Raising a Voice
Raising a Voice | White River Medical Center, White River Health System, Michelle Bishop, nursing shared governance, Magnet designation, North Mississippi Health System, North Mississippi Medical Center

Michelle Bishop with Sheri Davis, RN and Wendy Miller, RN. The mannequin is controlled by a computer and simulates a wide variety of patient care scenarios including chest pain, allergic reactions and breathing difficulty.

More Hospitals Turning to Nursing Shared Governance

When the professional guideline committee that reviews dress code at North Mississippi Medical Center (NMMC) brought up the question—What about nurses going back to wearing all white instead of different colored scrubs so patients could more easily identify them?—the 1,200 staff nurses at America’s largest rural nonprofit hospital were glad to have council representation in the form of nursing shared governance.

“Instead of saying, ‘well, if someone thinks it’s a problem, then it must be a problem,’ our staff on the councils went back to their units and talked to nurses and patients,” said Shannon Fryery, director of nursing leadership for NMMC. “Overwhelmingly, when patients were interviewed, they said yes, they knew who their nurses were, that nurses introduced themselves to the patients and wrote their name on a the dry erase board in the patient’s room. In our research, based on hesitancy in some patient interviews on one unit where the staff wasn’t as good about going in and introducing themselves, we went back and made sure that unit’s nurses were following the standard we would expect from nursing.”

Defining nursing shared governance is like “pinning Jell-O to a wall,” as pioneers of the practice have described it. But one thing’s for sure. Nursing shared governance, which has been around for nearly three decades, is making a comeback. The innovative organizational model gives staff nurses control over their practice and sometimes extends their influence into administrative areas previously controlled only by managers.

“The concept … had its start at Vanderbilt University Medical Center,” said Marilyn Dubree, RN, MSN, executive chief nursing officer for Vanderbilt University Medical Center. The recent boost in shared nursing governance activity signals “less a resurgence than an acknowledgment that a positive work environment is critical for both excellence in nursing practice, nurse retention and patient safety and quality. An engaged clinical workforce is one that is optimistic about their input being sought and utilized to impact patient care. That engagement leads to many positive outcomes, including collaboration with other team members, physicians, administrators.”

Robert Hess, PhD, an expert in nursing shared governance, wrote in a 1998 editorial, “A Breed Apart—Real Shared Governance,” in the Journal of Shared Governance, comments that hold true a dozen years later:

“As the last nursing shortage waned, shared governance disappeared from many of the some 1,000 healthcare institutions where it had thrived. Some programs were victims of mergers and acquisitions; others just sputtered out from exhaustion. A few enlightened nurse administrators and staff kept their programs going. Others kept remnants of shared governance in play through less transforming participatory management and decentralized structures. With more than enough nurses, some shortsighted top brass turned their attention from addressing who controlled practice to considering more pressing fiscal issues. One anonymous administrator spoke from that point of view: ‘Why should I care about what staff think? If they don’t like it, I can replace them all tomorrow.’ That was a time of plenty. But now a brand-new nursing shortage is revitalizing shared governance and its promise is to put control over nursing care in the hands of practicing professionals and retain these professionals.”

For example, Overlake Hospital Medical Center in Bellevue, Wash., created a Nursing Congress in 1984 to provide nurses a voice in patient care and practice decisions. The name was changed in 2000 to Clinical Care Congress to include all multidisciplinary staff members. The Seton Family of Hospitals in Central Texas has a shared governance model so successful that it’s been highlighted nationally.

Also spurring increased participation: the American Nursing Credentialing Center (ANCC) requires hospitals to have a shared governance model to achieve prestigious Magnet status, an accreditation shared by less than 10 percent of hospitals in the United States. The Magnet-designated American University of Beirut Medical Center holds one of the only ANCC-accredited providerships for continuing nurse education outside the continental United States.

Hess cautioned early on that the implementation of shared governance isn’t easy, noting:
  • Shared governance is a journey, not a destination.
  • The journey can be long and steep.
  • Not every environment is conducive to shared governance.
  • Although not everyone might make the journey, it should be open to all.
  • Is the journey worth the price?

This summer, nurse leaders at NMMC—with approximately 2,100 staff nurses, unit coordinators and nursing assistants—celebrated the 1-year mark of shared governance by unveiling a logo bearing their commitment to the practice.

“It’s a journey, to be sure,” said Fryery. “It’s difficult to conceptualize and plan. You have to see what fits your culture so you can define it for your organization. That was one of the biggest challenges—determining what it is, and then communicating it to our leadership so they would understand what we really wanted to do in nursing here.”

After getting the green light from hospital administrators last May, five councils were put into place representing nurses in practice, education, quality, evidence-based practice and resource management. Since the first official meeting last June, several improvements have been made.

“For example, the practice council recognized a need to enhance IV documentation and reporting, and piloted a project that’s been very successful,” said Fryery. “Also, the evidence-based council addressed a noise issue and has piloted a quiet time project as a result of comments that were returned on patient satisfaction surveys. The project incorporated a Rest Promotes Healing campaign for a designated time of the day and night. This has been embraced by patients, staff and physicians. We felt that nursing could own and correct this problem,” said Fryery.

In Batesville, Ark., White River Medical Center, a 199-bed, 425-nurse regional referral center and the flagship facility of White River Health System (WRHS), is also a year into the practice.

“When we began our Magnet journey, we were encouraged to see how many of the Magnet components were already a part of our corporate culture,” said Michelle Bishop, RN, Magnet coordinator for WRMC. “Being a Magnet organization is not about the title, it’s about being an organization that values excellence and provides patient care using evidence-based best practices that improve the health of our community one patient at a time. Magnet designation represents our mission to provide high quality patient care and our vision as the organization where patients choose to receive care, employees desire to work, physicians choose to practice, and family and visitors feel welcome.”

Dubree said a mixture of facilities—community, not-for-profit, for-profit, academic health centers and others—are using the precepts of shared governance, and hospitals with unions are finding ways to use some aspect of shared governance.

“It’s truly less driven by the type of facility than the readiness of leadership and staff to embark upon a journey of genuine partnership,” she said, “to work together for optimal patient care.”

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