Improving the Efficiency of Nursing Shared Governance through an Innovative Magnet Aligned Approach

Girard, Anita S.

Abstract

Aim: Effective shared leadership leads to improved nursing satisfaction, patient outcomes, and patient satisfaction (McHugh et al., 2013). After 15 years of experience with Shared Governance, and over 900 members per year, the Shared Governance councils within an academic medical center had high listed participation, but very low engagement, with little to no cross-council communication. This process improvement project used lean methodology to provide the foundation for restructuring an existing shared governance model to align the strategic priorities of an academic medical institution, and the Magnet Program Recognition Model (MPRM) to improve overall efficiency and nursing engagement.

Methods: A stakeholder retreat was conducted. Nine core hospital-wide councils, and numerous sub-committees and unit-based councils were identified: each predominately an information sharing session, with little cross-council communication. The core councils were restructured and reduced to 6 councils: Coordinating, Executive, Research & Innovation, Practice & Education, Quality & Practice, and Magnet Professional Growth & Development. A new unit based council structure was then developed. Membership to councils was redefined, requiring unit-level to organizational-level involvement for each participating nurse. In addition, new workflow changes were developed to track issues, develop action plans, and measure time to resolution.

Results: In one year, 6 new core councils involving 150 RN were developed. Within the first 3 months of the councils starting, charter goals and membership composition was determined. Participation was reduced overall, but balanced with a five-fold increase in engagement time (8 hours per month versus 1.5 hours per month from the previous model), resulting in reduced overall FTEs (8.29 v 4.8). Results on workplace measures of engagement increased for 5 out 5 Magnet measured categories.

Conclusion: Shared Governance was successfully restructured, designing new workflow processes aimed to improve cross-council communication and shared leadership decision making. This change has improved employee participation in shared leadership and led to improvements in measures of nurse engagement. Overhauling shared governance in an academic medical center has benefits beyond a new meeting structure.