Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Professional Nursing Governance in a Large Australian Health Service

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Professional Nursing Governance in a Large Australian Health Service

Article excerpt

Health care services are under increasing pressure to ensure fiscal responsibility and accountability for the care that is provided. An organisation's governance system forms the basis of how this accountability framework is operationalised. Effective governance is vital for quality clinical care across large health service organisations.

Professional nursing governance refers to the role nurse's play in decision-making and accountability for patient care (Newman, 2011). This involves the organisational processes and structures that effect the interplay of control and influence that staffand management encounter (Hess, 2011a). For example, commitment from the interdisciplinary executive health care team impacts on implementing and sustaining nursing's involvement in organisational decision-making processes and governance (Robertson-Malt & Chapman, 2008).

Shared governance exists when health care professionals (e.g., nurses) are able to have greater influence and control over their practice (Hess, 2011b). Shared governance models are characterised by management and staffworking collaboratively in decision-making, at both a unit level and organisational level. Staffempowerment is fundamental to shared governance, including both the state of empowerment itself and the structures that facilitate it (Bogue, Joseph, & Sieloff, 2009).

The perceived importance of shared governance in nursing is reinforced by the Magnet Recognition Program® (Magnet) which acknowledges excellence in nursing care. Hospitals seeking Magnet status are required to demonstrate a system of shared decision-making and participatory management (i.e., shared governance) that encourages feedback from staffat all levels of the organisation (American Nurses Credentialing Center [ANCC], 2011). This staffinvolvement is pivotal to shared governance.

There is no one way to approach shared governance. Various models such as the nursing peer review model (Fujita, Harris, Johnson, Irvine, & Latimer, 2009) and blended evidence-based practice models (Gloeckner & Robinson, 2010; Waddell, 2009) have been proposed. Nonetheless, there is general agreement that shared governance requires cultural commitment and change (Dunbar et al., 2007; Moore & Hutchison, 2007), which in itself requires significant resources and time to implement (Williamson, 2005). Shared governance should be viewed as an ongoing process that needs to be embedded in an organisation for it to be successful.

In moving towards shared governance, Robertson-Malt and Chapman (2008) highlight the importance of formalising policies and procedures for meetings to maximise communication and staffparticipation at all levels. Consistent with this idea, the nursing executive team at one large Australian healthcare organisation commenced a programme to enhance professional governance at ward level. The first stage of this project was designed to improve ward meetings and reporting mechanisms. This study was conducted to measure professional nursing governance in the organisation and to explore the effect of this first stage of an ongoing programme to enhance professional nursing governance.

The objectives of the study were: to measure the effect of structured ward meetings and reporting processes on nurses perceptions of professional nursing governance; to measure nurses' perceptions of professional nursing governance in individual wards across a large health service; and to compare professional nursing governance of a large Australian health service with Magnet and non-Magnet status hospitals.

METHOD

Design

This descriptive post-test study measured the differences in professional nursing governance in eight intervention wards and eight matched-control wards.

Setting and sample

The study was conducted at a large, multisite metropolitan Australian health service that employs over 4,000 nurses across primary, secondary and tertiary health services. …

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