New School for Nursing Governance

Shared Decision Making

What is this all about?

1. “Magnet” Gap Analysis2. Ways to attract and keep nurses

Action Step--Task Force Formed

Nursing Staff Conception of Work Environment at

SLH/MCJ

National Quality Forum (NQF) Survey

Mayo Clinic voluntarily

participates in this survey—

results passed on to JCAHOWhat are the responses to

the current survey?

Survey Highlights

NURSE PARTICIPATION IN HOSPITAL AFFAIRS

Nurses have opportunity to serve on hospital/nursing committees 89%

Career development/clinical ladder opportunity 78%

Staff nurses involved in governance of the hospital 68% Opportunities for advancement 62%

Administration listens/responds to employee concerns 56%Opportunity to participate in policy decisions 53% Nursing administrators consult w/staff on daily issues 51%Chief nursing officer is visible and accessible 48%

RN Turnover Considerations

RN TURNOVER, 2006

(projection based on statistics from 1/1-10/2/06)

SLH: 124/800 = 15.5%

MCJ: 23/200 = 11.3%

TOTAL: 147/1000 = 14.7%

RN Turnover Considerations

COSTS OF NURSE TURNOVER

Financial (from JONA article):$60,000 per staff RN

Other (impact of untrained or no staff on patients, staff, & management):

much of this is UNKNOWN

RN Turnover Considerations

FINANCIAL IMPACT OF REDUCTION IN NURSE TURNOVER

A reduction of nurse turnover for SLH of THREE PERCENT (to about three-fourths of the present rate) brings the yearly rate down from 15.5% to 12.5%.

This would result in the need to fill 24 fewer FTEs per

year, and could provide a projected savings (based on the research) of over $1.4 million per year.

RN Turnover Considerations

ADDITIONAL IMPACT OF REDUCTION IN NURSE TURNOVER

-Less stress on RN staff

-Less stress on nurse managers

-Improved continuity of care

-Better patient outcomes

Being Proactive

POSSIBLE RESPONSES:

Do Nothing and hope for the bestWait until the dust settles, then actChange the way we govern ourselves

WHAT IS SHARED DECISION MAKING?

Participatory Management

Examples

Post-WWII Japanese corporations (Sony, Honda) Information management companies

Style and characteristics

Constantly preoccupied with improving outcomes Employees on all levels allowed & encouraged to participate

in organizational problem solving and decision making This model developed to best respond both to:

rapid technological change the needs of today’s workers

Management Paradigms

“Theory X”

Workers are uninformed, lazy, and untrustworthy

Managers must control workers and motivate them through a combination of control systems, fear of discipline or dismissal, and organizational rules

Management Paradigms

“Theory Y”

Workers are highly motivated and can be trusted to contribute to the organization’s objectives if given the opportunity to participate in organizational decision making

Managers consult with and involve employees at all levels of the organization in organizational problem solving and decision making

Contrasting Environments

Traditional

Follow directions Abide by present rules Follow chain of command Do the job – NO complaints NO mistakes tolerated

Contrasting Environments

Shared Decision Making Ask questions, make suggestions Active problem solving Effective communication

at all levels Members responsible for

environment and quality of products/service

Contrasting Environments

Traditional

Run a tight ship Keep the boss happy Punish mistakes Deny errors The boss is always right Don’t rock the boat

Mushroom Management!

Contrasting Environments

Shared Decision Making

Talk to those doing the work Give up control Embrace errors Encourage questioning

Contrasting Environments

Shared Decision Making

Invite challenges: WHY? Show the way by being an example

for others to follow Eliminate barriers to innovation Encourage Staff :

“Find out for yourself”

What Happens When Shared Decision Making Is Present?

Management moves from directing and controlling to coaching, questioning and facilitating

Mutual shouldering of responsibility

Interactive structure Hidden talents appear

What Happens When Shared Decision Making Is Present?

Communication is multi- directional

Problems are identifiedand resolved

Quality of work represents the staff’s own efforts

Feeling of community Frustration & disappointment

replaced by challenge, excitement and progress

VISION:

Grow a truly professional nursing community at SLH/MCJ through a shared decision making philosophy and framework.

The care & feeding of this community will provide many benefits for both the staff and the facility.

MISSION:

Foster innovation, accountability and autonomy within the professional nursing community at SLH/MCJ

Utilize an Advisory Council to promote and support the shared

decision making process

Who Benefits From Shared Decision Making?

The Professional Nurse

The Patient

The Organization

The Professional Nurse

Encourages professional nursing practice

Enhances communication, collaboration and problem-solving

Promotes patient care that is

creative, evidence-based, efficient and driven by those who deliver it

Encourages and rewards professional growth

The Professional Nurse

The Bottom Line:

Increased job satisfaction, leading to higher nurse retention and lower staff stress

The Professional Nurse

The Patient

Improved outcomes Increased patient satisfaction

The Organization

Improved cost-effectiveness of service

Reduced recruitment and orientation costs

Creation of a more dynamic, energetic, and innovative environment

The Decision Making Continuum

Decisions made by individuals

Command ConsultativConsultativee

CConsensus

Low

High

Shared Shared Decision Decision MakingMaking

Accep

tanc e

Time

Decision Making ModelsDecision Making Models

Implementation

Orientation Education Communication Involvement Support for attendance

at Nursing Council

THE NEXT STEP…

QUESTIONS & COMMENTS

References

Anthony, M.K. (2004). Shared Governance Models: The Theory, Practice, and Evidence. Online Journal of Issues in Nursing, 9(1). Retrieved from http://nursingworld.org on Sept. 28, 2006.

Caramanica, L. (2004). Shared Governance: Hartford Hospital’s Experience. Online Journal of Issues in Nursing, 9(1). Retrieved from http://nursingworld.org on Sept. 28, 2006.

Herrin, D.M. (2004). Shared Governance: A Nurse Executive Response. Online Journal of Issues in Nursing, 9(1). Retrieved from http://nursingworld.org on Sept. 28, 2006.

Jones, C. (2005). The Cost of Nurse Turnover, Part 2. Journal of Nursing Administration, 35(1).

Porter-O’Grady, T. (2004). Overview and Summary: Shared Governance: Is It a Model for Nurses to Gain Control Over Their Practice? Online Journal of Issues in Nursing, 9(1). Retrieved from http://nursingworld.org on Sept. 17, 2006.

Porter-O’Grady, T., & Hitchings, K.S. (2006). Elements of Successful Shared Governance: How to Create a Pathway to Professional Nursing. Audioconference Sept. 20, 2006; hcPro: Marblehead, MA.

Bland-Jones, Cheryl. The Costs of Nurse Turnover, Part 2. JONA, 35(1).

References