This article is the second in a series that details key principles in forming and sustaining a lasting culture of shared governance and nursing autonomy. The first article, in the November 2013 issue, described the philosophical underpinnings of shared governance.
“To create an autonomous nursing staff requires a change of attitude, but not a new technology. It can be achieved without a large capital outlay or the use of esoteric sciences. Autonomy has, as its basic components, personal accountability and shared power and influence. This accountability and influence are outcomes of the organizational format and the style of behavior whereby nurses organize for practice. An autonomous nursing staff is feasible. It is professionally exciting. It cannot be done for nurses; it must be done by them. Will nurses aspire to this level of professional development?”
—Luther Christman, PhD, RN
In the late 1970s, Luther Christman envisioned and created the Professional Nursing Staff (PNS), a shared governance organization (SGO), at Rush University Medical Center. Today, the PNS has 2,000 members, 17 standing committees, and unit and department advisory committees—all working collaboratively in a large academic medical center. From its inception, the PNS structure was designed to give nursing equal parity with Rush’s administration and medical staff. Both the PNS and the medical staff have committee structures that evaluate the care they provide in regard to their respective disciplines; both are accountable to the board of trustees.
The work of the PNS is conducted by committees whose members represent all levels of nursing in all practice areas, including faculty, ambulatory/clinic, perioperative, interventional, and advanced practice, as well as all general and specialty inpatient areas. Policies, structures, and resource allocation emanating from these committees form, shape, and direct nursing practice.
Ensuring the success and viability of a shared governance structure requires a commitment by the larger organization to allocate financial and operational resources. This article offers suggestions on key tactics and mechanisms to help ensure the growth and success of an SGO.
Resource allocation
At the outset, administrators should consider establishing a dedicated cost center and budget to cover the SGO’s operational expenses so it can fulfill its obligations. Ideally, the SGO should have oversight of and accountability for this budget. Having an independent cost center for shared governance demonstrates a commitment to, and a formalized role of, shared governance within the larger institution.
Allocating protected nonclinical time to lead and conduct the organization’s business is a major
budget consideration. At Rush, the PNS president, president-elect, secretary, treasurer, and chairs of selected standing committees have protected time to attend to their duties. Personnel expenses for committee-member involvement are covered by individual unit and departmental budgets. The PNS budget also covers office space, equipment, supplies, programming, food, conferences, and travel expenses. Time allocation and financial needs are reevaluated annually to make sure appropriate time and resources are designated to meet formal PNS responsibilities and annual goals.
Creating dedicated space to improve communication and visibility
Securing a space for officers and other PNS members formalizes and equips the organization to conduct business in a timely and efficient way. Such administrative tools as computers, pagers, archival storage processes, and dedicated phone lines create a sense of identity and improve accessibility of PNS members within the facility.
One component of space allocation is strategic use of technology to enable accessibility, transparency, and enhanced communication. Using such platforms as the Internet and intranets, along with electronic meeting capability, shared network drives, and interactive educational platforms, gives PNS members timely access to information. Technology also promotes regular opportunity for involvement and expands access to those on other shifts or departments. Developing both internal and external websites that house committee and team communication mechanisms promotes work between meetings, establishes the shared governance brand both inside and outside the facility, and allows storage of key documents.
A culture of mentoring: Developing and supporting emerging leaders
Transitioning from the role of direct patient-care expert to that of an organizational leader with broad visibility and influence requires preparation. A formalized mentoring plan for PNS officers, committee chairs, and new members is essential. The plan must address the scope and responsibilities of the role, shared governance tenets, and such elements as accountability for clinical practice, quality, patient safety, patient experience, evidence-based practice, and organizational metrics.
At Rush, PNS leaders engage in such activities as hospital-wide new-leader orientation, mentorship by the PNS past-president’s council, a human resources talent-development program, advisory board leadership-development workshops, Illinois Organization of Nurse Leaders conferences, American Organization of Nurse Executives’ aspiring nurse leader program, and the National Magnet Conference®. These activities help advance leadership
and a nursing culture that fosters diversity and inclusion, which empower and engage staff.
Mentorship also is essential within the unit’s and department’s shared governance advisory councils. These members’ roles and responsibilities must be defined, as outlined in the bylaws. When units and departments share responsibility for meeting annual goals of the shared governance executive committee, a synergy toward goal attainment builds toward collective success. This accountability thread extends from shared governance quality meetings with the chief nursing officer and nursing associate vice presidents to the departments and units.
PNS quality discussions focus on analyzing outcomes and systems that support continuous improvement. For example, quality projects have focused on pressure ulcers, patient satisfaction, and staff engagement. Projects are generated at the unit level. At the departmental level, staff and leadership presentations generate sharing and celebrate winning strategies. Staff develop leadership skills through presentations and project participation, enhancing professional growth and goal attainment. (See Student involvement in shared governance by clicking the PDF icon above.)
Strategic representation within the organization
Annually with the transition of officers, the PNS president and president-elect evaluate their strategic representation on various committees and determine their continued involvement as well as opportunities for the upcoming year. Shared governance representation on committees and structures that address patient care, quality, and safety is critical. Developing relationships with key stakeholders, such as the medical staff president, top-level executives, and university deans further establishes parity and collaboration. Nursing SGO leaders need to participate in key decision-making discussions that affect patient care at all levels. Currently, the PNS president is a member of several key facility wide committees, including the board of trustees’ Quality of Care Committee and Process Improvement Oversight Committee.
Stay focused on the goal
Achieving an autonomous nursing staff is possible when an organization commits to putting
key supportive mechanisms in place. To echo Dr.Christman, this doesn’t require large amounts of resources or radical organizational change. Success of the SGO depends on developing an infrastructure that enables it to fulfill its obligations as outlined in the bylaws. An autonomous nursing staff enhances intraprofessional collaboration, improves patient outcomes, and advances the nursing profession.
Selected reference
Christman L. The autonomous nursing staff in the hospital. Nurs AdmQ. 1976;1(1):37-44.
Erik McIntosh is a nurse practitioner in the Department of Internal Medicine at Rush University Medical Center in Chicago, Illinois. Margaret Waszkiewicz is a unit director in Rehabilitative Services at Johnston R. Bowman Center at Rush. Cathy Catrambone is President-Elect of Sigma Theta Tau International and an associate professor in adult health and gerontological nursing at Rush University College of Nursing in Chicago. Rachel Start is the Magnet® Program Director at Rush Oak Park Hospital in Oak Park, Illinois.
