| Description |
Background: Shared governance is a structural framework for shared decision-making that positively impacts nursing practice and improves professional accountability. It empowers frontline nurses and clinical staff by giving them a voice in all decisions that affect their work. Local Problem: A Mountain West academic health system recently adopted the Councilor Model of shared governance. Clinical staff leaders are chairs or co-chairs who lead their local department's team council in shared governance. These leaders oversee quality improvement projects and evidence-based practice changes, lead council meetings, communicate with other leaders and councils, and track shared governance activities. Clinical staff leaders require leadership training to gain the skills and competencies to lead their teams successfully. However, not all organizations know where to start addressing nurse leader training gaps. Methods: Guided by the Johns Hopkins Evidence-Based Practice Model, a needs assessment was conducted at a Mountain West academic health system to identify leadership skills and competency gaps among clinical staff leaders and system barriers to shared governance. Interventions: A thorough literature search identified the skills and competencies needed for shared governance and specific behaviors that lead to the success of shared governance leaders and teams. Survey questions were tailored to identify gaps. Qualitative and quantitative survey questions were developed and administered to gather clinical staff leader perceptions of their shared governance activities. Descriptive statistics were used to analyze survey responses from clinical staff leaders, including demographic questions, Likert-scale items, and yes/no questions. Each open-ended survey response was reviewed, trends were identified and organized, and commonalities were outlined. A Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis was conducted by collecting data from small focus groups involving a subset of clinical staff leaders and their mentors. Additionally, two interviews were performed. An organizational shared governance expert was interviewed to identify potential barriers and facilitators for shared governance within the organization. The Magnet program director was interviewed to assess the current onboarding and training process for clinical staff leaders. Results: Need assessment findings from an online survey (n=95) highlight gaps in leadership skills and competencies and desired behaviors in shared governance across several key areas: fostering engagement, communication skills, consistency, meeting leadership, prioritization, time management, and evidence-based practice. The SWOT analysis highlighted strengths in fostering psychological safety, and team councils have successfully implemented practice changes. The weaknesses include challenges with team council engagement and underutilized dedicated shared governance time. Opportunities included offering structured time for shared governance activities and standardizing the council meeting process. Potential threats included inconsistent council meetings and the isolation of team councils from other councils across the organization. Conclusion: Identifying leadership and competency skills specific to the organization will inform future onboarding and continuing needs of clinical staff leaders. Recommendations were devised, and an executive summary was provided to key stakeholders. Addressing the identified gaps will likely enhance shared governance, improve nurse autonomy and engagement, and lead to higher-quality nursing care and better patient outcomes. |
