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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
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