This completed study describes the measurement of nurses’ perceptions of collaborative governance (CG) over 5 years after implementation of a CG structure developed to transform culture and empower nurses to be more involved in decision making. The study is important since few evidence-based studies regarding CG exist in the literature.
Transformation leaders inspire others to achieve more than they thought possible for themselves (Porter-O’Grady & Malloch, 2015). The Magnet culture requires transforming the organization culture and facilitating leadership growth and empowerment of all nurses in the organization (Dearmon, 2015). CG is a structure and process used to change organizational culture by empowering and engaging clinical nurses in interprofessional decision-making as compared to the traditional hierarchical decision-making model (Ansell & Gash, 2008; Barden, Griffin, Donahue & Fitzpatrick, 2011; Hood, 2016). Benefits of CG have been described as advancing the scholarly work of clinical nurses, improved patient outcomes, and improvements in clinical nurse job satisfaction (Burkoski & Yoon, 2013; Myers, et al., 2013; Parkosewich, 2013). CG facilitates the transformation of the organization and is a developmental process that can be measured over time (Larkin, Cierpial, Stack, Morrison, Griffith, 2008).
After a review of the literature exploring best practices in collaborative governance (Burkman, 2012; Dearmon, 2015; Franklin, Murphy & Cook, 2014), the nurse leaders and clinical nurses at the study site designed, implemented, and evaluated a CG organizational structure with a conceptual model (Bretschneider, Eckhardt, Glenn-West, Green-Smolenski & Richardson, 2010). This study surveyed clinical nurse perceptions of the CG structure annually to measure growth and enculturation.
Intervention: Recognizing that leadership was the key to transforming organizational culture (Hood, 2016; Slatyer, Coventry, Twigg & Davis, 2016), the first step forming the Magnet Steering Leadership Council (MSLC) comprised of clinical nurses and nurse leaders who began the work of designing the CG structure for the hospital. Once the CG councils were identified (Professional Development Council, Research & Innovation, Healthy Work Environment, Quality & Patient Safety, Professional Practice), clinical nurses were invited to participate on hospital-wide councils and/or unit practice councils (UPCs). The clinical nurse members and nurse leaders developed charters to outline responsibilities, deliverables, and terms of membership complete with annual SMART goals. Communication systems were developed to facilitate information exchange among the UPCs and house-wide councils. Magnet Factoids disseminated electronically familiarized all employees with the work of the councils and Magnet components. Council accomplishments were reported yearly at professional development workshops and featured in the Nursing Annual Report. CG councils were evaluated by clinical nurses and interprofessional participants to identify opportunities for growth.
Methods:
After Institutional Review Board approval, the study was conducted in a large metropolitan hospital located in the Southwestern region of the United States. The study used a time series quantitative survey design to test perception changes of CG over 5 years. The hypotheses were: (1) nurses will improve their perceptions of CG over time as a result of their involvement with the CG process in UPCs and hospital-wide councils; and (2) nurses will perceive that CG enhances their professionalism as the CG structure and process matures. The CG Survey was used to measure the nurses’ perceptions of CG. The 39-item instrument has a reported Cronbach's alpha of .97 and is rated on a 4-point Likert scale from 4 (strongly agree) to 1 (strongly disagree). The instrument has three subscales – understanding CG; Commitment of the organization to CG; and personal perceptions of CG. Data was collected each May-June since 2012 and analyzed with SPSSv23.
Results:
A total of 562 nurses responded over the 5 years (Y) (n = 131, Y1; n = 181, 2; n = 121, Y3; n = 84, Y4; and n = 45, Y5). While mean (M) ages differed slightly over the 5 years, there were no significant differences in mean ages (M = 42 years combined), years employed at the hospital (M =12 years), work status, ethnicity or highest degree earned. There were significant differences (p = .000) in nurses’ perceptions for the total CG scale score (Y1 M = 2.82 to Y5 M = 3.96) and the three subscales – perception (Y1 M = 2.91 to Y5 M = 3.86); knowledge (Y1 M = 2.79 to Y5 M = 3.98), and commitment (Y1 M = 2.80 to Y5 M = 3.99) from year to year (only Y1 and Y5 reported here). Nurses reported that CG enhanced the level of professionalism among nurses (M = 3.97) and among all staff (M= 3.8).
Conclusions:
Although the generalizability of the study is limited since it is a single site study, the results indicate a CG structure and process does enhance nurses’ perceptions of CG over time as the structure matures and contributes to nurses’ perceptions of enhanced levels of professionalism. This study provides new knowledge about the importance of measuring the effect of CG structures over time on nurses’ perceptions, knowledge and commitment to CG. The study has global implications for nursing, since collaborative structures and processes that facilitate nurses’ decision making at the point of care have promise to improve patient outcomes and contribute to job satisfaction and retention among nurses.