Shared Governance and Nursing Accountability Term Paper

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Shared Governance to Improve Jacobi Hospital's Quality

Shared governance is used and exhibited in my organization by promoting shared decision-making and accountability to the nursing staff. The positive outcomes of shared governance include increased nurse satisfaction, retention, and motivation. Exhibiting shared governance expects nurses to act with ethical confidence by taking control of their practice at the point of care, improving quality patient care, promoting survey response and increasing HCAHPS scores as a result. The nurses have access to the resources required to generate change, and influence outcomes. Shared governance concepts must be incorporated in this organization in order to improve patient satisfaction and HCAHPS scores, it is important to set up monthly meetings between personnel in charge of patient care. Nurses and nursing assistants must be told to adhere to standards of care for each patient by coordinating and written assignments of patients per nurse with a nursing assistant to aid in the various duties like bathing and glucose monitoring. Having monthly meetings for personnel will allow smoother communication and delivery of effective standards of care that will improve the hospitals scores. A move needs to be made by inviting staff to participate, expecting them to perform, as far as shared governance is concerned. All those involved must be expected to take up responsibility, be accountable and exercise the authority expected of their roles. That is, there needs to be an alignment between the model in use, which is the Collaborative Practice Model and shared governance. Secondly, the decision matrix must be affirmed so that it is clear how decisions are made, given the fact that consensus may not always work. Another clarification of the hospital's quality improvement is that of the coordinating Council's role, which should ensure that the hospital's goals are aligned with those of shared governance. Also, the medical staff partnerships should be aligned so that everyone understands the role of shared governance, and the whole team gets to work it. In accordance with this model, the management needs to be engaged, so that any small groups tasked with decisions on things like performance, practice and education can be done away with, so that everything falls within the governing council's structure. For the sake of ensuring that decisions are made in good time, the chairman of the council needs to be authorized to make decisions in line with the council's goals, on their behalf, when it is impractical to call up the entire council. Nurses should be provided with opportunities for clinical advancement, and through this, make room for involvement in the council. Advance practice nurses, most importantly, should be involved.

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Many Advanced Practice Nurses take up major responsibilities at the Jacobi hospital, including the 24-hour watch of patient care units (Caramanica, 2004).

Shared governance is a key component of improving organizational quality. While evidence-based practice can be used to improve any one procedure or task, improving overall quality is usually a matter of building an organization that is more capable of improving quality. There are a few implications for this. One is that the organization's structure and culture need to be more oriented towards quality improvement. This is where shared governance comes into play. Under the shared governance model, responsibility is shared, but ultimately everybody in the organization is responsible for quality. Departments that work together hold each other accountable, especially when quality objectives are missed. A shared governance model creates the mechanisms for communication between units that not only allows them to work together to provide better service levels, but also allows them to be more accountable, something that is also associated with higher quality levels. Nurses with autonomy over their practices give superior patient care. Empower a nursing committee to make decisions about safe patient care. Policies implemented by nurses are more effective. Nurses will be more engaged in improving patient satisfaction when they develop ideas themselves. Exhibiting shared governance expects nurses to act with ethical confidence by taking control of their practice at the point of care, improving quality patient care, promoting survey response and increasing HCAHPS scores as a result. The nurses have access to the resources required to generate change, and influence outcomes.

It is worth noting that responsibility -- which is turned into a collaborative organizational process under the shared governance model -- always brings with it the issue of accountability. In other words, it would be possible to misinterpret the concept of shared governance grievously, turning it into a bureaucratic collaboration in "passing the buck," or using the collaborative notion of responsibility into a way for individuals to believe they can escape accountability. For this reason, it is evident that a shared governance model would require specific methods for incorporating accountability to the patients, medical providers, payers and personnel. But there is an easy and simple way to do this, and it requires understanding one of the chief advantages of a shared governance model. In some very important sense, shared governance is a method for gathering and producing positive productivity data -- we can see this most readily in the incorporation of evidence-based practice, where essentially what is being generated and evaluated by staff is data, both consumed (in the form of new research and models….....

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