Impact of Shared Governance on Pediatric Hematology/Oncology Nurse Satisfaction

Kimberly Johns, MSN, RN, PCNS-BC, CPON Iris Mamier, PhD, RN

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.

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.

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

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?

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).

PDCA-Deming Circle

http://info.craftechind.com/blog/bid/251365/Improving-Quality-Control-with-the-Deming-Cycle

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

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

Participant Demographics Members of Shared Governance Council

»7 participants

»Years of Experience ~ Range from 1-8 years ~ Average of 4.6 years

Not Members of Shared Governance Council

»11 participants

»Years of Experience ~ Range from 1-28 years ~ Average of 9.3 years

Participant Demographics

Age Range Members of Shared Governance

Not Members of Shared Governance

20-30 years 57% 60%

30-40 years 29% 10%

40-50 years 14% 20%

50-60 years 0% 10%

-No participants had prior experience with Shared Governance

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”

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”

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”

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 (emails, 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

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

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/emails

Strengths and Limitations

Strengths

»Consistent demographics

»Honest feedback

»Engaged participants

Limitations

»Timeframe

»Participation

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

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