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Show Implementing Nursing Shared Governance at University of Utah Health Jessica Cormier, BSN, RN, Sheila DeLong, MSN, RN, NPD-BC, Mary-Jean (Gigi) Austria, MS, RN, OCN (Magnet Program Director), Kim Mahoney, MEd, Bridgette Maitre, Kevin Pompei MEd, Kristen Mauck, MBA, Team Chairs (n=220), Mentor Council Mentors (n=203), Excellence Councils (n=39), Tracey Nixon, MSN (Chief Nursing Officer) Figure 1. U of U Health Councilor Model Our approach: We adapted a councilor model of shared governance (Figure 1) that rests on four governance council types (Figure 2), and four supporting structures (Figure 3). July 6, 2023, we began implementation with the goal of initiating all four council types and four supporting structures by June 30, 2024 (Figure 4). SY STE ED TER M E N T O R TEAM COUNCILS + MENTOR COUNCILS EXCELLENCE COUNCILS Provide information and advocate for team needs Coach and facilitate decision making and problem solving COORDINATION COUNCIL Provide expert guidance in three areas of excellence: Provides structure and communications to connect councils Patient Care, EBP/Research, Professional Growth CNO oversight ensures adequate sponsorship and resourcing Figure 3. Four Supporting Structure Types + + + BYLAWS (processes) + + GATHERINGS (huddles/meetings) COORDINATION (comms) SG Website houses bylaws and Council documents When/how to gather determined by individual Councils Developed collaboratively, updated annually Bimonthly updates via blog, newsletter and other forums On-demand training, project tools and support contacts Oversight of annual bylaws review and Council reporting ONBOARD ORGANIZE MOBILIZE RECOGNIZE Q1: Jul - Sep Q2: Oct - Dec Q3: Jan - Mar Q4: Apr - Jun 7/6: Nursing Shared Governance begins. • Nov.: Council Chair trainings begin. • 7/6: Shared Governance Pulse site launches with registration, orientation, and comms materials. • Nov.: Team Board Kits distributed to teams and built locally with huddle process. 7/6-9/15: Team Council online registration opens. All details and reg link available on Pulse site. • • 10/1-12/31: Mentor and Excellence Councils organize; prepare for Team Council implementation in Q3. • 1/15: Team Councils submit Team Board Photo & Huddle process. • 5/15: Present Shared Governance implement process at Poster Fair. • Feb.: Full shared governance process implementation begins. • May: Annual process eval issued across dept. • 6/14: All Councils submit proposed changes and FY25 plan. • 6/30: Bylaws updated and announced. • Feb-Mar: Teams learn to manage L1-L2 PINS. • Feb-Jul: All other councils learn to support L3-L4 PINS. Ongoing: All Councils engage in shared governance proceedings MILESTONE #1 MILESTONE #2 All Team Councils submit All Team Council registrations Team Board photo & huddle submitted by Sep 15. plan by Jan 15. 2. Equipment (57, 12%) – requests to add, repair, or replace equipment 3. Staffing (54, 11%) – scheduling, floating, and workload concerns 4. Well-being (53, 11%) – parking, benefits, breaks, and other improvements to team well-being 5. Supplies (36, 7%) – mostly basic, from Q-tips and gloves, to PPE and refrigerators TOP 5 ACROSS ALL AREAS 6. Training (27, 6%) – clinical, technology, and communication-related training 7. Safety (23, 5%) – address staff security, privacy, and patient safety needs 8. Compensation (17, 4%) – mostly cost of living, PTO, and incentives 9. Communication (16, 3%) – need for signage changes and improvements to meetings/huddles 10. Facilities (8, 2%) – suggestions for work environment renovation, redesign, and repairs 11. Competence (4, 1%) – requests for peer review evals and expanding non-nurse competencies 84% of PINS are assigned to the correct level (L1-L4) 66% of PINS fall within Team Council decision-making scope (L1-L2) 33% of PINS will need to advance to Mentor Council for support (L3-L4) 71% of PINS apply to Patient Care 26% of PINS apply to Professional Development & Engagement 1% of PINS apply to Research & Evidence-Based Practice Resource needs reflect four themes: Equipment, Staffing, Supplies, Facilities 67% of PINS “Need more information” to appropriately support team needs using App 13% of PINS would benefit other teams if they “share process and outcomes” of their work 1% of PINS fall within manager scope of decision making (HR-related) Figure 4. Four Quarters of Implementation • 1. Workflow (185, 38%) – process changes to address efficiency, care delivery, and coordination 63% of teams are using EmpowerU App CONNECTION (EmpowerU App) Councils meet, document and report proceedings Standards guide governance policies and procedures What we learned: ID E N TIFIE D THE M E S + What we did: We performed a qualitative analysis of 484 PINS (problems, ideas, needs, and suggestions) submitted to EmpowerU App by 69 Team Councils between 2/5/24 – 3/5/24. Why we did it: (1) Gauge progress onboarding Team Councils, (2) Identify actionable insights to improve process, and (3) Inform development of dashboards for tracking/reporting. + + Results PIN S IN S IGH TS + Empowered to make decisions and solve problems The problem: There are close to 6,500 team members in the Department of Nursing who represent over 230 different job roles. To ensure every team member has a voice, we require a model that provides local forums for surfacing problems, ideas, needs, and suggestions at the team level, supported by a governance process to prioritize, resource, and resolve them. ENGAGED EXPERTS T E A M E X C E L L E N C E C O O R D I N A T I O N Figure 2. Four Governance Council Types Identify local problems, ideas, needs & suggestions (PINS) Methods z EN TC Why it matters: A pillar of the ANCC Magnet culture, Shared Governance is an evidencebased approach to collaborative decisionmaking that has been shown to improve nurse satisfaction, retention, and patient outcomes. The process design is collaborative, inclusive, & transparent. As councils mature, communication and decisionmaking can flow between groups rather than in a traditional topdown management structure. N TIE PA What it is: Nursing shared governance is a professional practice model empowering nurses to make decisions about patient care, clinical practice standards, policy, professional development and evidenced-based care. MS TH IN Background KIN G U of U Health’s councilor model1-3 is aligned with nursing strategic priorities and capable of supporting our complex network of five hospitals and 12 community clinics. MILESTONE #3 MILESTONE #4 All Team Chairs utilize EmpowerU App by Mar 1. All mentors review team PINS by Mar 15. All councils submit FY25 updated plan for implementation by Jun 14. Discussion Analysis reveals that 69 of 110 teams are using EmpowerU App and successfully following the shared governance process. Support resources, app improvements, and training in scientific problemsolving methodologies will be needed in FY25. References 1. Overcash, J., Petty, L. J., & Brown, S. (2012). Perceptions of shared governance among nurses at a midwestern hospital. Nursing Administration Quarterly, 36(4), E1–E11. https://pubmed.ncbi.nlm.nih.gov/22955226/ 2. Joseph, M.L., Bogue, R.J. (2016). A theory-based approach to nursing shared governance. Nursing Outlook, 64(4). 339-351. doi: https://doi.org/10.1016/j.outlook.2016.01.004 3. Bretschneider J, Eckhardt I, Glenn-West R, Green-Smolenski J, & Richardson C. (2010). Strengthening the voice of the clinical nurse: the design and implementation of a shared governance model. Nursing Administration Quarterly, 34(1), 41–48. https://doi.org/10.1097/NAQ.0b013e3181c95f5e Acknowledgement Thank you to all UUHC Department of Nursing team members for their many contributions and high engagement in implementing Nursing Shared Governance. DEPARTMENT OF NURSING |
