result may be divided.

dudette10, MSN, RN · Sep 28, 2011

I will give you some advice, and that is it will only work if you get a lot of support from management and the higher-ups. The bedside nurses get extremely frustrated putting their time and effort into something to have it go no where.

This is probably the most important piece of advice regarding shared governance. In any industry, in any job, management trends have a tendency to parade in with great fanfare and then slink out quietly because they aren't implemented effectively.

StrwbryblndRN · Sep 28, 2011

We have started this same thing a few months ago. I am in support of it but have not seen changes. There have been a few snags that have encouraged nurses not to be involved. Nurses do not want to be apart of it because no one believes it will amount to anything.

Sounds good in theory and so far that is it.

princessp · Sep 28, 2011

This is being mandated by admin. so I guess they will support it. I am a bedside nurse so I absolutely understand the mistrust of anything new admin. wants to try and I will say this is the 3rd attempt in my 29yrs at this hospital, to implement sg. I'm trying to be more positive and would be very happy if we could make this work. I've always had a problem with people who don't do my job telling me how to do my job. That being said, any ideas on how to start? Admin has already chosen to have 3 committees to represent quality, education, and professional practice with suggestions for each about what we cover. I just don't understand how you go from the ideas to actually doing it so anyone who can help, I would be most appreciative. Thanks for the comments.

princessp · Sep 28, 2011

so how did you guys start? what types of things have you tried? what worked and what didn't?

StrwbryblndRN · Sep 28, 2011

When it was first started, my manager sent out invites in the mail, made personal calls to invite all the nurses to boost initial attendance. I have only attended one meeting and suggested a change. So far my suggestion is the only one I know of.

Of the first meeting I attended, I felt too much time was spent trying to figure out why no one (especially noc shift) did not want to attend. I have a feeling it will fizzle if there is too much talk. Especially if the talk is of other topics besides changes for the better.

MunoRN, RN · Sep 28, 2011

Shared Governance has been around for more than 30 years and more often than not, it fails. There are some programs that have lasted for many, many years. The characteristic common to the ones that survive is that the committees are truly driven by staff Nurses, not the administration. You need administration's cooperation, but if the committees just become puppet governments for the administration then it will never gain the respect of the floor staff and will fail.

Work with the administration but control your own agenda and be assertive.

princessp · Sep 28, 2011

Nursing voted for the people we wanted on the committees, then admin. chose the chair and co-chair. These got together and chose the people we wanted in the individual groups. We tried to choose a representative group to cover all the units. That's as far as we've gotten. We have another mtg next week where we are supposed to come up with objectives that support the hospital mission statement (guess I'll need to look that up:o) I guess I'm just lost about what happens after that.

dudette10, MSN, RN · Sep 28, 2011

This is being mandated by admin. so I guess they will support it. I am a bedside nurse so I absolutely understand the mistrust of anything new admin. wants to try and I will say this is the 3rd attempt in my 29yrs at this hospital, to implement sg. I'm trying to be more positive and would be very happy if we could make this work. I've always had a problem with people who don't do my job telling me how to do my job. That being said, any ideas on how to start? Admin has already chosen to have 3 committees to represent quality, education, and professional practice with suggestions for each about what we cover. I just don't understand how you go from the ideas to actually doing it so anyone who can help, I would be most appreciative. Thanks for the comments.

The nursing process is just another problem-solving technique that has been adopted for nursing. Assess, diagnose (problem identification), plan, implement, evaluate. You will do the same with shared governance.

I'm a big fan of pilot programs. I'm not sure you will be able to address problems on every unit because every unit has it's own problems. Pick a unit to pilot shared governance on. You can tweak the program, and, if successful, you will more easily get buy-in from other units on the whole shared governance idea.

How to start, Assess: Find out from the bedside nurses what the problems are. It's like qualitative research. You need to find themes in what all the nurses are saying to identify the problems that matter to them. You could do this via a well-written survey that is introduced at a meeting. Sometimes, fact-finding meetings can get out of hand with so much being thrown around, so that's why I suggest a survey introduced at a meeting. A free-form survey might work because you don't really know right now what the problems are. Let them tell you in their own words.

What current measures are in place to use as a baseline? If there aren't any, you may have to create them for a baseline before the pilot.

During the meetings with your pilot unit, impress upon the nurses that the surveys represent their voices. Give a deadline and visit each unit to remind them of the deadline and provide extra copies. Their participation is key to making this work.

Review data, Diagnose: Collect the surveys and review them for themes/problems. Identify one or two problems in each practice area. You can't address them all, but you can address those problems that keep coming up in the surveys.

Communicate findings: You can do this via email, posting a flyer at each unit, or a meeting. Get their buy-in on the problems you would like to address. After all, you identified these problems from their survey results. You'll always have some people who feel you are focusing on the wrong thing, but you can tell them you've picked the problems that were most prevalent in the surveys and that shared governance is an ongoing process, i.e. other problems can be addressed later.

Obtain solutions and float the solutions, Plan: Identify your goals. Do research on solutions to the problems identified and bought into. Provide information about proposed solutions and ideas for implementing. You can tweak researched solutions based on feedback.

Implement: Create the measures for each goal. Inform nurses on the pilot unit how to navigate the new process. Train them on it. Ask them to adhere to it, but to keep notes on problems with the process. This is very important! Tweaking of a pilot program is essential for the success of a full roll-out.

Evaluate: After the pilot period is completed, collect data on how it went. What went wrong; what went right. What were the results for what you measured? Are the results improved over baseline?

You may not be successful in the pilot. That's what pilots are for. You don't want to spend a crapload of money (time) implementing an idea across the organization that doesn't work!

Hope this helps.