The Impact of Interprofessional Shared Governance and a Caring Professional Practice Model on Staff's Self-report of Caring, Workplace Engagement, and Workplace Empowerment Over Time

Abstract

OBJECTIVE To describe the impact of the implementation of interprofessional shared governance and a caring professional practice model (Relationship-Based Care [RBC]) on the staff's self-report of caring, work engagement, and workplace empowerment over a 4-year time frame. BACKGROUND Shared or interprofessional governance has moved mainstream within healthcare settings, particularly within agencies seeking to sustain high reliability in the offering of quality patient care services and/or interest in meeting Magnet® standards or embarking upon the Pathway to Excellence®. Nurse leaders report that organizations having implemented shared governance thrive, citing professional governance as key to workplace engagement and empowerment, particularly related to quality care initiatives. Transition to interprofessional shared governance structures typically takes 2 to 3 years. It is unknown whether related outcome variables are sustainable over time. METHODS Utilizing Watson's theory of human caring and appreciative inquiry as underlying frameworks, a longitudinal, quantitative study design was employed. Interprofessional focus groups and introductory sessions were offered to inform and engage all personnel within the medical center. Motivated units were identified, professional shared governance council members elected, and unit-specific education provided. Quality improvement initiatives were facilitated within unit councils, and formal leadership programs to enhance project guidance and to support staff empowerment skills for the managers of the units that were up-and-running were provided. Preimplementation and postimplementation measurements of staff's caring, workplace engagement and work empowerment were assessed, compared, and trended across units over time. RESULTS Only work empowerment scores among staff working within RBC units were sustainable and increased progressively and significantly over time. Work engagement levels initially rose and then stabilized over time. Caring levels remained stable despite the implementation of a caring professional practice model. Statistically significant correlations were noted between work engagement and empowerment, followed by the relationship between work engagement and caring, followed by the relationship between empowerment and caring. CONCLUSIONS The sustainability of work empowerment is likely related to the periodic provision of education for leaders regarding leading within an empowered work environment. A stronger focus on staff caring, particularly within quality improvement initiatives, with leadership guidance, will be paramount moving forward.

An integrative review on interventions for strengthening professional governance in nursing

“…Discrepancies in quality assessment were mainly related to limited information about adjustment for confounders and differences between groups in the follow‐up stage. Most of the quasi‐experimental studies had no control group, and two studies only achieved a 55% quality score as the employed methods could not determine causality (Di Fiore et al., 2018; Olender et al., 2020). The only qualitative study included in this review (Kyytsönen et al.…”

“…The goal of five of the interventions described in the identified studies was to enhance staff involvement and empowerment, as well as the work of existing nursing councils, by establishing new decision‐making structures. Three interventions were based on Kanter's empowerment theory (Meyers & Costanzo, 2015; Moore & Wells, 2010) and Watson's theory of human caring (Olender et al., 2020). The study by Dechairo‐Marino et al.…”

“…The described interventions aimed to create one council for one division (Meyers & Costanzo, 2015), three new councils at the unit level (Dechairo‐Marino et al., 2018) or hospital level (Moore & Wells, 2010), or several new councils at different levels of the organisation (Brull, 2015; Olender et al., 2020). Various types of education or orientation were offered to either the whole staff or different stakeholders to make the intervention more efficient (Table 1).…”

“…In addition, interventions included increased library access, paid council time, expanding staff involvement in department budgeting decisions (Dechairo‐Marino et al., 2018), staff nurses serving as co‐chairs and nursing executives partnering with the council co‐chairs for planning and problem‐solving (Moore & Wells, 2010). Videoconferencing between clinics was also offered to ensure that nurses could attend the meetings (Meyers & Costanzo, 2015), and unit managers were afforded leadership empowerment programmes so that they could support council work (Olender et al., 2020; Table 1).…”

“…As such, councils are key to employee engagement and at the heart of PG (Hess et al. 2020; Olender et al., 2020).…”