Joining Kaweah Delta Health Care District in January 2005 as Vice President and CNO Linda Pruett, RN, MSN, NEA-BC, inspired nursing staff and leaders to build a shared governance structure as the first step in the journey toward Magnet designation. Now, six years later, the structures and processes developed by and for Kaweah Delta nurses in Visalia, Calif., have been identified as a practice exemplar by the American Nurses Credentialing Center Commission on Magnet.
“I knew we needed a foundation to give bedside nurses a voice and control over practice decisions,” Pruett said about the April designation. “Our challenge was absorbing learnings about shared governance structures, developing our own model, and educating nurses at all levels in less than a year.”
Governance model design
Nursing leaders and staff developed bylaws to support a governance design consisting of three levels of nurse-led councils, each with decision-making authority appropriate to their circle of influence.
Empowering nurses through decision making at the point-of-care, councils representing individual nursing units, Unit-Based Councils, are the foundation for Kaweah Delta’s nursing shared decision-making model.
The second level of the councilor model encourages examination of nursing practice interests through a wider lens; four Nursing Practice Councils integrate all unit-based councils. The third and final level of the shared governance model, the Professional Practice Council, brings nursing practice council staff, support service nurses, and leaders together as representatives of professional nurses at all levels across Kaweah Delta, to oversee practice issues and improvements from an organizational perspective.
Workshops provided staff and leaders with information about shared governance concepts and decentralized decision making in nursing practice. Since the launch of UBCs in February 2006, the first Tuesday of each month has been designated Shared Decision-Making Tuesday to facilitate staffing/scheduling efforts on council days and establish a predictable forum for global education related to key nursing practice initiatives. Communication between council levels of the shared decision-making structure is bidirectional, flowing to and from UBC, NPC and PPC.
“The NPC provides an opportunity for UBCs to resolve unit issues directly instead of using management,” said John Briggs, cath lab staff RN. “It provides a forum for staff to be heard and for UBCs and NPCs to work collectively on projects.”
The Hess Index of Professional Nursing Governance survey was administered in February 2009 and March 2010 to evaluate governance acculturation. According to Robert Hess, RN, PhD, FAAN, founder, Forum for Shared Governance, “The overall mean score for this 2010 survey was 179, up from the 170 score from last year and past the minimal cutoff of 173 for shared governance. Congratulations.”Kaweah Delta Health Care District’s Magnet Champions in August 2010.
Additional praise about Kaweah’s shared governance structure comes from the Magnet Recognition Program Summary Report: “Information flows seamlessly through the councils and collaboration is optimized by the council structure. The councils are talking about things that matter to nurses, and therefore are able to change and improve nursing practice and patient care through this work.”