Impact of Shared Governance on Pediatric Hematology/Oncology Nurse Satisfaction. Kimberly Johns, MSN, RN, PCNS-BC, CPON Iris Mamier, PhD, RN

Transcription

1 Impact of Shared Governance on Pediatric Hematology/Oncology Nurse Satisfaction Kimberly Johns, MSN, RN, PCNS-BC, CPON Iris Mamier, PhD, RN

2 Purpose:»To evaluate a unit based shared governance council one year after implementation and to assess staff nurses perceptions of how this change has effected nursing and patient outcomes.

3 Introduction and Background»Healthcare systems should provide safe, quality care with controlled costs.»shared nurse governance structures engage nurses from the bedside in decisions about their own professional practice.»staff involvement facilitates ongoing improvement to meet the goals of improved patient outcomes and quality care.

4 Objectives and Aims»Identify effective components of the shared governance unit based council»identify areas for improvement within the shared governance unit based council»derive recommendations regarding further development of the shared governance unit based council

5 PICOT Question»In pediatric oncology nurses, what is the effect of implementing a unit based nursing shared governance council on staff nurses perceived patient and nursing outcomes one year after implementation?

6 Literature Summary»Magnet hospitals show that implementing nurse governance structures leads to higher levels of nurse job satisfaction and nurse engagement ultimately leading to better patient outcomes (Hess, et al 2011, level 3).»Shared nurse governance is recommended as best practice to improve engagement (Ott and Ross, 2014, level 3).»Development of a clear structure to support shared governance is key to long term success (Joseph and Bogue, 2016, level 3).

7 PDCA-Deming Circle

8 Project Design»Pediatric Oncology/Hematology RNs from Unit 4800»2 sets of Focus Groups ~ Group 1: RNs actively involved in the unit based council ~ Group 2: RNs not actively involved in the council»questions focusing on perceptions ~ RN satisfaction with and understanding of shared governance unit based council role

9 Project Methodology»Use of Focus Groups and Interviews ~ Qualitative method ~ Gather unique perspectives and opinions within the team ~ Comparison between perceptions of council members versus non-council members

10 Participant Demographics Members of Shared Governance Council Not Members of Shared Governance Council»7 participants»11 participants»years of Experience ~ Range from 1-8 years ~ Average of 4.6 years»years of Experience ~ Range from 1-28 years ~ Average of 9.3 years

11 Participant Demographics -No participants had prior experience with Shared Governance Age Range Members of Shared Governance Not Members of Shared Governance years 57% 60% years 29% 10% years 14% 20% years 0% 10%

12 Results Review: Theme 1»Theme: Felt represented»from the Staff: ~ even when I knew that changes couldn t be made it felt good to know that they were speaking for us ~ do a good job with suggestion box and asking around for ideas ~ our voice is being shared ~ I feel like the nurses are respected and opinions matters on this unit

13 Results Review: Theme 2»Theme: Lack of clarity»from the Staff: ~ it would be nice to have more standardization in our care, I don t always know what they are working on ~ details sometimes get lost after projects are going ~ shared governance seems ambiguous, I don t really know what it is ~ new staff don t know about shared governance

14 Results Review: Theme 3»Theme: Open to change»from the Staff: ~ the nurses in peds hem/onc want to do the best for their patients ~ staff are open to change and new ideas but they need to know more about what is happening ~ nurses ask for change more now than they did before

15 Result Review: Suggestions»Suggestions from the staff: ~ Poster with shared governance projects and members ~ More parent feedback on our care as it is happening ~ More communication about what is happening ( s, surveys) ~ More communication about plans especially during difficult times ~ List of active projects and timelines ~ Quick education on the floor ~ Standardization of patient care and ongoing education with staff ~ Check off process for high risk cares ~ More input from the staff

16 Evaluation»What went well: ~ Staff feel that they have a new venue for ideas ~ Staff feel represented ~ Honest feedback from the participants»what could be improved: ~ General communication about shared governance ~ Increase awareness about members of the council

17 Outcomes»Changes based on feedback: ~ Shared Governance Information Board Member roles Current projects ~ Invitation to all staff to attend specific time in council meetings ~ Plan for engaging staff more in ongoing projects via surveys/ s

18 Strengths and Limitations Strengths Limitations»Consistent demographics»timeframe»honest feedback»participation»engaged participants

19 Projections for Future Work»Plan for ongoing evaluation process»develop tools to guide shared governance projects from beginning to end»plan for communication of projects over time both at the unit and hospital level

20 References» Atefi, N., Abdullah, K., Wong, L., & Mazlom, R. (2014). Factors influencing registered nurses perception of their overall job satisfaction: a qualitative study. International Nursing Review, 61(3), » Barden AM, Griffin MTQ, Donahue M, Fitzpatrick JJ. (2011) Shared governance and empowerment in registered nurses working in a Hospital Setting. Nursing Administration Quarterly, 35(3), » Blake, N. (2015). Creating a Healthy Workplace. The Healthy Work Environment Standards: Ten Years Later. AACN Advanced Critical Care, 26(2), » Bretschneider, J., Eckhardt, I., Glenn-West, R., Green-Smolenski, J., & Richardson, C. (2010). Strengthening the voice of the clinical nurse: the design and implementation of a shared governance model. Nursing Administration Quarterly, 34(1), » Castaneda, G. A., & Scanlan, J. M. (2014). Job Satisfaction in Nursing: A Concept Analysis. Nursing Forum, 49(2), » Doody, O., Slevin, E., & Taggart, L. (2012). Preparing for and conducting focus groups in nursing research: part 2. British Journal of Nursing, 11, 1-5.» Elwyn, G., Edwards, A., Mowle, S., Wensing, M., Wilkinson, C., Kinnersley, P., & Grol, R. (2001). Measuring the involvement of patients in shared decision-making: a systematic review of instruments. Patient Education and Counseling, 43, 5-22.» French-Bravo, M., & Crow, G. (2015). Shared Governance: The role of buy-in in bringing about change. Online Journal of Issues in Nursing, 20(2), 1-8.» Frith, K., & Montgomery, M. (2006). Perceptions, knowledge, and commitment of clinical staff to shared governance. Nursing Administration Quarterly, 30(3), » Hess, R. (2014). Implementing shared governance: No turning back. Nurse Leader, 12(4),

21 References» Hess R, Desroches C, Donelan K, Norman L, and Buerhaus P. (2011) Perceptions of nurses in magnet hospitals, non-magnet hospitals, and hospitals pursuing magnet status. Journal of Nursing Administration, 41(7-8), » Immanuel St. Joseph s Mayo Health System. Embracing a nursing shared decision making model. Retrieved from Lambrou, P., Merkouris, A., Middleton, N., & Papastavrou, E. (2014). Nurses perceptions of their professional practice environment in relation to job satisfaction: a review of quantitative studies. Health Science Journal, 8(3), » Lewin, K. (1951). Field Theory in Social Science. Tavistock Publications, London.» Joseph, M. L., & Bogue, R. J. (2016). Article: A theory-based approach to nursing shared governance. Nursing Outlook, 64(4), » Kramer, M., Schmalenberg, C., Maguire, P., Brewer, B., Burke, R., Chmielewski, L., &... Waldo, M. (2008). Structures and practices enabling staff nurses to control their practice. Western Journal of Nursing Research, 30(5), » Meyers, M., & Costanzo, C. (2015). Shared governance in a clinic system. Nursing» Administration Quarterly, 39(1), » Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management - UK, 20(1), » O May, F. & Buchan, J. (1999). Shared governance: a literature review. International Journal of Nursing Studies, 36(4), » Ott, J., & Ross, C. (2014). The journey toward shared governance: the lived experience of nurse managers and staff nurses. Journal of Nursing Management, 22(6),

22 References» Roberts-Turner, R., Hinds, P. S., Nelson, J., Pryor, J., Robinson, N. C., & Jichuan, W. (2014). Effects of Leadership Characteristics on Pediatric Registered Nurses Job Satisfaction. Pediatric Nursing, 40(5), p.» Shaha, M., Wenzel, J., & Hill, E. (2011). Planning and conducting focus group research with nurses. Nurse Researcher, 18(2), » Titler, M.G., Kleiber, C., Steelman, V., Rakel, B., Budreau, G., Everett, L.Q., Buckwalter, K.C., Tripp-Reimer, T., & Goode, C. (2001). The Iowa Model of Evidence-Based Practice to Promote Quality Care. Critical Care Nursing Clinics of North America, 13(4), » Torres, A., Kunishige, N., Morimoto, D., Hanzawa, T., Ebesu, M., Fernandez, J., Nohara, L., SanAgustin, E. and Borg, S. (2015), Shared Governance: A Way to Improve the Care in an Inpatient Rehabilitation Facility. Rehabilitation Nursing, 40, » Wells, J., Manuel, M., & Cunning, G. (2011). Changing the model of care delivery: nurses perceptions of job satisfaction and care effectiveness. Journal of Nursing Management, 19(6), » Wilson, J., Speroni, K.G., Jones, R.A., & Daniel, M.G. (2014). Exploring how nurses and managers perceive shared governance. Nursing, 44(7), 19-22p.