The Paradigm Shift to Professional Nursing Governance at Rush Oak Park Hospital, Oak Park, IL
The Paradigm Shift to Professional Nursing Governance.
Karen M. Mayer, PhD, MHA, RN, NEA-BC, FACHE, is the chief nurse at Rush Oak Park Hospital (ROPH), one of the few hospitals that is fully accredited in shared governance by the Forum for Shared Governance.
Professional nursing governance at ROPH goes beyond a mere sense of empowerment to actually giving nurses the power to control their professional lives. A paradigm shift in the role of the CNO accomplishes this. The role shift is founded on the concept of a nursing voice by the nursing expert. The CNO at ROPH does not consider nursing administrators to be the voice of nursing in the organization. The CNO instead seeks the clinical nurses commiserate with the situation to provide their expert knowledge. The CNO supports this shift by creating an environment of education, coaching, and mentoring to prepare bedside nurses in all settings to be the experts at the interprofessional “table” of stakeholders. This environment supports select nurses’ understanding of their role as representatives of other nurses and their professional conduct, speaking the language of the physicians and administrators. Their new language skills include how to present factual information without drama, using references valued by the audience, and having the back-up materials in hand.
The ROPH culture encourages nurses to use their governance structure to create their dream world for nursing, while being innovative in the process (Mayer & Start, 2019). However, excitement in generating change does not automatically ensure adoption; innovations have not always progressed as planned. An understanding of change models and project management when implementing innovative ideas is critical. Nurses need to identify their empowerment in the progress toward the implementation of innovation, while knowing they can start over, if necessary. And professional empowerment of nurses has contributed to our high RN engagement scores, which exceed national benchmarks in all seven domains. RN engagement surveys indicate employee willingness to stay with the organization. The survey questions are related to seven domains on RN Autonomy, Professional Development, Leadership Access and Responsiveness, Interprofessional Relationships, Adequacy of Resources & Staffing, Fundamentals of Quality Nursing Care, and RN-to -RN Teamwork.
ROPH nurses dream big in creating their ideal world of being a caregiver and finding the joy in nursing. Through this process the ROPH medical/surgical nurses confronted the task-focused work environment at the bedside, where nurses were seldom accomplishing the sense of calling that once prompted them to enter the profession (Wrzesniewski, McCauley, Rozin & Schwartz, 1997). These nurses embarked on a return to their calling. Their concept of that calling is based on the idea of hands-on caring as the joy of nursing. In their visioning, they wished to increase human contact with patients. The CNO mentored them in creating a staffing model that was budget neutral, yet still achieving the desired care environment. As a result, efforts have been made to increase the time nurses have with each patient to really know their patients. In essence, our nurses have chosen to take back simple aspects of care given away during nursing shortages, such as obtaining the patient’s menu choices. The process changes allow lower nurse-patient ratios as less support staff are needed in the organization (Mayer, 2019). The concept enhances patient-focused care, while optimizing nursing time with a patient. This example demonstrates how nursing professional governance can partner with a nursing administrator toward the goal of making the bedside a nursing career destination.
A further step toward the bedside as a nursing career destination is that the nursing governance activities are supported as paid time. This has been accomplished through attrition by not replacing nursing educators, case managers, or other dedicated nursing positions and spreading those duties and paid hours to bedside nurses. The multiple bedside nurses are thus able to have a portion of their full-time equivalent (FTE) positions to be education- or project-focused. These activities qualify for progression in our nursing career ladder as defined by the nursing governance program. Financial support has been built into the career ladder and has periodically increased, primarily funded by a reduction in nursing turnover expenses. The nursing governance program also advocated for dedicated FTE time for bedside nurses who have qualified as clinical instructors (CIs) to teach for an affiliated college of nursing. The quality of the clinical education for nursing students is enhanced as CIs have current relevant bedside experience, while allowing MSN-prepared nurses to expand their career path and remain at the bedside (Mayer & Start, 2019).
The ROPH nurses also find satisfaction through conscious acts of kindness. From unit councils to organizational-level committees, the professional governance groups weave opportunities for nurses to participate in volunteerism in the community. Staff are able to choose from a variety of activities, including packing extra hospital cafeteria food for the local food pantry, health screenings, homeless shelter supplies and health education, staffing 5K first aid tents, hospital representation on community philanthropic groups, community board positions, and local school support. Some hospital-sponsored activities are paid hours, others are purely voluntary. The nurses have shared their greater understanding of their patients’ needs upon seeing the daily realities in the community we serve. In turn, it has led to further efforts to support the community (Mayer & Start, 2019).
We believe the paradigm shift to recognizing every nurse for their expertise and supporting their professional presence has increase the respect for every nurse regardless of role. This is supported by television and radio advertisements in the recent Rush marketing campaign that featured nursing as the reason for the care excellence in the Rush organization.
Mayer, K. & Start, R. (Sept, 2019). Bedside nursing as a destination: Changing the career trajectory. The Voice of Nursing Leadership, 8-10.
Wrzesniewski, A., McCauley, C., Rozin, P., & Schwartz, B. (1997). Jobs, careers and callings: People’s relations to their work. Journal of Research in Personality, 31, 21-33