Shared Governance Effect on Nursing Outcomes

Introduction The economy has made it necessary for hospitals to consolidate into integrated systems. Government and private insurance stipulations for reimbursement have become rigorous and dependent on quality and readmission rates. Hospital-acquired infections or injuries are no longer reimbursable (Underwood & Hayne, 2017). The changing landscape has been challenging for the healthcare worker, affecting morale, and in turn, patient care. It is essential for hospitals to perform at the highest level for patient outcomes and safety, in addition to creating healthy work environments for employees. Shared/Transformational Governance is key to developing top functioning hospitals. Involving the staff in decision making creates an improved process, and enhances employee engagement and satisfaction, patient outcomes, and financial status. Improving the quality of health care is a worldwide initiative. Nurses are advocates for high-quality patient care. It is essential for nurse executives and bedside nurses to unite through shared governance to repair broken processes. Collaboration between leadership and staff is vital to determine the issues and find the solutions (Dearmon, Riley, Mestas, & Buckner, 2015)

Leveraging the Power of Shared Governance

Shared governance (SG) creates an evidence-based framework to support decision making in healthcare organizations by encouraging nursing staff ownership of nursing practice issues. This project assessed the current state of shared governance at a community hospital through: (a) deployment of Hess\u27s Index of Professional Nursing Governance (IPNG) and the National Database of Nursing Quality Indicators (NDNQI) nursing satisfaction surveys which were open to nurses working in areas included in the SG framework at the project site, and (b) retrospective review of Unit Practice Council (UPC) and Nursing Senate (NS) minutes and agendas. Kotter\u27s theory of change and the logic model informed interventions aimed at creating an effective SG. IPNG data were analyzed using Hess\u27 scoring guidelines to establish total governance and subscale scores. Mean IPNG scores of nurse leaders, clinical nurse managers, and staff nurses were compared using a 1-way ANOVA based on job title, education, employment status, and shift. NDNQI results were analyzed based on benchmarked Magnet objectives and comparison to previous year\u27s surveys. Meeting agendas and minutes were analyzed for attendance and initiation of interventions. Outcomes of this project included successful creation of a UPC on a medical telemetry unit; alignment of meeting times to promote attendance; paid access to remote meeting attendance; standardization of meeting minutes and agendas; and unit-specific, outcomes-data dashboards. Implementation of this model to improve the effectiveness of SG can lead to positive social change through improvement in the decision-making process in the nation\u27s healthcare institutions. Inclusion of all members of the healthcare team in the decisions that impact practice helps ensure comprehensive, evidence-based, and patient-centric care

The Relationship between Nurse Manager Leadership Style and the Enculturation of Shared Governance

Shared governance, a participative model of governance, implemented by healthcare organizations for more than 30 years has been associated with empowerment, job satisfaction, and retention of registered nurses. Recent studies document a lack of participation in shared governance by registered nurses; the reason for the change is unknown. The nurse managers\u27 role in this change is unknown. The purpose of this non-experimental, cross-sectional survey design study was to test Bass\u27 theory of transformational leadership that examines the relationship between the leadership style of the manager and the enculturation of shared governance in acute care hospitals in the United States. A random sample of 111 nurse managers, who were members of the American Organization of Nurse Executives, were surveyed on leadership style using the Multi-factor Leadership Questionnaire and unit governance, using the Index of Professional Nursing Governance. Data was analyzed using Pearson\u27s Product Moment Correlation and a statistically significant positive relationship was found between transformational leadership style and shared governance. No relationship was found between other leadership styles and shared governance. There was no relationship between the achievement of a shared governance score on the participation subscale of the Index of Professional Nursing Governance and transformational leadership style. The study contributes to social change through the identification of the manager\u27s use of a transformational leadership style to foster the autonomy and empowerment of nurses to cultivate a positive the work environment using a shared governance model, which results in registered nurse retention and decreased organizational turnover costs

Internet... the final frontier: an ethnographic account: exploring the cultural space of the Net from the inside

The research project The Internet as a space for interaction, which completed its mission in Autumn 1998, studied the constitutive features of network culture and network organisation. Special emphasis was given to the dynamic interplay of technical and social conventions regarding both the Net’s organisation as well as its change. The ethnographic perspective chosen studied the Internet from the inside. Research concentrated upon three fields of study: the hegemonial operating technology of net nodes (UNIX) the network’s basic transmission technology (the Internet Protocol IP) and a popular communication service (Usenet). The project’s final report includes the results of the three branches explored. Drawing upon the development in the three fields it is shown that changes that come about on the Net are neither anarchic nor arbitrary. Instead, the decentrally organised Internet is based upon technically and organisationally distributed forms of coordination within which individual preferences collectively attain the power of developing into definitive standards. --

Building Excellence through Shared Governance and Continuous Process Improvement

Abstract Background: Nursing shared governance in the hospital setting is a well-established structure for shared decision-making between staff nurses and nurse leaders to improve nursing practice, quality of care, and patient safety. Establishing effective, shared governance can take several years: new skills must be acquired, new behaviors accepted, and new professional commitments made. Newcomers to shared governance require support, education, and the opportunity to acquire requisite skills; otherwise, interest, commitment, and achievement of desired outcomes cannot be sustained. Local Problem: A large hospital in California established a shared governance structure in 2018. Performance gaps between two high-performing Nursing Unit Councils (NUC) and the other 11 NUCs indicated the need for education and skill-building in performance improvement. Context: The sustainability of shared decision-making, nursing ownership of the practice, and nurse engagement in the organization would be threatened without an environment that supports and generates performance improvement. Interventions: Two comprehensive learning sessions, and a toolkit, introduced shared governance foundational components and a performance improvement framework to engage nurses in process improvement. Outcome Measures: The outcome measures were greater understanding of the IHI Model of Improvement, increased use of performance improvement methodology, and improved perception of shared governance. Results: Knowledge of performance improvement methodology and perceptions of shared governance improved in all focus areas. Familiarity with the IHI Model for Improvement increased by 29%, knowledge of SMART goals by 5%, and utilization of outcome measures by 47%. Staff nurse participation in the development and evaluation of policies rose 18%, staff nurses providing professional and educational programs increased 60%, and staff nurses\u27 access to nursing department goals and objectives improved 17%. Conclusion: Intentional education and development of nurses in performance improvement and shared governance yields mature shared decision-making and effective problem-solving. Keywords: shared governance, decision-making, nursing, performance improvemen

Implementation of Shared Governance

Implementation of shared governance in any facility presents challenges for leadership as well as the nursing staff. The implementation of shared governance for this organization yielded positive results operationally, and for the development of nursing overall

Sales and Promotions: A More General Model

We embed the Varian (1980) model in a broader setting that considers how switcher/loyal customer segments are determined. Generally, customer acquisition is deterministic while pricing is randomized. The equilibrium outcome depends on the timing of customer acquisition relative to pricing. If sellers acquire customers before setting prices, the unique equilibrium is asymmetric. If sellers acquire customers and set prices simultaneously, the unique equilibrium is symmetric. Our results provide a fundamental justification for previous analyses that variously assumed the outcome to be asymmetric or symmetric. The comparative statics for the asymmetric and symmetric equilibria are identical.competition, pricing, customer acquisition

Unified Theory of Relativistic Identification of Information in a Systems Age: Proposed Convergence of Unique Identification with Syntax and Semantics through Internet Protocol version 6

Unique identification of objects are helpful to the decision making process in many domains. Decisions, however, are often based on information that takes into account multiple factors. Physical objects and their unique identification may be one of many factors. In real-world scenarios, increasingly decisions are based on collective information gathered from multiple sources (or systems) and then combined to a higher level domain that may trigger a decision or action. Currently, we do not have a globally unique mechanism to identify information derived from data originating from objects and processes. Unique identification of information, hence, is an open question. In addition, information, to be of value, must be related to the context of the process. In general, contextual information is of greater relevance in the decision making process or in decision support systems. In this working paper, I shall refer to such information as decisionable information. The suggestion here is to utilize the vast potential of internet protocol version six (IPv6) to uniquely identify not only objects and processes but also relationships (semantics) and interfaces (sensors). Convergence of identification of diverse entities using the globally agreed structure of IPv6 offers the potential to identify 3.4x10[subscript 38] instances based on the fact that the 128-bit IPv6 structure can support 3.4x10[subscript 38] unique addresses. It is not necessary that all instances must be connected to the internet or routed or transmitted simply because an IP addressing scheme is suggested. This is a means for identification that will be globally unique and offers the potential to be connected or routed via the internet. In this working paper, scenarios offer [1] new revenue potential from data routing (P2P traffic track and trace) for telecommunication industries, [2] potential for use in healthcare and biomedical community, [3] scope of use in the semantic web structure by transitioning URIs used in RDF, [4] applications involving thousands of mobile ad hoc sensors (MANET) that demand dynamic adaptive auto-reconfiguration. This paper presents a confluence of ideas