Nursing in a changing landscape

Abstract

In North America during the 1970s, a concept was introduced into healthcare organisations called ‘shared governance’ which was an evidencebased method for curbing the damaging effects of the shortage of nurses (for example, negative patient outcomes, high cost of agency staff and overtime). Shared governance is also known as ‘shared leadership’ which is a principle that provides nurses with opportunities to participate in the decisionmaking processes that affect their practice. Their ultimate goal is to deliver high-quality health care that is personand family-centred. It empowers nurses to reflect their professional values in order to promote positive behaviour and practice—for example, by promoting care that reflects the needs of the individual patient and their family. The concepts of shared governance and shared decision-making are not new. Philosophy, education, religion, politics, business and management, and now health care, have all benefited from a variety of shared governance process models implemented in many diverse and creative ways across generations and cultures. The traditional approach to a lot of national, regional and local programmes is to set up committees, structures or boards made up of key stakeholders responsible for overseeing a programme of work delivered by a series of subgroups. This can lead to a lack of ownership by those affected, or problems of alignment with local work. We also know that education, professional standards and judgement are not the only determinants of professional nursing practice. Nurses have not always been empowered to fully exercise their clinical judgment for patient and family care, which, according to evidence, is a factor in job satisfaction and ultimately quality of care. Employees must structure their practice within resources and rules set by their organisation or employers, often in the form of policies and procedures, which can have a profound effect on how they deliver health care. Using shared governance as an approach will enable nurses to influence and shape their contribution to quality according to their professional values. Nurses in North America in the late 1980s and early 1990s (Porter-O’Grady, 1987; McDonagh et al, 1989; Metcalf and Tate, 1995) identified shared governance as a key indicator of excellence in nursing practice and described shared governance as a management process model for providing a structure for organising nursing work within organisational settings. It allows strategies for empowering nurses to express and manage their practice with a greater degree of professional autonomy. This allows for personal and professional accountability to be respected and supported within the organisation. Leadership support for nurses delivering frontRory Farrelly NHS Greater Glasgow and Clyde Director of Nursing Acute Services Division line care enables them to maintain quality nursing practice, job satisfaction and financial viability when partnership, equity, accountability and ownership are in place (Green and Jordan, 2002; Anthony, 2004). Using ward/unit/team practice for implementing shared governance at the point of care is about change. But how do we make change painless? With changing technology, increasing patient acuity, and patients and families who are more knowledgeable today about health and social care, change is our only constant. We must embrace new skills, take more professional risks and move further than ever before in advancing nursing for the 21st century and beyond. There is rarely time to become comfortable with new information before it is replaced with new ideas, processes and concepts with a promise of higher quality and lower cost. We must therefore work in partnership and develop strategies to help us as nurses to accept change and realise future possibilities. Change may not be an option, but how to engage in it is open to negotiation and does not have to be painful. For example: ■ Begin with the right attitude ■ Let your confidence show ■ Be autonomous in your practice ■ Be an expert leader ■ Be solution focused ■ Create and innovate ■ Let integrity rule ■ Communicate with everyone ■ Strike a balance between work and play ■ Become a teacher, preceptor, mentor and coach ■ Be flexible and adaptable. Nurses are learning and implementing new ways of providing family-centred care, new technologies and new ways of thinking and working. Organisations now need to learn that the nurse at the front line of the service is crucial to the success associated with changing the environment of care. We must be prepared for new roles, new relationships and new ways of managing and leading. Shared governance is about moving from a traditional hierarchical model to a relational partnership model of nursing practice. BJN