The Importance of Shared Governance in Achieving Nursing Excellence

The Stanley Shalom Zielony Institute for Nursing Excellence at Cleveland Clinic was founded on a number of principles designed to promote and ensure nursing excellence. And from a big picture standpoint, nursing excellence is driven by nurses who:

• Deliver high-quality nursing care
• Implement nursing in a professional and competent manner
• Demonstrate a holistic approach to caring
• Possess certain personal qualities that enhance practice and relate to patients, families, peers, hospital leadership and community members in a competent, cooperative manner

Attaining nursing excellence necessitates that nurses have an essential role in implementing evidence-based practices (EBP) that contribute to positive patient outcomes.

Frameworks developed by the American Nurses Credentialing Center (ANCC) (an arm of the American Nurses Association (ANA)) for the Magnet Recognition Program® and Pathway to Excellence® Program require nurses to engage in the process of incorporating new evidence into practice.

For example, the Magnet designation program was established in 1994, when research found that patient care outcomes were better in hospitals where there was an environment that empowered nurses, valued their contributions and supported nursing leadership. Similarly, Pathway to Excellence was established in 2007, and is awarded to hospitals or medical centers that are committed to a work environment where nurses excel in the practice of safe, quality patient care.

Organizations that receive these nationally known recognitions support collaboration, leadership, quality, safety, research and professional development.

In 2012, Cleveland Clinic health system set a goal for all system hospitals to be recognized as either a Magnet or Pathway to Excellence hospital. Proudly, we are well on our way to achieving that goal as our last hospital recently completed the process for consideration as a Pathway to Excellence-recognized hospital.

Nursing excellence and the value of shared governance

The foundation in achieving ANCC recognition – whether Magnet or Pathway to Excellence – is a shared governance structure that gives nurses across care settings a voice to affect their practice and the care provided to patients.

Shared governance is a working model of participatory decision making in which nurses are organized to make decisions about clinical practice standards, quality improvement, staff and professional development, and research.

ANCC considers the concepts of shared governance throughout an organization when granting both Magnet and Pathway to Excellence program recognition. The shared governance model is based on four core principles, and this month at Cleveland Clinic’s annual ‘Shared Governance Day’ the Cleveland Clinic Nursing Institute unveiled a new enterprisewide shared governance structure centered on these principles.

Each shared governance key principle represents a primary component of Cleveland Clinic’s new model. The components of the model include:

• Equality: Shared and equal focus on patients, services, and staff as all essential to providing safe and effective care
• Empowerment: Authority and autonomy to make decisions about nursing practice
• Accountability: Responsibility and willingness to invest in ethical practices through shared decision-making
• Partnership: Emphasis on collaboration and teamwork among caregivers and between caregivers and patients/families

At the center of the Nursing Institute shared governance model is the Nursing Institute professional practice model. The professional practice model is the model Cleveland Clinic nurses follow to deliver world-class care, and it’s based on the philosophies of relationship-based care, thinking in action and serving leader – and, is centered on the guiding principle of ‘Patients First.’

‘Patients First’ is a core concept of nursing practice at Cleveland Clinic – and a primary goal of all shared governance activities.

This representation depicts the Nursing Institute’s belief that the primary focus of nursing is at the unit/clinic level – where nurses provide direct patient care. Ideas and recommendations generated at the unit/clinic level flow inward via unit/clinic representatives to the councils empowered to act on these issues. Councils consult and collaborate with each other to achieve the best decisions to successfully facilitate and ensure quality patient care and outcomes.

Thus, the mission, vision and values of Cleveland Clinic Nursing provide a focus for the shared governance structure. And the shared governance structure promotes excellence in the delivery of nursing care.