A Guest Column from TruthPoint partner, Creative Health Care Management
By Gen Guanci, MEd, RN-BC, CCRN-K, Consultant, CHCM 

Shared Governance Will NOT Be Successful if the Nurse Manager Doesn’t Support It!

A clear understanding of the role of the nurse manager (or any nurse leader) in a shared governance unit practice council (UPC) is critical to the individual manager’s success, as well as the council’s.  Many times individuals in nurse manager positions are the “get it done” people within an organization.  They plan meetings, facilitate, and get the work done.  This type of facilitation, known as basic facilitation, helps a group solve a problem by using process skills. This is a short-term fix where the group depends on the facilitator or nurse manager.  Despite the value of this short-term problem solving in some situations, this is exactly what not to do as you build your shared governance culture.

The nurse manager’s role in building a shared governance culture is as a support or developmental facilitator. His or her role uses a longer-term strategy where the team learns how to facilitate its own processes. The nurse manager must help councils function more effectively now and in the future without taking charge of the process. The nurse manager not only helps the council members work on a specific issue, but encourages them to look at the issue from all sides, see things for themselves, use their own critical thinking, and come to their own conclusions. In developing a shared governance culture, the nurse manager spends more time coaching the members on the process, roles, tools, and techniques before and after the meeting, rather than during it. In most situations, the nurse manager does not attend the meetings, but may stop in to show visible support and address any questions that may have arisen. The end goal of the nurse manager’s support, coaching, and mentoring is for the team to develop the skills that enable them to move forward and address the key issues of their unit.

The exciting role of the nurse manager is to inspire, role model, and advance the council while at the same time helping council members learn to facilitate their own process. Serving as a guide and catalyst, the manager helps people focus their energy while fostering learning, creativity, productivity, and ownership.

Desired Outcomes of the Shared Governance Process

The first step of any group is to determine the desired outcomes. In shared governance UPCs, one desired outcome is acceptance of the responsibility, authority, and accountability (R+A+A) for nursing practice and the outcomes associated with that practice as a unit. These outcomes include patient satisfaction, nurse-sensitive indicator outcomes exceeding the benchmark mean the majority of the time, and RN satisfaction. While the nurse manager may have hopes and dreams for the council, these are not nearly as important as the hopes and dreams the council members have for themselves. We have seen time and time again that nurse managers realize after the fact that unit staff respond to, and adopt action plans that the UPCs develop much sooner and with less push back than would have been with the nurse manager’s plan for the unit. 

Expectations of the Nurse Manager in Supporting their UPC

  • Provide the time for UPC members to attend meetings.
  • Obtain a schedule of all UPC meetings.
  • Review all UPC meeting minutes.
  • Support the chair/co-chair in agenda development.
  • Empower UPC members.
  • Clearly articulate expectations.  Expectations include what the UPC can or cannot make decisions on, what criteria decisions to meet, and within what timeframe.  If you find yourself saying, “They should know…,” then shame on you. You have not articulated your expectations.
  • Create a culture of accountability for yourself, council chair/co-chair, and members.
  • Meet with the chair/co-chair before meetings to review agenda and any boundaries which council needs to know before they begin their work or make decisions. 
  • Give authority.
  • Coach or help the chair/co-chair to work through any anticipated issues or problems.
  • Provide tools to complete unit projects.
  • Allow staff to try and perhaps later realize their decision, while safe, was not the best one for the given situation. In other words, allow staff to learn from their mistakes.
  • Meet with the chair/co-chair after meetings to debrief, offer feedback, and coach for skill development.
  • Manage any attempts on the part of the chair/co-chair to defer meeting management to you. This is not your council or your meeting.
  • Get out of the way.
  • ALLOW change.
  • Celebrate successes.

By supporting your staff as they form and grow their UPC, you will also see the individuals grow personally, as well as professionally.  What better reward is there for a leader than to watch their staff blossom?

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