Shared governance basically refers to the collaborative decision-making that is mainly based on the principle of accountability, ownership, and partnership, particularly on a point of service. Shared governance has been used in various sectors, including healthcare sector. It is decision-making model that encourages the involvement of all staff in making decisions, especially those that directly affect their practice or roles in an organization (Finkelman, 2016). The shared governance is mainly used in healthcare sector to empower workforce to actively take part in decision making, leading to increased creativity and quality healthcare services. The shared governance, therefore, is one of the models that can be used by nurses to offer quality care for patients.
Review and Summary of Two Sources
The first sources is titled “ Introduction: The concept behind shared governance” by Swihart Diana. It is an introduction to the concept of shared governance, it she discusses the definition of shared governance, four principles of shared governance, historical development of the model, and its application in nursing. According to Swihart, shared governance is currently one of the strategies that are used by various health institutions to address the nursing shortage. She defines shared governance as a shared decision-making that is based on the four main principles that include ownership, partnership, accountability, and equity. Therefore, the shared governance principles that are discussed by the sources include partnership, equity, accountability, and ownership. Swihart argue that shared governance can only be effective when employees are involved in 90% of the key decisions that are made in the institution (Bamford-Wade & Spence, 2012). Only 10% of the critical decisions should be made by the management. The author also argues that the traditional centralized management structure is no longer effective in the modern healthcare setting.
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Shared governance was developed in 1970s, and it found its way in the healthcare and nursing areas in early 1980s after nurses became dissatisfied with the centralized management system. To effectively implement shared governance in nursing, nursing managers should mainly be accountable for patient care delivery, but she should not do all the tasks. The nurse manager should be accountable for giving directions and evaluating past decisions and outcome. Bedside nurse, on the other hand, takes charge of the overall care of the patient and his outcome. In addition, other healthcare practitioners like dietician, pharmacists, and lab technicians share the responsibility of ensuring that patient’s needs are adequately met. Shared nursing plays important role of ensuring that nurses provide quality and timely care to patients (Bamford-Wade & Spence, 2012).
The second source is titled “Implementation of Shared Governance” by Glasscock Sherly. The primary objective of the source is to discuss how shared governance is implemented in rural health care centers and to evaluate the impact of the perception of nurses of their control over the practice. According to the source, the main stakeholders who are included in the shared governance include model include nurses, nurse manager, patients, physicians, ancillary departments, and physicians (Glasscock, 2012). Some of the benefits associated with shared governance, especially among nurses include low burnout rate, high retention of nurses, decreased emotional exhaustion and high level of mental health of nurses and other physicians, enhanced autonomy and job satisfaction.
Glasscock argues that patients are also likely to benefit from shared governance model because it leads to quality care services, low medical errors, enhanced patients’ security and safety, and improved personal care. At the same time, shared governance models like to positive change in organizational culture, work environment, collegial communication, and improved productivity. In order to effectively implement shared governance model in a healthcare setting, the management and employees should be ready to embrace shared decision-making and embrace new organizational culture and structure (2012).
Observation of Current Nursing Model being implemented
Based on my observation, I strongly believe that the nurses in the environmental setting I visited were trying to implement shared governance model in trying to meet the needs of patients who were visiting the clinic. However, they were not strictly complying with the concept and principles of shared governance. Unlike in many cases where staff in a hospital may use physical meetings to collaborate and collectively make decisions together, I observed that employees in the institution were relying on modern technology to make critical decisions that were touching on the needs of patients.
First, I observed that patients visiting the clinic were required to first visit the customer care desk that was placed directly opposite the main entrance. They were required to make inquiry and consult nurses who at the customer care desk. The nurses at customer care desk would then consult the relevant health personnel in the clinic before the patient was sent in for medical services. I observed that there was constant communication between nurses at the customer care desks and nurse manager who was in the nearby office. In many cases, the nurse manager was directing patients to either clinical officer or the doctor who were also present in one of the rooms.
Secondly, I observed frequent consultation and communication between clinical officer or doctor and the laboratory officer. In many cases, the doctor or clinical officers was seeking clarification from the lab personnel whenever there was some information that needed clarification. Occasionally, either a doctor or clinical officer could visit laboratory to consult to consult lab technician of the results. In some cases, a lab officer was required to repeat lab test to confirm the results. Therefore, a lot of communication was taking place between a doctor and laboratory officer, especially before a nurse was taken for nursing care in one of the wards.
In addition, I could clearly observe that the nurse manager was in charge of all the nursing care that was taking place in the hospital. I saw her moving from one ward to another talking to besides nurses. They could sometime hold brief discussion, especially when the patient needed additional care or attention. However, bedside nurses were always close to patients. There was close coordination and communication between nurses, pharmacists, and doctors in order to ensure that patient’s needs are timely addressed to enhance the quality of care in the clinic. The medical practitioners in the clinic heavily relied on phone and email communication to make joint decisions. Nevertheless, it was clear that the clinic was executing shared governance model.
Recommended Different Nursing Care Model
Another appropriate nursing care model that can be utilized in the clinic the Progressive Patient Care (PPC) model. This is the nursing care model where patients are put in units based on the care they need, which is supposed to be determined according to their degree of illness. Sometimes patients are placed in care units based on their medical specialty or the medical care they need. It is, therefore, the systematic grouping of patients based on their dependency and degree of illness. PPC is “the right patient, right bed, and right care services” model that is tailor-made to meet specific needs of patients. This model is appropriate for patients who need intensive care, intermediate care, self-care, and bed-attached care. It can be used to meet specific needs of patients visiting the clinic, leading to high-quality care for patients ( Finkelman, 2016) .
According to Finkelman (2016), PPC model is appropriate because of its many advantages. First, it ensures that patients receive specialized care. Secondly, it ensures that patients who are not seriously or critically sick are not deprived of nursing and medical attention. In addition, the model is beneficial to nurse because it helps in ensuring that nurses make good use of their special capabilities and they adequately plan for nursing care for the patient. Therefore, PPC is as good as shared governance model, even though they are based on different approaches and principles.
Conclusion
Shared governance model is one of the most effective nursing care models that can be used to meet the needs of patients as well as those of nurses. It ensures that patients get quality healthcare services. On the other hand, shared governance model meet the needs of nurses as it is linked to high job satisfaction, reduced fatigue and burnouts, and enhanced performance. At the same time, it ensures effective relationship and collaboration between bedside nurses, nurse manager, and other personnel in healthcare setting. Apart from shared governance model, clinics can also use PPC that is equally effective in meeting specific needs of patients, leading to quality care.
References
Bamford-Wade, A. & Spence, D. (2012). Shared governance: A vehicle for engagement and change. Nurse Education Today , 32(3), 191-194. https://www.deepdyve.com/lp/elsevier/shared-governance-a-vehicle-for-engagement-and-change-wN28z0mptz
Finkelman, A. (2016). Leadership and management for nurses: Core competencies for quality care (3rd ed.). Boston, MA: Pearson.
Glasscock, S. (2012). Implementation of Shared Governance . Bellarmine University. Retrieved from https://scholarworks.bellarmine.edu/cgi/viewcontent.cgi?referer=https://www.bing.com/ &httpsredir=1&article=1006&context=tdc
