Intro/Problem statement: Engaged in the journey to attain Magnet® designation, the nurses at a large academic medical center recognized that the organization’s current shared governance structure was ineffective and deferred to management for most decisions. An initiative to strengthen and reimagine how shared governance was structured was essential to professional nursing practice and improve patient outcomes.
Materials/Methods: A task force consisting of nurses from across the care continuum and at all levels of the organization met for over a year to examine current evidence and network with other organizations. The task force created a new shared governance structure based on the Magnet domains and principles of a healthy work environment. The foundation of the model is the nursing professional practice model with clinical nurses leading both unit-based and organizational level councils while nurse leaders serve as mentors and facilitators. To operationalize the new model, the task force created templates for council charters, agenda’s, meeting minutes, and action logs. Interactive educational sessions were developed and focused on empowering clinical nurses to take ownership of practice change and improvements. After implementation of the model, organizational council chairs and nurse leaders monitored council activities and outcomes, revising the shared governance bylaws as the new structure matured. At the end of each council term, members were encouraged to share their council accomplishments as both the unit and organizational level. The creation of an annual Nursing Showcase provided the opportunity for clinical nurses to share best practices as well as develop their skills presenting to their peers and colleagues.
Results: Eighteen months after implementation of the re-imagined nursing shared governance model, the organization experienced improvements in nurse engagement and quality outcomes. Prior to implementation, RN engagement scores outperformed national benchmarks in only four of seven categories: adequacy of resources and staffing, autonomy, fundamentals of quality nursing care and professional development. After implementation, participation in the RN engagement survey increased and the organization outperformed national benchmarks in all seven categories, with statistically significant improvement in autonomy, leadership access and responsiveness, professional development, and RN to RN teamwork and collaboration. Unit level performance on nursing sensitive indicators has improved, with more than 80% of the units outperforming benchmarks for a majority of the last 8 quarters for catheter associated urinary tract infections and hospital acquired pressure injuries as well as more than 60% outperforming in falls with injury and central line associated blood stream infections.
Conclusions: By strengthening and reimagining nursing shared governance at a large academic medical center, clinical nurses exercised the ability to set goals and create practice environments that support professional practice and improved patient outcomes.