Shared Decisions are the Best Decisions: Nurses Leading. Interprofessional Shared Governance

Transcription

1 Shared Decisions are the Best Decisions: Nurses Leading Interprofessional Shared Governance Susan R. Allen, PhD, RN-BC AAMN General Session September 26, 2015

2 Session Objectives Define interprofessional shared governance and its importance in a health care environment that requires collaboration and shared decision making for optimal outcomes. Describe how interprofessional shared governance structures promote nursing leadership. Examine the ways in which the development of clinical nurses as leaders in shared governance may assist in meeting the current and future nursing leadership needs in health care.

3 Cincinnati Children s Photo(s)

4 If nurses would stand up and lead, And society would recognize nurses for what they are, we would improve the quality of, and transform health care nurses must live up to being the most trusted profession, they must do more. Linda Burns Bolton, DrPH, RN, FAAN July 2011

5 Introduction Shared governance models have been widely implemented in health care organizations during the past three decades. These models are based on professional values and principles of autonomy, engaged participation and shared decision making by direct-care providers and organizational leaders. Nursing shared governance models were implemented first and remain much more common. Interprofessional shared governance models are needed in the current health care environment.

6 Background: Shared Governance Direct caregivers must have responsibility and authority for decisions related to their practice. (Porter-O Grady, 2009) Shared governance is ownership of the organization s work by those who provide its services, and gives direct caregivers the responsibility for decisions related to their practice. (Beglinger, 2003; Howell, et al, 2001) Shared power with managers through shared governance is a key factor leading to control over practice. (Kramer, et al., 2008)

7 Significance Nurses should be full partners with physicians and other health care professionals in redesigning health care in the U.S. Strong nursing leadership is needed throughout the system, from bedside to boardroom to achieve this vision. Nurses should have a voice and see health policy decision making as something they can shape rather than something that happens to them. Nurses need to develop leadership competencies. (Institute of Medicine, 2010)

8 Summary Nurses can fill the leadership gap in health care by developing nurse leaders. Our greatest source of leadership lies within the nurses providing patient care. We must develop direct-care nurses as leaders to best achieve our potential as leaders in the health care environment. Participation in shared governance develops leadership skills in direct-care nurses

9 Video

10 Cincinnati Children s Shared Governance History : Exploration of governance models and design of Cincinnati Children s nursing structure 1989: Implementation of Nursing Shared Governance : Formation of Department of Patient Services 1999: Implementation of Intradisciplinary Shared Governance Structure : Nursing and allied health representatives work together to enhance shared governance 2008: Implementation of interprofessional shared governance structure

11 Why Interprofessional Shared Governance?

12 Reflections How do you practice currently? In professional silos? In interprofessional teams? How do you make decisions about patient care currently? How do you make decisions about practice currently? Nursing practice? Interprofessional practice?

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14 Cincinnati Children s Interprofessional Practice Model

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16 Patient Care Governance Council (PCGC) PCGC Purpose: To make decisions that affect the patient/ care-provider relationship, encompassing professional practice, education and inquiry that span across professions and are system-wide in scope. PCGC Accountabilities: Foster a community of shared governance Connect point of care clinicians Represent professions when addressing system-wide topics Facilitate information sharing regarding interprofessional Oversight of the IPM and Interprofessional SG charter Contribute to Cincinnati Children s strategic plans

17 Other Interprofessional Councils & Committees Interprofessional Management Council (IMC) Interdisciplinary Clinical Informatics Committee (ICIC) Clinical Advancement Committee Magnet Committee Clinical Content Committee Pharmacy & Therapeutics Committee Nutrition Support Committee Equipment & Standards Committee Environment of Care Committee

18 The Concern: Nursing s voice may be diluted in an interprofessional shared governance structure.

19 When a large group of people get together and give voice, we can make a difference in our governance. Martin Luther King, Jr. August 28, 1963

20 Shared Governance Quantitative Research at Cincinnati Children s Baseline data on the nursing and allied health perceptions of shared decision making were collected prior to launching the interprofessional SG structure using Hess s Index of Professional Governance (IPG) survey tool IPG survey was repeated in 2010, two years after the interprofessional shared governance was launched

21 Comparison of 2007 & 2010 Findings Index of Professional Governance Overall Scores* for Nursing and Allied Health Professionals by Survey Year AlliedHealth 182 RNs Mean=179.4 SD=51 N= Mean=170.5 SD=55 N=471 Mean=177.8 SD=55 N= Mean=169.4 SD=51 N= Allen, 2015 *=Significance at α =.05

22 Difference in IPG Scale Scores By Year and Disciplines * * Allen, 2015

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24 Qualitative Research Study Questions What are the values, beliefs and experiences of clinical nurse council leaders in a health care organizational culture with shared governance? What are the experiences and the meanings of caring practices to clinical nurse council leaders in shared governance? How is shared leadership and shared decision making experienced by clinical nurse council leaders in shared governance? What are the barriers to being a nursing leader, shared leadership and shared decision making?

25 Study Participants Fourteen Key Participants: Chair and chair-elects of the nursing shared governance councils Thirty-one General Participants: Advanced practice nurses, educators, facilitators and managers on the nursing shared governance councils

26 Data Collection and Analysis Individual and focus group interviews using an inquiry guide Interview sessions were audio-taped and transcribed verbatim and systematically analyzed Immersion with the shared leadership, shared decision making and care experiences by attending shared governance council meetings; field notes were generated during the meetings Data were coded and analyzed using N-Vivo 9 to identify patterns and themes

27 Study Findings: Leadership Development Finding Voice and Discovering the Leader Within It (council leadership) stimulated me to think and be and grow as a person. It allowed me to say, If I can do this as a little staff nurse and I can do it. I did do it! I lived through it and I learned from it. Words of a Council Chair Allen, 2015

28 Study Findings: Leadership Development Using Own Voice and Giving Voice to Others I feel like it s my job at times to push other people, you know, into those roles; that I see great leadership potential in them and they are newer and they are scared. Just give them one little shove and then tell them that you will be right there to help them. I feel like that has then helped other people gain some confidence. Words of a Council Chair-Elect Allen, 2015

29 Study Findings : Leadership Development Discovering the Big Picture and Accountability for Practice I think if you know how the big picture works, at least for me if I can understand why I need to do it that way, I m going to do it better when I do learn (a change in practice) because I do understand why it needs to be done that way. It s buying into that whole package, you know I think (you are) more accepting of any change if you understand the why of it, and so this has allowed me to learn the why of it. Words of a Council Chair Allen, 2015

30 Study Findings : Leadership Development Clinical Nurse Participation in a Hierarchy There are rules that are considered in a hierarchy kind of structure. And so I think then it s hard to feel like as you re sitting in the council structure that you really have an equal voice to somebody that sits in a manager position or a vice president position, or you know, that you feel like, Um, I m a nurse, you know, instead of I am a nurse that works at this institution and I have just as much right to make, you know, an informed decision as anybody else does just trying to get that out of your head and looking at it as we re all equal partners on this council and we all have different points of view and different voices but ultimately we re all coming forward with our feedback and our votes for things and you know, we all are equal. Words of a Council Chair-Elect Allen, 2015

31 Study Findings : Leadership Development Choosing to Bring About Change in the Organizational Culture It is being able to say, You know what? This is my practice and you can t tell me what to do. I mean, you can ask for my input but I have control over this. We can work together to solve the problem, but we have to work together. You can t just do it. It was feeling that, and then it was changing, and how different if felt after you knew you influenced it and made a difference... Once someone feels the way we felt after, it will continue to grow. Allen, 2015 Words of a Council Chair

32 Study Findings: Interprofessional Leadership Making a Positive Difference Through Shared Decision Making There s sharing of ideas and points of view and the reasoning behind them and then there s discussion on how to intertwine those points of view and reasoning, so that things that can t be given up or changed for whatever reason aren t. The decision has developed from all these points of view, so it s like a spider-making web... and that s what it is. It s just everything coming from every direction but it all turns out to just be beautiful, and that works. Allen, 2015 Words of a Council Chair-Elect

33 Study Findings: Interprofessional Leadership Achieving Consensus in Shared Decision Making It s when all the right people are at the table from bedside nurses to pharmacists to physicians to educators. It s everybody coming together for the mutual purpose of seeing if this idea is feasible and beneficial and productive the understanding that it is the team that makes the difference. That s what shared leadership is, it s the engagement of everybody. Words of a Council Chair Allen, 2015

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35 Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has. Margaret Mead

36 Thank you very much! Thoughts or Questions?