R ESEARCH COR N ER Exploring how nurses and managers perceive shared governance By Janet Wilson, BSN, RN; Karen Gabel Speroni, PhD, RN; Ruth Ann Jones, EdD, MSN, RN, NEA-BC; and Marlon G. Daniel, MPH, MHS Abstract Background: Nurse managers have a pivotal role in the success of unitbased councils, which include direct care nurses. These councils establish shared governance to provide innovative, quality-based, and cost-effective nursing care. Purpose: This study explored differences between direct care nurses’ and nurse managers’ perceptions of factors affecting direct care nurses’ participation in unit-based and general shared governance activities and nurse engagement. Methods: In a survey research study, 425 direct care RNs and nurse managers were asked to complete a 26-item research survey addressing 16 shared governance factors; 144 participated (response rate = 33.8%). Results: Most nurse participants provided direct care (N = 129, 89.6%; nurse managers = 15, 10.4%), were older than 35 (75.6%), had more than 5 years of experience (76.4%), and worked more than 35 hours per week (72.9%). Direct care nurses’ and managers’ perceptions showed a few significant differences. Factors ranked as very important by direct care nurses and managers included direct care nurses perceiving support from unit manager to participate in shared governance activities (84.0%); unit nurses working as a team (79.0%); direct care nurses participating in shared governance activities won’t disrupt patient care (76.9%); and direct care nurses will be paid for participating beyond scheduled shifts (71.3%). Overall, 79.2% had some level of engagement in shared governance activities. Managers reported more engagement than direct care nurses. Conclusions: Nurse managers and unit-based councils should evaluate nurses’ perceptions of manager support, teamwork, lack of disruption to patient care, and payment for participation in shared governance-related activities. These research findings can be used to evaluate hospital practices for direct care nurse participation in unit-based shared governance activities. Background Hospitals are continuously seeking opportunities to improve their performance by providing innovative, quality-based, cost-effective care. Principles of shared governance have been integrated in nursing infrastructures as a means of providing a transformational framework for direct care nursing staff and improving an organization’s overall performance. The three core principles associated with shared governance are as follows: www.Nursing2014.com 1. Responsibilities for nursing care delivery must reside with clinical staff. 2. Authority for nurses to act must be recognized by the organization. 3. Accountability for quality patient care and professionalism must be accepted by the clinical staff.1 Shared governance activities give direct care nurses an opportunity to partner with nursing management to achieve optimal patient outcomes and to increase nurse job satisfaction, nurse productivity, and nurse retention.2 Shared governance provides the framework for a collaborative environment of nursing leaders and direct care nurses. Together, they can formulate a partnership of shared decision making for clinical and operational practices.3 Direct care nurses play a vital role in helping realize the objectives set forth in the 2010 Affordable Care Act.4 Nurses need to overcome barriers that prevent them from responding effectively to rapidly changing healthcare settings. Direct care nurses’ and nurse managers’ perceptions of direct care nurse participation in shared governance need to be explored. When direct care nurses and nurse managers recognize differences in their perceptions, ideally they can improve unit-based and overall shared governance by leveraging the diversity that these two different perspectives can provide to improve patient outcomes. The literature lacks an examination of direct care nurse or nurse manager factors perceived as important for direct care nurse participation in unit-based and overall shared governance activities. Also absent is a delineation of identifiable differences by nurse job responsibilities and factors important to both direct care nurses and nurse managers for direct care nurse participation in shared governance. For the literature review, PubMed, EBSCOhost, ProQuest, and the July l Nursing2014 l 19 Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. R ESEARCH COR N ER Cochrane Library databases were searched for the years 2006 to 2012. Search terms included engagement, physician-nurse relationship, relationshipbased care, shared governance, staff nurse participation, participation, barriers, and positive nursing workforce environments. This survey study was conducted to identify factors that could be used by nurse managers and shared governance leaders (unit council chairs) to strengthen direct care nurse participation in shared governance activities at the unit level. The researchers created the study survey based on factors about shared governance derived from the literature review and hospital direct care nurses’ perceptions. The study was conducted at Shore Health System, a two-hospital, not- for-profit, rural healthcare system located in Easton and Cambridge, Md. The healthcare system, which obtained American Nurses Credentialing Center (ANCC) Magnet® recognition in October 2009 and redesignation in 2014, has 188 licensed beds and employs about 500 nurses. Members from the hospitals’ nursing research council served as the 11-member panel that performed content validity for relevance and clarity of a 26-item survey. (See Glossary of research terms.) Members rated each survey question according to a 4-option relevance scale (1 = not relevant, 2 = somewhat relevant but unable to assess question relevance without major revisions, 3 = quite relevant but needs minor revisions, and 4 = relevant). The panel also rated the clarity of Glossary of research terms • Bonferonni corrections. A statistical adjustment used in the case of multiple simultaneous comparisons to reduce the chance of committing a type I error (the probability of rejecting the null hypothesis when it’s true). • Chi-square analysis. A statistical method used to test the association between two nominal variables based upon the Chi-square distribution. • Content validity. Measures how well a particular scale or indicator variable explains or represents a theoretical construct. • Convenience sampling. A nonprobability-based method of sampling that each question on the survey according to a 4-option clarity scale (1 = not clearly written with no potential for revision, 2 = not clearly written and needs major revision, 3 = clearly written, but needs minor revision, and 4 = clearly written). The panel received content validity forms for the survey, a copy of the survey, the study abstract, and instructions for evaluating the survey. Based on panel responses, questions with 80% or greater agreement about question relevance and clarity were retained, and those with less than 80% agreement were revised. The final panel review generated a scale content validity index of .94 for the 26-item survey (demographics = 8 items; shared governance activities = 1; engagement level = 1; and shared governance perception factors = 16). Purpose The study’s purpose was to explore differences between direct care nurses’ and nurse managers’ perceptions of specific factors that could affect the direct care nurses’ participation in unit-based and general shared governance activities. Factors associated with direct care nurse engagement were also explored. selects individuals based on accessibility. • Fisher exact tests. Similar to a Chi-square test in that it’s testing the association between two nominal variables, where the nominal variables have only two categories. • Frequency distribution. The classification of all values in a particular variable that are collected in a study. • Likert scale. A symmetric rating scale that allows respondents to indicate their agreement with a stated question or construct. • P value. The probability that a sample’s effect or estimate is as large or larger in the population given that the null hypothesis is true. • Scale content validity index. The degree to which a scale’s content validity assesses the underlying construct(s) being measured. • Selection bias. A systematic bias in the statistical results of a study that’s attributed to the selection of study participants. Methods In this survey research study, data were collected from September to November 2011. Inclusion criteria for the study included direct care nurses and nurse managers who were employed in the categories of full-time, part-time, relief, or weekends. Nurses who were employed on a per diem or temporary basis were excluded. The principal researcher delivered study packets to eligible nurses’ unit-based mailboxes. The study packet consisted of a one-page letter 20 l Nursing2014 l July Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. www.Nursing2014.com describing the study, the institutional review board-approved informed consent form, the survey instrument, and an interoffice envelope preaddressed to the researcher. Of the 425 eligible direct care nurses and nurse managers asked to participate, 144 returned surveys (response rate = 33.8%). The 26-item survey asked nurses to self-report perceptions of activities in which they’d participated over the past year and their level of engagement. For purposes of this research, engaged was defined as a nurse who’s fully involved and enthusiastic about his or her work and who acts in a way that furthers nursing on the unit. The survey also asked nurses 16 questions associated with their perception of the importance of several specified factors that affect direct care nurse participation in shared governance activities. These were measured with a 5-point Likert scale (1 = not at all important; 2 = not very important; 3 = neutral; 4 = somewhat important; and 5 = very important). The study was continued until a minimum target sample of surveys had been received (N = 128), or 30% of the system’s eligible 403 direct care RNs (N = 121) and 22 nurse managers (N = 7). The study was designed to let the target sample size be met; additional surveys were received during this time. Statistical analyses were completed using SAS (version 9.1.3, Cary, NC). Frequencies distributions were calculated to describe the survey items. In addition, Fisher exact tests and Chisquare analysis examined the differences and associations between the study groups for each study item/ response. Bonferonni corrections were used in cases of multiple comparisons to reduce error. www.Nursing2014.com Results Of the 144 nurses participating in this study, 129 (89.6%) were direct care nurses and 15 (10.4%) were managers. Most participants were over age 35 (75.6%), had an associate’s degree (37.5%), had more than 5 years of experience (76.4%), and worked more than 35 hours per week (72.9%). Direct care nurses and managers differed significantly in their education, years of experience, and hours worked per week. Managers were typically older and had more education and more experience. The largest percentages of nurses who participated in the survey worked in the ED (15.3%) and medical/surgical/ oncology unit (12.5%). No significant differences in the survey results were seen between the two system hospitals. Two significant differences in direct care nurses’ and managers’ perceptions for the shared governance factors evaluated were noted: “direct care nurses perceiving nurses on the unit work as a team” in the response category of “very important” (direct care nurses = 76.6%, managers = 100%, P = 0.05); and “direct care nurses feeling they have the ability to make changes at unit level,” also for the response category of “very important” (direct care nurses = 62.0%, managers = 93.3%, P = 0.05). The top four factors ranked as “very important” overall (direct care nurse and nurse manager responses combined) were: 1. direct care nurses perceiving support by unit manager (very important overall = 84.0%, direct care nurses = 83.0%, managers = 93.3%) 2. direct care nurses perceiving nurses on unit work as team (very important overall = 79.0%, direct care nurses = 76.6%, managers = 100%, P = 0.05) 3. direct care nurses feeling time to participate in activities without disrupting patient care (very important overall = 76.9%, direct care nurse = 75.8%, managers = 86.7%) 4. direct care nurses believing they’ll be paid for activities beyond scheduled shift (very important overall = 71.3%, direct care nurses = 72.7%, manager = 60.0%). Regarding activity participation during the previous year, managers reported a higher participation rate for 11 of the 12 activities measured; of these, all but three were statistically significant. Direct care nurses reported more activity for only one category, which was “charge nurse when designated” (direct care nurse = 68%; manager = 33.3%). Regarding engagement level, 79.2% of participants had some level of engagement. A significantly higher percentage of managers were very engaged compared with direct care nurses (direct care nurses = 36.4%; managers = 86.7%). Discussion As a result of this research, four primary factors were identified that were perceived by direct care nurses and nurse managers to influence direct care nurse participation in shared governance activities. (See What factors influence shared governance participation?) Ideally, to strengthen direct care nurse participation in shared governance activities both at the unit level and in general, nurse managers need to focus on the following: • supporting direct care nurses’ participation in shared governance activities • ensuring unit nurses work as an effective team • ensuring that no disruptions to patient care occur as a result of July l Nursing2014 l 21 Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. R ESEARCH COR N ER What factors influence shared governance participation? TEAMWORK Unit nurses work as an effective team SUPPORT Nurse managers provide support for direct care nurses to participate in shared governance activities OPTIMAL PATIENT CARE Participation in shared governance doesn't disrupt patient care Direct care nurse participation in unit-based and overall shared governance activities nurses participating in shared governance activities • ensuring that nurses are paid for participation in shared governance activities. Our findings support shared governance survey research that assessed the knowledge, commitment, and perception of shared governance.5 These earlier research results showed a need to enhance enabling factors and to reduce the barriers associated with shared governance. Shared governance enabling factors were continued management support, providing council members time to do their work, and providing education to council participants on the roles and processes of shared governance. This additional focus on shared governance activities will enhance the opportunity for direct care nurses and managers to evaluate their partnerships aimed at achieving optimal patient outcomes and increasing nurse job satisfaction, nursing productivity, and nursing retention.2 Additional research is needed to define clear shared governance out- COMPENSATION Direct care nurses are paid for participation in shared governance activities comes and attributes such as participation, scope of decisions, and level of authority to lead to the implementation of strategies that may predict the long-term success of shared governance within organizations.5 The traditional approach to engaging direct care staff nurses in daily activities also needs to be studied if managers are conducting more quality improvement activities, evidence-based practice projects, and research studies than direct care nurses. Research is also needed to identify relationships between shared governance (the degree to which it’s present in an organization) and the organization’s outcomes, such as those nursing sensitive indicators reported in national databases. A limitation of this study is the selection bias inherent with survey research designs employing convenience sampling. Nurses participating in this survey may have been more engaged than nurses who chose not to participate. Also, these findings may not be generalizable to hospitals in nonrural settings or to those without ANCC Magnet recognition. Also, a limited number of nurse managers were included in this study. Research in larger hospital systems having more nurses and managers is suggested. Conclusions Based on these study findings, nurse managers and unit council leaders/members should evaluate their nurses’ perceptions of manager support, teamwork, lack of disruption to patient care, and pay for their participation in shared governance-related activities. These research findings can be used to facilitate evaluation of hospital practices for direct care nurse participation in unit-based shared governance activities. ■ REFERENCES 1. Anderson EF. A case for measuring governance. Nurs Adm Q. 2011;35(3):197-203. 2. Frith K, Montgomery M. Perceptions, knowledge, and commitment of clinical staff to shared governance. Nurs Adm Q. 2006;30(3):273-284. 3. Gavin M, Ash D, Wakefield S, Wroe C. Shared governance: time to consider the cons as well as the pros. J Nurs Manag. 1999;7(4):193-200. 4. Howell JN, Frederick J, Olinger B, et al. Can nurses govern in a government agency? J Nurs Adm. 2001;31(4):187-195. 5. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press; 2010. At Shore Health System in Easton, Md., Janet Wilson is the chair of nursing shared leadership and faculty for Critical Care and Graduate University (a hospitalbased nurse residency program); Karen Gabel Speroni is chair of the nursing research council; Ruth Ann Jones is director of acute care; and Marlon G. Daniel is a statistician and faculty for Critical Care and Graduate University. Research Corner is coordinated by Cheryl Dumont, PhD, RN, CRNI, director of nursing research and the vascular access team at Winchester Medical Center in Winchester, Va. Dr. Dumont is also a member of the Nursing2014 editorial board. The content in this article has received appropriate institutional review board and/or administrative approval for publication. The authors have disclosed that they have no financial relationships related to this article. DOI-10.1097/01.NURSE.0000450791.18473.52 22 l Nursing2014 l July Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. www.Nursing2014.com Chapter 12 - Assignment You are the supervisor of a surgical services department in a nonunion hospital. The staff on your unit have become increasingly frustrated with hospital policies regarding staffing ratios, on-call pay, and verbal medical orders but feel that they have limited opportunities for providing feedback to change the current system. You would like to explore the possibility of moving toward a shared governance model of decision making to resolve the issue and others like it but are not quite sure where to start. Instructions: 1. Review Learning Exercise 12.6 - Problem Solving: Working Toward Shared Governance (located in Chapter 12 of the textbook) 2. Answer the following questions: a. Who do I need to involve in the discussion and at what point? b. How might I determine if the overarching organizational structure supports shared governance? • How would I determine if external stakeholders would be impacted? • How would I determine if organizational culture and subculture would support a shared governance model? c. What types of nursing councils might be created to provide a framework for operation? d. Who would be the members on these nursing councils? e. What support mechanisms would need to be in place to ensure success of this project? f. What would be my role as a supervisor in identifying and resolving employee concerns in a shared governance model? 3. Your paper should be: o o Typed according to APA style for margins, formatting and spacing standards. Typed into a Microsoft Word document, save the file, and then upload the file Chapter 12 Organizational Structure Formal Versus Informal Organizational Structure • Formal: The emphasis is on organizational positions and formal power. – Provides a framework for defining managerial authority, responsibility, and accountability • Informal: The focus is on the employees, their relationships, and the informal power that is inherent within those relationships. – Has its own leaders and communication channel (grapevine) Copyright © 2018 Wolters Kluwer · All Rights Reserved Question Tell whether the following statement is true or false: Assigning tasks is part of the informal structure. A. True B. False Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer B. False Rationale: The formal structure involves planning activities such as assigning tasks, whereas the informal structure is covert and less structured. Copyright © 2018 Wolters Kluwer · All Rights Reserved Bureaucracy as an Organizational Design • There must be a clear division of labor. • A well-defined hierarchy of authority must exist. • There must be impersonal rules. • There must be a system for dealing with work situations. • There must be a system of rules for covering the rights and duties of each position. • Selection for employment must be based on technical competence. Copyright © 2018 Wolters Kluwer · All Rights Reserved Organization Structure Terminology • Span of control • Line authority • Staff authority • One man, one boss • Unity of command • Scalar chain • Authority • Responsibility • Accountability Copyright © 2018 Wolters Kluwer · All Rights Reserved Unity of Command • It is indicated by the vertical solid line between positions on the organizational chart. • This concept is best described as one person/one boss in which employees have one manager to whom they report and to whom they are responsible. • It is difficult to maintain in some large health-care organizations because the nature of health care requires a multidisciplinary approach. Copyright © 2018 Wolters Kluwer · All Rights Reserved Question Why can unity of command be difficult to maintain? A. It can be difficult to keep track of who one reports to. B. The organizational chart can be confusing. C. The multidisciplinary nature of health care makes it difficult to maintain. Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer C. The multidisciplinary nature of health care makes it difficult to maintain. Rationale: Unity of command is a simple system, but sometimes, overly simplified in a complex field such as health care. Copyright © 2018 Wolters Kluwer · All Rights Reserved Span of Control • Refers to the number of people directly reporting to any one manager and determines the number of interactions expected of him or her • Too many people reporting to a single manager delays decision making, whereas too few results in an inefficient, top-heavy organization. Copyright © 2018 Wolters Kluwer · All Rights Reserved Centrality • Where a position falls on an organization chart • Degree of communication of a particular management position • The middle manager often has a broader view of the organization. • Decisions are made by a few managers at the top of the hierarchy. Copyright © 2018 Wolters Kluwer · All Rights Reserved Levels of Management Top-level managers • Board of directors • Chief executive officer • Administrators Middle-level managers • Nursing supervisors • Department heads First-level managers • Team leaders • Charge nurses • Primary care nurses • Case managers Copyright © 2018 Wolters Kluwer · All Rights Reserved Advantages of the Organization Chart 1. Maps lines of decision-making authority 2. Helps people understand their assignments and those of their coworkers 3. Reveals to managers and new personnel how they fit into the organization 4. Contributes to sound organizational structure 5. Shows formal lines of communication Copyright © 2018 Wolters Kluwer · All Rights Reserved Disadvantages of the Organization Chart 1. Does not show the informal structure of the organization 2. Does not indicate the degree of authority held by each line position 3. May show things as they are supposed to be or used to be rather than as they are 4. Possibility exists of confusing authority with status Copyright © 2018 Wolters Kluwer · All Rights Reserved Types of Organizational Structures • Line structures • Ad hoc design • Matrix structures • Service line organization • Flat designs Copyright © 2018 Wolters Kluwer · All Rights Reserved Flattened Organization Structure Copyright © 2018 Wolters Kluwer · All Rights Reserved Ad Hoc Design • Modification of the bureaucratic structure • Sometimes used temporarily to facilitate project completion within a formal line organization • Overcomes the inflexibility of line structure • Serves as a way for professionals to handle increasingly large amounts of information • Uses a project team or task approach and is usually disbanded after a project is completed • May result in decreased employee loyalty to the parent organization Copyright © 2018 Wolters Kluwer · All Rights Reserved Question Tell whether the following statement is true or false: Ad hoc design is incompatible with a formal line structure. A. True B. False Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer B. False Rationale: Ad hoc design can be used temporarily to facilitate project completion within a formal line organization. Copyright © 2018 Wolters Kluwer · All Rights Reserved Matrix Organizations • Designed to focus on both the product and the function • Have a formal vertical and horizontal chain of command • Have fewer formal rules and fewer levels of the hierarchy • Can cause slow decision making due to information sharing • Can produce confusion and frustration for workers because of dual-authority hierarchical design Copyright © 2018 Wolters Kluwer · All Rights Reserved Service Line Organizations • Used in some large institutions to address the shortcomings that are endemic to traditional large bureaucratic organizations • Sometimes called care-centered organizations • Smaller in scale than large bureaucratic systems Copyright © 2018 Wolters Kluwer · All Rights Reserved Flat Organizational Designs • Remove hierarchical layers by flattening the scalar chain and decentralizing the organization • Continue to have line authority, but because the organizational structure is flattened, more authority and decision making can occur where the work is being carried out • Despite being very flat, often retain many characteristics of a bureaucracy Copyright © 2018 Wolters Kluwer · All Rights Reserved Scalar Chain The decision-making hierarchy, or pyramid, is often referred to as a scalar chain. Copyright © 2018 Wolters Kluwer · All Rights Reserved Centralized Versus Decentralized Decision Making • In organizations with centralized decision making, a few managers at the top of the hierarchy make most of the decisions. • In decentralized decision making, decision making is diffused throughout the organization, and problems are solved by the lowest practical managerial level. Usually, this means that problems can be solved at the level at which they occur. Copyright © 2018 Wolters Kluwer · All Rights Reserved Question A company that always directs problems to managers at the top of the hierarchy is using A. Centralized decision making B. Decentralized decision making Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer A. Centralized decision making Rationale: In centralized decision making, a few managers at the top make most of the decisions, whereas in a decentralized process, problems are often addressed at the level at which they occur. Copyright © 2018 Wolters Kluwer · All Rights Reserved Stakeholders • Those entities in an organization’s environment that play a role in the organization’s health and performance, or that are affected by the organization • May be both internal and external • Every organization should be viewed as being part of a greater community of stakeholders. Copyright © 2018 Wolters Kluwer · All Rights Reserved Definitions—Accountability, Responsibility, and Authority • Accountability is the moral responsibility that accompanies a position. • Responsibility is related to job assignment and must be accompanied by enough authority to accomplish the assigned task. • Authority is the official power to act and direct the work of others. Copyright © 2018 Wolters Kluwer · All Rights Reserved Organizational Culture • The values and behaviors that contribute to the unique social and psychological environment of an organization • A sum total of values, language, past history of “sacred cows,” formal and informal communication networks, and the rituals of an organization • Differs from organizational climate (how individuals perceive the organization) Copyright © 2018 Wolters Kluwer · All Rights Reserved Organizational Climate Organizational culture is often confused with organizational climate—how employees perceive an organization. The perception may be accurate or inaccurate, and people in the same organization may have different perceptions about the same organization. Copyright © 2018 Wolters Kluwer · All Rights Reserved Question How employees perceive an organization is the A. Organizational climate B. Organizational culture C. Organizational chart D. Organizational structure Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer A. Organizational climate Rationale: The climate is subjective, based on the perceptions of individual employees. Copyright © 2018 Wolters Kluwer · All Rights Reserved Building a New Culture Success in building a new culture often requires new leadership and/or outside analysis. Copyright © 2018 Wolters Kluwer · All Rights Reserved Shared Governance • Introduced in the 1980s • Nurses at every level play a role in the decisions that affect nursing activity throughout the system. • Nurse-managers move out of traditional industrial model roles into collegial models, becoming moderators of the service process. • Usually defined by a structure of rules or bylaws Copyright © 2018 Wolters Kluwer · All Rights Reserved Participatory Management Although participatory management lays the foundation for shared governance, they are not the same. Participatory management implies that others are allowed to participate in decision making over which someone has control. Thus, the act of “allowing” participation identifies for the participant the real and final authority. Copyright © 2018 Wolters Kluwer · All Rights Reserved Characteristics of Magnet Hospitals • Well-qualified nurse executives in a decentralized environment, with organizational structures that emphasize open, participatory management • Autonomous, self-managing, self-governing climates that allow nurses to fully practice their clinical expertise, flexible staffing, adequate staffing ratios, and clinical career opportunities • A professional practice culture in all aspects of nursing care • Compliance with standards in the ANA’s Scope and Standards for Nurse Administrators Copyright © 2018 Wolters Kluwer · All Rights Reserved The 14 Forces of Magnetism for Magnet Hospital Status 1. Quality of nursing leadership 2. Organizational structure 3. Management style 4. Personnel policies and programs 5. Professional models of care 6. Quality of care 7. Quality improvement 8. Consultation and resources 9. Autonomy Copyright © 2018 Wolters Kluwer · All Rights Reserved The 14 Forces of Magnetism for Magnet Hospital Status—(cont.) 10. Community and the hospital 11. Nurses as teachers 12. Image of nursing 13. Interdisciplinary relationships 14. Professional development Copyright © 2018 Wolters Kluwer · All Rights Reserved Pathway to Excellence • Recognizes health-care organizations with foundational quality initiatives in creating a positive work environment, as defined by nurses and supported by research Copyright © 2018 Wolters Kluwer · All Rights Reserved Committees • Too many committees in an organization is a sign of a poorly designed organizational structure. • To be productive committees should have – An appropriate number of members – Prepared agendas – Clearly outlined tasks – Effective leadership Copyright © 2018 Wolters Kluwer · All Rights Reserved Organizational Effectiveness • Structure clearly defined • Build few management levels • Unit staff need to see where their tasks fit • Organizational structure enhances communication and decision making. • Staff is organized to create a sense of community and belonging. • Nursing services organized to develop future leaders Copyright © 2018 Wolters Kluwer · All Rights Reserved LEARNING EXERCISE 12.6 Problem Solving: Working Toward Shared Governance You are the supervisor of a surgical services department in a nonunion hospital. The staff on your unit have become increasingly frustrated with hospital policies regarding staffing ratios, on-call pay, and verbal medical orders but feel that they have limited opportunities for provid- ing feedback to change the current system. You would like to explore the possibility of moving toward a shared governance model of decision making to resolve this issue and others like it but are not quite sure where to start ASSIGNMENT: Assume that you are the supervisor in this case. Answer the following questions: 1. Who do I need to involve in this discussion and at what point? 2. How might I determine if the overarching organizational structure supports shared governance? How would I determine if external stakeholders would be impacted? How would I determine if organizational culture and subculture would support a shared governance model? 3. What types of nursing councils might be created to provide a framework for opera- tion? 4. Who would be the members on these nursing councils? 5. What support mechanisms would need to be in place to ensure success of this project? 6. What would be my role as a supervisor in identifying and resolving employee concerns in a shared governance model?
Purchase answer to see full attachment