Dear Editor,
The article "Perceptions Shared Governance Among Nurses at a Midwestern Hospital," published in the October/December 2012 issue of Nursing Administration Quarterly, outlined barriers to implementation of shared governance.1 It is an important issue for nursing leaders as development and engagement of the professional nurse is necessary as our nation faces increasing complexity of challenges in health care delivery. Nursing leaders implementing shared governance should not only be supporting but proactively anticipating barriers and strategically planning implementation.
As a nurse manager for 160 employees on 2 medical surgical telemetry units, in a large health care system in Houston, Texas, I can speak first hand to the value of promoting a culture of shared governance in nurses. Our agency has obtained pathways to excellence and is beginning our journey to Magnet recognition through the American Nurses Credentialing Center.2 As with any major change, getting the staff buy-in is an essential first step. Nurses need to both understand and see the value and impact that they can have on an organization through shared governance. Shared governance is transformational to organizations, as it empowers frontline staff to have responsibility and accountability for decision making.3
To provide motivational support, my agency has integrated active participation in councils as a requirement for career ladder advancement. Nurses are promoted by their peers by creating a portfolio that demonstrates their contributions to the organization, commitment to excellence, and clinical expertise through professional certification. As a clinical manager, I provide leadership both for the establishment and the sustenance of the shared governance structure. Leaders need to relinquish a level of structured decision making to the council and have nurses be actively engaged in decisions.4 Prior to implementation, I marketed the model by providing journal articles, e-mails, staff meetings, huddles, and flyers. The council was self-nominated and elected by their peers.
As a frontline leader, the 3 barriers to implementation and sustenance were poor engagement, attendance, and conflict. To support engagement, I provided reassurance and continuous support for their decision making. Each of the council members has a white scrub jacket that is monogramed with Shared Governance Representative. The council members wear the coats when attending meetings and when completing council initiatives on nonproductive time. I have also posted the members' pictures in the hallway with the term that they have been elected for. I consistently provide and track reward and recognition for all frontline staff participating in shared governance initiatives. To promote attendance, I schedule members for nonproductive paid time on meeting days and have the council send monthly updates that include meeting attendees. Most nurses learn leadership skills through their practice, some nurses may not have not had the opportunity to develop the skills required to be an effective council leader.1 Our organization implemented basic leadership development training through our organizational development department for meeting etiquette, basics of change management, and use of evidence-based practice.
The implementation of shared governance requires deliberate and planned leadership support. Understanding potential barriers to implementation and sustenance allows for nursing leaders to plan strategies that overcome. Investing in our nurses, in Shared Governance and in certification, promotes not only professional nurses' development but also organizational development as it brings innovation, creativity, and certified knowledge into practice.
Sincerely,
-Jeanette Pennick, BScN, RN
2007, Tall Timbers Lane
Pearland, TX 77581
[email protected]
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