Ask the nursing experts!

Nurse Leader Insider, April 13, 2017

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Q: What are the basic requirements of shared governance systems?

A: There are four elements that are essential to the successful implementation of shared governance in the earliest stages of process development:

  1. A committed nurse executive must be invested in process empowerment and willing to undertake the efforts and energy necessary to implement shared governance.
  2. A strong management team in terms of commitment to one another, to nursing, to the organization, and to building the structure and implementing the process.
  3. The process cannot be implemented if employees do not have a basic understanding of shared governance and can build on that understanding with a working knowledge of what is to be accomplished. There must be a clear destination.
  4. The plan and timeline for implementation are critical for benchmarking and charting progress points.

 Guidelines for forming the governance bodies:

  • A decision-making group is empowered to make decisions that form a baseline for thinking organizationally when implementing shared governance.
  • Create an appropriate size group (seven to 10 participants and generally no more than 14 to 15) to facilitate effective group decision-making. It generally requires about seven people to represent the organization or service line (e.g., nursing) equitably. The presence of more than 15 participants reduces the group’s ability to reach decisions or consensus and move the agenda and work forward.
  • Decisional groups must be accountability-based.
  • Within the organization, all groups, committees, and task forces relate to governance bodies or councils.
  • Communication within and across all groups, committees, task forces/teams, and governing councils is critical to the success of implementation and ongoing operations of shared governance management process model.

- Diana Swihart, PhD, Dmin, MSN, CS, APRN, BC

Q: How can I prepare the nurses on my unit for changes in our organization?

A: Change efforts that fail are usually not because of unneeded changes or poorly thought out changes, but because of a lack of due diligence during preliminary planning. If your team members are low on the change-readiness continuum, there will be a longer lead time to prepare them. Some activities that will need to be completed prior to implementation to help improve readiness are:

  • Establish a group to lead the change on your unit. Kotter (1996) calls this the "guiding coalition." This group will lead the change on your unit. The group may be just a few people, depending on the magnitude of the project, but it should include staff with credibility, leadership skills, and informal influence abilities.
  • Create a communication plan. The more ingrained the practice and the more emotionally bound to the practice, the bigger the need for abundant communication. This should come from you, the manager, as well as the guiding team. Identify "what's in it for me" (WIIFM.) Let them know how this will help them and communicate this frequently. They need to know how this will, in the end, make their lives better. Your communication plan should include who you will communicate to, the vehicle (meeting, personal, e-mail, poster, etc.), timing (dates), and the responsible party (who is in charge of the communication).
  • Address resistance. Not everyone will overtly express resistance. Watch body language. Keep your ears open. Invite them to talk to you about it. Talk with them privately if needed since some may not want to verbalize their fears or concerns in front of others. Listen to feelings behind the content. Coach your guiding team on how to listen to concerns and get input. Your staff may have some great ideas on how to make the change easier or more effective.
  • Get their input into how the change will transpire. The more input you get into any change, the more buy-in you are likely to have.
  • Create and communicate the vision (Kotter, 1996). Paint the picture of what the future will look like. Make it appealing to your staff. The change team should create the vision and be ready to articulate it.
  • Provide skills training and the time and opportunity to practice. This is a crucial step if the change requires new skills. Be sure the training is thorough and practice time is adequate.

- Patty Kubus, RN, MBA, PhD

For more answers like this, check out the Ask the Expert section in Strategies for Nurse Managers. Have a question for our HCPro authors? You can send them here.

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