Research-based planning for change: assessing nurses' attitudes toward governance and professional practice autonomy after hospital acquisition

Perception of Shared Governance Among Registered Nurses in Ambulatory Care Center at a Tertiary Care Hospital in Saudi Arabia

Background

Shared governance is considered a model for mounting autonomous decision making in nursing profession and practice. This study aimed to assess how registered nurses in an outpatient department in a tertiary care hospital perceive shared governance.

Methods

We conducted a cross-sectional study among a convenient sample of registered nurses in an outpatient department. A self-administered, Index of Professional Nursing Governance (IPNG) questionnaire was used to measure the study outcome. A descriptive analysis was used to describe nurses' characteristics and study outcomes.

Results

A total of 186 nurses completed the questionnaire. Of whom, 151 (92.1%) were female, and 78 (47.3%) were aged between 20 and 30 years. Only 54 (29.3%) and 59 (31.7%) had indicated a shared decision in terms of controls and influence scales, respectively. The majority of the nurses indicated traditional shared across shared governance scales except in the access information scale.

Conclusion

The findings showed a prevalent traditional nursing management style in the study setting. Supportive strategies and education must be provided for both managers and staff nurses to develop and implement shared governance in their practice.

Integrating qualitative and quantitative research methods

There are a growing number of authors arguing the case for integrating qualitative and quantitative research methods within research projects. A study was carried out to identify the amount of published work integrating qualitative and quantitative research methods and to assess the quality of the outcomes of studies purporting to use both methods. Electronic searches of the health literature and critical appraisal of a random sample of papers retrieved was undertaken as well as a hand search of five journals. Over one-quarter (130, or 27%) of the papers from the electronic searches were theoretical discussions about the merits of mixing research methods, 22% (110) were papers purporting to have used mixed methodologies. Critical appraisal of the sample papers showed the qualitative and quantitative elements varied. Where the results of the different parts of the study were integrated, the outcomes from the research were more convincing than they might otherwise have been. Other papers had little discussion about the balance or integration of the different types of results. Hand searching revealed very few mixed method papers. Further work is required to refine and develop ways to mix methods to generate the evidence required to support practice.

Slicing and dicing shared governance: in and around the numbers

Hospitals seeking Magnet status must demonstrate empowering structures and processes that involve nurses in governance and decision-making about their practice. Shared governance--an organizational innovation that legitimizes health care professionals' decision-making control over their practice, while extending their influence to administrative areas previously controlled by managers--can achieve this. However, evidence connecting shared governance with clinical, professional, and organizational outcomes has been sparse. Research using the Index of Professional Nursing Governance is changing that. Innovative uses of the Index of Professional Nursing Governance is strengthening new shared governance programs, rejuvenating old ones, and finally connecting innovative models to favorable outcomes.

Professional autonomy of nurses in hospital settings--a review of the literature

Autonomy is regarded as an essential element of professional status. Especially nurse managers have an important role in searching for ways to empower nurses and to provide conditions that promote autonomous practice. This article provides an overview of the empirical research literature on the professional autonomy of nurses in hospital settings. The aim is to clarify the concept and to give information on how the autonomy of nurses has been studied through the decades. The definitions of autonomy and the results of empirical research are reviewed. Further, the article offers a description of the methodologies used in the studies of the autonomy of nurses over the years: data collection methods, samples and research contexts. The review focuses on empirical articles published between 1966 and December 2009 retrieved from the CINAHL and MEDLINE databases. The studies were classified based on a content analysis. This review draws attention to the complexity of the concept of autonomy and its various definitions. Moreover, the data for studies have been collected primarily by questionnaires; the sampling methods have been nonrandomized and the samples varying. It would be necessary to study autonomy in different countries using the same instrument.

Changes of subjective stress and stress-related symptoms after a merger announcement: a longitudinal study in a merger-planning company in Japan

To investigate the influences of a merger on employees in a Japanese company, changes of subjective stress and stress-related symptoms after a merger announcement in a major Japanese financial company were explored using longitudinal study surveys. Seventy-one participants responded to the first and second questionnaires, consisting of stress and symptoms, personal characteristics, lifestyle, medical examination, and work-related factors. After the merger announcement, the prevalence of subjective stress, anxiety, and impatience increased significantly from 46.5% to 78.9%, 18.3% to 40.8%, and 15.9% to 29.0%, respectively. The study suggests that subjective stress and stress-related symptoms may increase after a merger announcement. To reduce the negative impact of mergers, employers are expected to provide mental health-promotion programs in a merger-planning company.

Educating to manage the accelerated change environment effectively: Part 1

Without appropriate educational preparation, nurse managers may not have the competencies to effectively manage accelerated change that is so pervasive on the front lines of healthcare organizations in transformation. Part 1 of this article describes the findings from an extensive literature review of nursing, business, and higher education literature on the subject of change management. A comprehensive reference list is provided. Part 2 reports the results of a Delphi study from which baccalaureate-prepared nurse manager experts and nurse educator experts in baccalaureate nursing programs validated what linear and nonlinear change management concepts they believed were relevant in managing change in today's dynamic environment. With key roles as organizational change agents, staff development educators and administrators can use the validated concepts to develop educational offerings to promote effective change management.

Shared governance: a literature review

This paper sets out to establish what is meant by shared governance, analyses the literature on shared governance implementation, and discusses emergent issues. The paper is based on research funded by the Department of Health (England) and by North Staffordshire NHS Trust. A literature search was undertaken using the terms 'shared governance' and 'empowerment', restricted to English language. The databases used were CINAHL, British Nursing Index, Medline, Social Sciences Citation Index and FirstSearch, and the search period was January 1988-May 1998. Initially, nearly 500 articles were identified. This search also highlighted articles describing participative management, professional practice models, and self-managed work teams. For the purposes of this review, only published articles which either described and/or evaluated the implementation of shared governance were analysed. According to these criteria, 48 studies, which were obtained by the cut-off date, were included for detailed assessment.

Hospital consolidation. Applying stakeholder analysis to merger life-cycle

Nearly three of every five hospitals in the United States have been involved in some form of consolidation during the past 5 years. Within this turbulent hospital merger environment, nurse executives are confronted with organizational, professional, and personal decisions. Stakeholder analysis is offered as one strategy to facilitate effectiveness throughout the hospitals' merger life-cycle.