Organizational Context, Shared Governance Structure and Outcomes in Veteran Affairs Hospitals

Abstract

For decades nurse executives have implemented shared governance structures as a nursing management innovation to transform the nursing organization from a bureaucratic hierarchy to a more organic, relational partnership. However, there is little generalizable evaluation of the effects of shared governance on nurse and patient outcomes. The purpose of this study is to examine organizational context and quality outcomes in relation to shared governance structures at VA hospitals. Structural contingency theory guided this ex post facto descriptive correlational study of the relationships between organizational context, nursing shared governance, and outcomes in VA hospitals in the United States. Veterans Health Administration administrative data from 54 VA hospitals were aggregated at the facility level for analysis. Context variables were hospital complexity level, case mix index, hospital teaching status, number of hospital beds, RN education level, and in-patient turbulence. Nurse executives reported on shared governance implementation including formal documentation of the structure in the form of policy, charter or by-laws, and total years. The outcomes analyzed were registered nurse (RN) job satisfaction, patient satisfaction, length of stay (LOS), hospital acquired Methicillin resistant Staphylococcus Aureus (MRSA), and hospital acquired pressure ulcers (HAPU). Data analysis included: descriptive statistics, correlation, MANOVA, ANOVA, and regression. Results indicated that 70% of VA hospitals had formally documented shared governance structures. RN satisfaction increased with more mature shared governance. HAPUs were significantly related to shared governance maturity. Increased in-patient turbulence was predictive of shorter LOS and fewer HAPUs. This study provides evidence of the impact of shared governance structure and the context of turbulence on nurse and patient outcomes enabling VA nurse executives to make evidence-based management decisions about how to best structure the nursing organization.