TUPELO—Robert Hess, PhD, an expert in nursing shared governance, said defining the practice was akin to “pinning Jell-O to a wall.”

 

Beyond the description—an innovative organizational model that gives staff nurses control over their practice and may extend their influence into administrative areas previously controlled only by managers—it’s difficult to ascertain. But the reason for its emergence is clear: the nursing shortage has revitalized the shared governance structure, which has been around since the early 1980s.

 

This month, nurse leaders at North Mississippi Medical Center in Tupelo (NMMC), America’s largest rural nonprofit hospital, will celebrate the 1-year mark of shared governance. NMMC has approximately 2,100 staff nurses, unit coordinators and nursing assistants. Of those, 1,200 are staff nurses.

 

“It’s a journey, to be sure,” said Shannon Fryery, director of nursing leadership for NMMC. “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.”

 

Laura Brower, who was the CNE for NMMC until she relocated last December, had envisioned incorporating nursing shared governance because of its many positive outcomes and also as a step toward the prestigious American Nurses Credentialing Center-Magnet® designation. Donna Lewis, who took over as CNE upon Brower’s departure, also supports the model.

 

“Having shared governance structure is key to engaging nursing staff, explained Fryery. “It really raises the bar on nursing-owned and –driven issues … focuses on professionalism … and is a great tool for developing nurse leaders. It’s important to note the councils do not make decisions regarding administrative issues such as salary and pay scale. ”

 

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.

 

The education council deals with training issues and ensures that staff feedback is obtained related to annual reviews and other required training. This team surveyed staff and nurse managers to see how the current system could be improved and better meet staff needs, as well as nurse managers’ desire to bring more training to the bedside. This council also led the charge for changes in the current clinical ladder program and will launch more flexible guidelines, which will encourage more staff to participate in the newly branded ADVANCE program, which ensures professional growth and retention of nurses at the bedside.

 

Nurses were glad to have council representation, said Fryery, when the hospital’s professional guideline committee, which reviews dress code, 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?

 

“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 Fryery. “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.”

 

The experience netted two positive outcomes, said Fryery.

 

“We maintained nurse satisfaction by allowing nurses to wear scrub colors defined for their unit because we did not get good feedback from them on wearing all white,” she explained. “More importantly in the process, we discovered a safety concern. The badges had the nurses’ first and last names. After interviewing the staff, we recommended a change to identifying them on their badges by first name only. Also, when we interviewed patients, we learned it was more important for them to clearly see the name and title than the department, so we also suggested putting the name and title in larger font, and the department in smaller font. We’re now in the phase of working out that changeover as new badges are issued.”

 

Another example: Nursing shared governance also trains staff to look at things from other perspectives, Fryery pointed out.

 

“Now nurses better understand … how what impacts one unit impacts others, especially with the shared documentation system,” she said. “It’s really opened up the eyes of the nursing leaders, who’ve asked why haven’t we always done this? Also, by involving staff, it eliminates the cycle of re-education because the system is perfected on the front end. By having a chance to use the staff as a sounding board, you get it right the first time. You will always get your best product if you truly involve those who will be the end user.”

 

Hospital administrators have been very supportive of the practice, said Fryery.

 

“Of course, at first, anything new makes some people nervous especially when it involves decision making,” she said. “I make sure to take issues to the councils that are important and appropriate.”

 

The councils have been challenged, Fryery admitted, on better communicating to staff nurses how their participation has led to process-improving changes. Beginning in June, all projects originating from or progressing through the shared governance councils will bear the shared governance logo. This branding will allow staff to truly see the impact of our councils.