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Shared Governance: Decision Making at the Local Level

Who doesn't like to be heard? It's an all too human feeling to not only want to speak out for others but also feel understood yourself. And in a healthcare organization with multiple departments, locations, managers, nurses, support staff not to mention varying shifts and responsibilities, it can be a challenge to bring all voices to the table. It is this unique challenge that Memorial Hospital of Converse County is seeking to meet, and not only meet but solve. We spoke with Chief Nursing Officer, Cristy Cobb, about the Shared Governance Initiative at Memorial Hospital; what it means, how it is proposed to work, and what is the ultimate goal.

The total goal of Shared Governance amongst nurses is to keep decision making local. Local as in that department, team or location within the greater organization, but as well to share that information across all areas of the organization. "Our goal is to be 'The Best healthcare organization in Wyoming,' part of that is that every patient has a great experience every time. But we can't look at it and go, 'Oh, whoops. We should have done this or that,'" said Cobb when discussing the need for information to be shared especially with regard to patient safety and ensuring quality care.

Another area the Shared Governance Committee seeks to help support is communication. Cobb shared the following queries that became part of their goal sets: "How do we support new people coming in that are brand new graduates that haven't been in the workforce that we make sure that we have a process for them in place. So staff indication is that we prepare them adequately, that we're doing checks and balances if they're not feeling comfortable. Are we checking it along the way, not just giving lip service?"

Communication has proven to be key time and again in helping many aspects of not only working relationships but addressing interdepartmental concerns. It isn't restricted to nurses only, but also includes staff from environmental or nutrition services who engage with patients on a routine basis. "As an example of how these teams are supposed to work together, we had a member of our environmental services team address something as simple as how we are filling the linen baskets in the patient rooms. They basically said 'Hey, these are really heavy when they are 100% full, so can we maybe change them out a bit sooner, maybe at 50-60% to help keep injuries down in our team.' This had been asked, but maybe not to the right individual, or at the right time so we wouldn't be aware if didn't get together. Now we have our staff make sure that they aren't overfilling [the baskets] so they can be easier to change out and not as much of a strain." stated Cobb. Addressing concerns together can add up to fostering more and more trust between the different teams and make communication all the easier.

Far from being just a forum to air concerns, the established panels work openly to resolve conflicts, address patient and staff needs proactively, and ultimately cultivate a team outlook so they are better able to keep progressing towards delivering better and better healthcare. All of this works to give a structure for support of resolution and advancement to our stated goals.

This also helps create a "Magnet" environment and also raises the possibility of being designated a "Pathways to Excellence" Hospital. The various areas of the Memorial Hospital organization represented include Inpatient Care, Surgery Services, MOB, ED, Oregon Trail Rural Health Clinic - Glenrock, Radiology, and Laboratory. These are all overseen by a larger central governing council that includes representatives from all of these sub-committees. They meet routinely to help foster an environment of transparency and communication.

Pathways to Excellence is a standard offered by the American Nurses Credentialing Center (ANCC) that seeks to implement several key programs for Nurses in the Healthcare Organizations. A Pathways to Excellence designating only comes after a Hospital or Healthcare Organization has been designated as a Magnet Environment. All of these designations equate to really one goal: making an environment that not only attracts but retains quality health care providers and helps foster their growth so that patients are well cared for in the long-term. "ANCC's Pathway to Excellence Program is a new organizational credential to recognize health care facilities that have created positive work environments where nurses can flourish. Pathway-designated organizations are deemed the best places to work for nurses, with high nurse satisfaction and retention. Research shows that healthy work environments improve not only nurse satisfaction, but also patient satisfaction and quality of care.

An eventual goal of a Pathways to Excellence Designation would conform to the community that our healthcare organization is committed to nurses, recognizes what is important to nursing practice, and values nurses' contributions in the workplace. In order to earn such a distinction, we would need to integrate and fully uphold twelve practice standards into our operating policies and overall structure. Some of these standards are already fully formed into our structure at Memorial Hospital of Converse County, which is a great start. Here are the twelve standards we must integrate into our healthcare environment in order to fully be considered for a Pathways Designation:

  1. Nurses control the practice of nursing.
  2. The work environment is safe and healthy.
  3. Systems are in place to address patient care and practice concerns.
  4. Orientation prepares new nurses.
  5. The CNO is qualified and participates in all levels of the facility.
  6. Professional development is provided and used.
  7. Equitable compensation is provided.
  8. Nurses are recognized for achievements.
  9. A balanced lifestyle is encouraged.
  10. Collaborative relationships are valued and supported.
  11. Nurse managers are competent and accountable.
  12. A quality program and evidence-based practices are used.

The forums for our Nursing Staff help to encourage this future goal for our organization by encouraging our Nursing Staff to control their practice whole also supporting collaborative relationships and overall encourage a healthy work environment that addresses patient care and concern ultimately. It is our hope that going forward these forums provide the very building blocks needed to provide an affirming environment for our Nursing Staff and that they are all impacted in positive ways from their implementation.