2. New School for Nursing Governance
Shared Decision Making

3. What is this all about?
1. “Magnet” Gap Analysis
2. Ways to attract and keep nurses
Action Step--Task Force Formed

4. Nursing Staff Conception of
Work Environment at
SLH/MCJ

5. National Quality Forum (NQF) Survey
Mayo Clinic voluntarily
participates in this survey—
results passed on to JCAHO
What are the responses to
the current survey?

6. 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%

7. 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%

8. 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

9. 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.

10. 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

11. Being Proactive
POSSIBLE RESPONSES:
Do Nothing and hope for the best
Wait until the dust settles, then act
Change the way we govern ourselves

12. WHAT IS SHARED DECISION MAKING?

13. 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

14. 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

15. 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

16. Contrasting Environments
Traditional
 Follow directions
 Abide by present rules
 Follow chain of command
 Do the job – NO complaints
 NO mistakes tolerated

17. 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

18. 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

19. Mushroom Management!

20. Contrasting Environments
Shared Decision Making
 Talk to those doing the work
 Give up control
 Embrace errors
 Encourage questioning

21. 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”

22. 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

23. What Happens When Shared
Decision Making Is Present?
 Communication is multi-
directional
 Problems are identified
and resolved
 Quality of work represents
the staff’s own efforts
 Feeling of community
 Frustration & disappointment
replaced by challenge,
excitement and progress

24. 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.

25. 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

26. Who Benefits From
Shared Decision Making?
 The Professional Nurse
 The Patient
 The Organization

27. The Professional Nurse
 Encourages professional nursing
practice
 Enhances communication,
collaboration and problem-solving

28. Promotes patient care that is
creative, evidence-based,
efficient and driven by those
who deliver it
Encourages and rewards
professional growth
The Professional Nurse

29. The Bottom Line:
Increased job satisfaction,
leading to higher nurse retention
and lower staff stress
The Professional Nurse

30. The Patient
 Improved outcomes
 Increased patient satisfaction

31. The Organization
 Improved cost-
effectiveness of service
 Reduced recruitment
and orientation costs
 Creation of a more
dynamic, energetic, and
innovative environment

32. The Decision Making Continuum
Decisions made
by individuals
Command ConsultativConsultativ
ee
CConsensus
Low
High
SharedShared
DecisionDecision
MakingMaking
Acceptance
Time
Decision Making ModelsDecision Making Models

33. Implementation
 Orientation
 Education
 Communication
 Involvement
 Support for attendance
at Nursing Council

34. THE NEXT STEP…

35. QUESTIONS & COMMENTS

36. 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).

37.  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