NR 531 Week 5 Shared Governance Proposal Example

Shared Governance Proposal: A Unit Practice Council for a 32-Bed Medical Unit, Designed Around the Arithmetic of Night Shift, Float Assignments and Quorum Before It Is Designed Around Principle

Student Name

College of Nursing, Chamberlain University

NR 531: Nursing Leadership in Healthcare Organizations

Instructor Name

Month Day, Year

Shared Governance Proposal: A Unit Practice Council for a 32-Bed Medical Unit, Designed Around the Arithmetic of Night Shift, Float Assignments and Quorum Before It Is Designed Around Principle

Why a Unit Council

The 32-bed medical unit I manage has 96 staff and no formal way for them to decide anything about their own practice. Unit decisions come from me, from the hospital's Nursing Practice Council, which has one seat for our whole division, or from habit. The hospital's governance review this term showed that even the Nursing Practice Council mostly recommends rather than decides. This proposal creates a unit practice council with a defined, limited authority to decide unit practice, and with the channels to forward what it cannot decide.

Research across hundreds of hospitals found that nurses reporting greater engagement in shared governance were less likely to report poor job outcomes and poor quality ratings (Kutney-Lee et al., 2016). A study of staff-led evidence-based practice councils in six community hospitals found that members described empowerment, leadership growth and a sense of meaning, provided that managers and executives were prepared to support the councils (Brody et al., 2012). The support condition is the part of that finding this proposal takes most seriously.

Purpose

The council decides how unit staff carry out hospital policy on this unit, and brings unit practice problems to the bodies that can solve them.

Membership

Seats. Nine voting members: three day registered nurses, three night registered nurses, one day patient care technician, one night patient care technician and one unit clerk. The nurse manager and the unit educator attend without a vote.

Nomination and terms. Staff nominate peers or themselves; the manager does not appoint. Terms run two years, staggered so that four or five seats change each year. No member serves more than two consecutive terms.

Chair. A staff nurse chair elected by the members, with the nurse manager as co-chair for agenda setting only. The staff chair runs meetings and signs decisions.

The Arithmetic

Most unit councils I have seen fail on attendance, not purpose. Before writing meeting rules, I checked them against our real schedules. Half of our registered nurses work nights. About one nurse in four floats to other units at least twice a month. The last attempt at a unit council, three years ago, met at 1400, which meant night members would have had to return six hours after leaving work. Records show it reached its quorum of seven at two of its first nine meetings and then stopped.

Using the last six months of schedules, I tested three designs. Meeting at 1400 monthly, the proposed membership would have reached a quorum of five with at least two night members at one meeting in six. Meeting at 0730, at the end of the night shift, it would have reached quorum at four of six, but day technicians and the clerk would often have been on the floor. Alternating 0730 and 1530 meetings, each held in the unit conference room with a video link, and scheduling members off the floor for that hour, reached quorum at all six. The proposal uses the alternating design, and the same test will be rerun each spring against that year's schedules.

Meeting Rules

Frequency. Monthly, alternating 0730 and 1530, for one hour.

Quorum. Five voting members, including at least two from night shift. Without night representation, the council cannot decide anything that affects nights, which is almost everything.

Voting between meetings. Items within the council's authority may be decided by secure email vote over five days, with the same quorum.

Record. The unit clerk member keeps minutes using the verbs "decided," "forwarded" and "deferred," with a reason for every deferral. A copy of the minutes goes up on the staff board next to the time clock and reaches the director within a week.

What the Council May Decide

The council may decide, without further approval, any unit workflow that stays within hospital policy: the order of tasks at shift change, how assignments are displayed, which unit education topics are offered, how unit supplies are arranged, how the unit recognizes staff and unit spending up to $500 from the unit education fund.

The council must forward, with a recommendation, anything that changes a hospital policy, affects another department, creates an order or protocol, needs money beyond $500 or changes staffing levels. Forwarded items go to the Nursing Practice Council through the division's seat, which a unit council member will hold.

Release Time

A nurse cannot attend a council from the floor. Each member will be scheduled off the floor for two paid hours a month, one for the meeting and one for council work, shown on the staffing grid as council time and covered by the resource nurse or a float. The cost is about $10,400 a year: nine members, two hours a month, twelve months, at an average loaded rate of $48. I will request it from the division's education and development budget. Without release time, the council would rely on unpaid time and would lose its night members first. The cost should be read against the alternative. The unit currently spends staff time on decisions that are made twice: once informally among staff, and again when a manager's instruction contradicts what staff agreed. A council that settles unit practice once, in a room where both shifts are present, should save some of that time, although I have not tried to count it.

Support and Review

Porter-O'Grady (2019) argues that shared governance lasts only when decision authority is real and clearly located. I will therefore commit to not overturning any decision within the council's scope; if I disagree, I will say so at a meeting and the council will decide again. The council's first item will be the unit workflow for the hospital's new automatic dietitian consult, which falls within its scope because the protocol itself is approved elsewhere. After one year, the council will report how many decisions it made, forwarded and deferred, and the membership will vote on whether to keep, change or end the design. I will also ask members, anonymously, whether they believe the council's decisions are respected. Brody et al. (2012) found that councils flourished where leaders were prepared to support them, and that question is the most direct test of whether I have been.

References

Brody, A. A., Barnes, K., Ruble, C., & Sakowski, J. (2012). Evidence-based practice councils: Potential path to staff nurse empowerment and leadership growth. Journal of Nursing Administration, 42(1), 28-33. https://doi.org/10.1097/NNA.0b013e31823c17f5

Kutney-Lee, A., Germack, H., Hatfield, L., Kelly, S., Maguire, P., Dierkes, A., Del Guidice, M., & Aiken, L. H. (2016). Nurse engagement in shared governance and patient and nurse outcomes. Journal of Nursing Administration, 46(11), 605-612. https://doi.org/10.1097/NNA.0000000000000412

Porter-O'Grady, T. (2019). Principles for sustaining shared/professional governance in nursing. Nursing Management, 50(1), 36-41. https://doi.org/10.1097/01.NUMA.0000550448.17375.28