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)

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. --

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

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

An investigation into some critical computer networking parameters : Internet addressing and routing

This thesis describes the evaluation of several proposals suggested as replacements for the currenT Internet's TCPJIP protocol suite. The emphasis of this thesis is on how the proposals solve the current routing and addressing problems associated with the Internet. The addressing problem is found to be related to address space depletion, and the routing problem related to excessive routing costs. The evaluation is performed based on criteria selected for their applicability as future Internet design criteria. AIl the protocols are evaluated using the above-mentioned criteria. It is concluded that the most suitable addressing mechanism is an expandable multi-level format, with a logical separation of location and host identification information. Similarly, the most suitable network representation technique is found to be an unrestricted hierarchical structure which uses a suitable abstraction mechanism. It is further found that these two solutions could adequately solve the existing addressing and routing problems and allow substantial growth of the Internet

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." (author's abstract)"Das im Herbst 1998 abgeschlossene Forschungsprojekt 'Interaktionsraum Internet' hat sich mit den konstitutiven Merkmalen der Netzkultur und Netzwerkorganisation beschäftigt. Im Vordergrund des Interesses stand das dynamische Zusammenspiel technischer und gesellschaftlicher Konventionen in der Organisation wie auch im Wandel des Netzes. Die ethnographisch angeleitete Binnenperspektive auf das Internet konzentrierte sich auf drei ausgewählte Bereiche, um Prozesse der Institutionenbildung und die Formen ihrer Transformation zu studieren: die hegemoniale Betriebstechnik der Netzknoten (UNIX), die grundlegende Übertragungstechnik im Netz (das Internet Protokoll IP) und einen populären Kommunikationsdienst (Usenet). Der Schlußbericht des Projekts enthält die Ergebnisse der drei Untersuchungsstränge. Gezeigt wird anhand der Entwicklung in den drei Feldern, daß sich der Wandel des Netzes weder beliebig noch anarchisch vollzieht. Das dezentral organisierte Internet beruht vielmehr auf technisch wie organisatorisch verteilten Formen der Koordination, in denen individuelle Handlungspräferenzen kollektiv definitionsmächtig werden." (Autorenreferat

Space Governance for the 21st Century: Balancing Space Development with Sustainability

The development of space is occurring in new ways and at an accelerated pace compared to even just a decade ago. As new and greater volumes of space activities, like large constellations of small satellites, space traffic management, and on orbit rendezvous, proximity, servicing, and assembly operations become routine, new international governance will be necessary to balance the development of space with space sustainability. While some international space governance does exist, it is poorly suited to govern new space activities and the environmental threats posed by space development. The need for new governance is well documented, yet the international community, and specifically the United Nations Committee on the Peaceful Uses of Outer Space (COPUOS), has been unable to organize around space governance and produce effective international governance measures.This research will compare governance regimes of the air, maritime, and internet domains to understand how stakeholders and international organisations approach governance of a global commons. Through the examination of the International Maritime Organization, International Civil Aviation Organization, and the multistakeholder group responsible for internet governance this research will draw insight into the organisational structures, processes, tools, and techniques that aid in the creation of international governance to inform new governance for space.Findings offer insight into the organisational qualities, governance tools, and necessary change needed to govern space more effectively. First, despite differences across case studies, there are key features of effective international governance present in each. Each system of governance is designed based on unique features and qualities of that domain and its stakeholders. Still, decision-making processes, membership participation, enforcement, and keeping pace with new technology all play central roles in effective international governance.Proper consensus decision-making can play an outsized role in whether a forum can advance governance or not. The case studies make clear that to properly use consensus as a decision-making approach requires thoughtful consideration of the increased transaction costs weighed against necessary agreement compliance. For example, not all governance outputs require a high degree of compliance to be effective and therefore do not justify higher transaction costs associated with strict consensus processes. Similarly, thoughtful use of consensus also requires evaluating where in the diplomatic process consensus is required. Not every diplomatic decision requires full consensus. Yet, COPUOS currently does not adjust its decision-making approach based on output or where in the diplomatic process it requires consensus, which has allowed the forum's use of consensus to hinder the development of new governance.Another finding is that strong governance leverages a multitude of governance tools. Treaties are an important governance measure, but so too are standards and recommended practices, guidelines, codes, performance-based measures, audit schemes, scoping exercises, and educational resources, among other tools. Many of the emerging space activities will continue to evolve quickly, which requires producing governance in a timely manner and continuous evolution of agreements. In each case study, evolving activities were governed by a spectrum of measures that allowed the IO to affect member behaviour quickly and overtime through complementary outputs.Each case study made clear that effective governance requires constant work across multiple workstreams, yet COPUOS is a small three body organisation with too few resources to increase work cadence or volume. A larger secretariat and the capacity to create new subcommittees or working groups is likely to aid space governance. COPUOS will require major changes to accommodate space governance needs. Finally, this research offers recommendations for future research capable of exploring additional possible solutions to existing space governance problems

Evaluating Shared Governance For Nursing Excellence

The national challenges of nursing shortages, decreased staffing levels, and increased patient acuities have contributed to nurse\u27s increased workload and job dissatisfaction. Nurses have become frustrated with the professional practice environment. The inability to make decisions about issues that affect their nursing practice and the care provided to their patients results in nurses leaving the work environment in search of higher job satisfaction. Employers are becoming more creative in their strategies to improve the work environment and retain nurses within their organizations. Healthcare leaders have implemented management strategies such as shared governance models. These models focus on providing a satisfying work environment that empowers employees in the decision-making of nursing practice. This was a descriptive study to evaluate the current state of shared governance in three hospitals in Las Vegas and Henderson, NV. The study used the Index of Professional Nursing Governance (IPNG) survey tool to obtain a baseline measurement of shared governance and a gap analysis using the American Nurses Credentialing Center iv (ANCC) Magnet Model© and the Forces of Magnetism© to evaluate structures and processes that support the infrastructure for shared governance. The results of the survey indicate that despite having shared governance structures in place, the overall governance scale at each of the three campuses scored below the minimum score of 173, which places the organization in a state of traditional governance, where decisions are primarily made by management and administration. Overall, opportunities exist in the organization to increase shared decision-making across all six subscales of the IPNG tool and to strengthen the infrastructure by closing gaps identified in the Magnet framework for structural empowerment and exemplary professional practice