As the co-chair of our Professional Practice Council at my hospital, I have the privilege of working alongside a group of people who are highly engaged and motivated to be part change in our hospitals. Our shared governance program includes participation in unit-based council, our hospital-wide council, and coordinating councils. Upon recent reflection, the shared governance leadership team has identified that there are some councils that can’t get through all the QI projects on their plates and some that are unable identify any QI projects to work on. There are some that have a robust membership and some that can’t seem to get more than 2 people to show up to. We know there are problems and that they are probably different for each council, so how do we help identify the problem and resolve it so that councils are all functioning optimally?
I was excited to find this research article that aimed to create a quantitative tool that could reliably identify the health of a council or committee. The utilized a group of experts to create a first draft of the Council Health Survey (CHS) and started a small pilot to get feedback. They took the feedback and sent it out to more hospitals to test-retest to determine reliability. With that feedback the revised it yet again and sent it out to 22 hospitals across the county. With the feedback they were able to get the CHS narrowed down to 25 questions that were able to help council leadership have quantitative data to assess and, if necessary, create action plans to improve the health of their council. The tool was well received and proved to be a positive addition to the leadership toolbox.
This idea of assessing the health of the council seems as though it could be implemented in other types of governing structures. Speaking from my own experience, it can be very frustrating for staff when there is an unhealthy governing body in the workplace. This can lead to staff burnout due to miscommunication or lack of communication. Problems are left unsolved and new unnecessary problems are created due to poor management. This tool seems like it would have a positive impact in many aspects of nursing.
Shared governance can be a wonderful addition to an organization, but an unhealthy council can definitely create more issues than they solve. It’s important that councils are set up for success rather than failure, by properly educating council leadership and providing facilitator if needed. Unhealthy councils also have a hard time with participation. If people feel like attending a meeting is a waste of time, they will not attend. I’m hopeful that this tool will help our councils to remain productive and healthy so they can do great work!
Meetings are difficult at times to attend when the subject matter is not really helping to move the work place forward. Meetings can be very productive, however, because they allow minds to meet and share ideas. This structure where there is a free flow of ideas on how to improve the workforce is a great structure to improve the work place for all employees and patients a like.
The technique explained seems to be of quality in your scenario or case. The concept itself is profound and can be made more versatile to various kinds of governing styles. Increasing personal and professional development and the quality of care with this technique in works of communication is further establishing better collaborative efforts in management (Bednarski, 2009). Staff involvement is necessary to set the example for discussion and also prompt the development and structure of the organization’s model for governance. Concluding an outcome resulting in better patient care structuring, increased staff morale, and managing workloads of healthcare workers.
Bednarski, D. (2009). Shared governance: Enhancing nursing practice. Nephrology Nursing Journal, 36(6), 585. Retrieved from https://search-proquest-com.ezproxy.fhsu.edu/docview/216528709?accountid=27424
I’ve seen first hand the impact an effective council can have on the morale of a unit. It’s a powerful force! Having an effective shared governance structure can have a huge impact on turnover/retention rates. Nurses love to make a difference, and that’s the whole objective of shared governance!
When it comes to council health in nursing it can be a very interesting organization/ shared governance with a lot of options. A lot of times that I’ve seen throughout my nursing career is these organizations have a lot control of the outcome of the survey because it can be constructed in a way to lead it towards what they want it to. A statistically significant difference can found in skills based on years of experience and in the application of the competencies based on nursing specialty preparation along with variations in knowledge can alter the outcome of the survey and its purpose (PHN 35. (2018).
Joyce, B. L., Harmon, M., Johnson, R., Hicks, V., Brown-Schott, N., Pilling, L., & Brownrigg, V. (2018). Community/public health nursing faculty’s knowledge, skills and attitudes of the Quad Council Competencies for Public Health Nurses. Public health nursing (Boston, Mass.), 35(5), 427–439. https://doi.org/10.1111/phn.12409
I’m encouraged by this particular survey because it’s administered by the council leadership and not a third party. It’s a tool to identify areas of strength and opportunity and putting actual statistical pieces of data behind them. This makes goals and action planning within the council measurable. I’m really excited about introducing it to our shared governance.
It is very important that the nursing practice council be set up for success. I feel that the nursing governance committee in my unit tries to get things changed, but we meet so many roadblocks. Melissa, one of the things you mentioned in your fishbone diagram was cancelled meetings due to staffing. This is a big one that I can relate to.
It is hard to find a time where everybody on the council can show up to the meeting. If we plan during the day, then nightshift members can’t show up if it falls the day after they work a shift. Management likes the meetings to be during their working hours so they can be present. However, we don’t have the staffing necessary so all of the nurse staff members can leave the unit at the same time.
Recently, there was an incident when a committee member left her patients with the charge nurse so she could attend the meeting. The charge nurse then left that nurse’s patients to go to a code blue in another ICU leaving the 2 nurses left in that pod to collectively watch 6 ICU patients, several of which were very unstable. One of the patients the charge nurse left was on a suicide watch, which led to a complaint filed by a family member when she arrived and no nurse was present in the room watching her husband. Luckily the patient was okay. Basically, the whole unit was in disarray with very unstable patients while several nurses went to a meeting. My whole point here is that there needs to be meeting times and possibly extra staffing designated so nurses can attend council meetings.
I found an article in a nursing management journal that discusses some of the problems related to nursing practice councils and the difficulties that could be faced. One of the suggestions for success that was mentioned was that council members should be provided with a protected time to meet. This could mean a staffing plan could be in place to staff up on days there are meetings, so nurses can safely leave the unit without affecting patient care. Another suggestion was to allow nurses to join the meeting via phone or videoconference from home (Medeiros, 2018). This would be a good idea for the nightshift members.
Medeiros, M. (2018). Shared governance councils: 10 essential actions for nurse leaders. Nursing Management , 49(7), 12–13. doi: 10.1097/01.numa.0000538920.83653.9b
Ugh…what a difficult situation! I’m so sorry that your unit had to deal with that. It could have ended with so much more than a complaint.
We have been cancelled several times in the past year for productivity and budget reasons. When it’s for the best interest of patient safety, it makes sense. When it’s because they don’t want to pay 30 nurses to attend an 8 hour meeting, that’s a little harder to swallow. It’s a bummer because it stalls the progress of the council when they have to go a month or two without meeting and it sends the message that the work that we are doing is not important.
In response to this barrier, part of our restructure is to decrease the time of our meetings so that budget doesn’t take as big of a hit when we meet. We also only meet 10 months per year, taking time off in July and December. July because of vacations (staffing) and December because it’s the end of the fiscal year (budget).
I really like the suggestions you found in your article. I am saving it to read later 🙂 Our division is working on creating a “bucket” for shared governance, so that sending people to meetings does not hit their productivity. It’s really exciting for me to think of having a dedicated budget for shared governance! I hope that this helps keep our meetings from being cancelled.