Magnet Hospitals and Shared Governance: Empowering Frontline Nurses

October, 2017

The American Nurses Credentialing Center (ANCC) National Magnet Conference is convening in Houston this week.

The ANCC Magnet Recognition Program® recognizes healthcare organizations for quality patient care, nursing excellence, and innovations in professional nursing practices. The Magnet designation means a hospital has met rigorous criteria and delivers exceptional nursing care.

A fundamental requirement of hospitals applying for Magnet status is that they must demonstrate an effective shared governance structure. Shared governance is a decision-making model focused on empowering the people who care for the patients. It’s a fairly simplistic idea with a very complicated execution.

People not involved with shared governance sometimes have difficulty understanding how it works. Compounding the complexity is that every hospital designs their own framework and their own idea of shared governance. The image at the top of this article is representative of what you would find in a Google search on the phrase “shared governance in healthcare.” There are as many shared governance models as there are Magnet Hospitals.

Respect for Frontline Decision Making

Earlier in my career, I was the CNO at a Magnet Hospital – a 1200-bed university medical center. We used a shared governance model to ensure that the nurses at the bedside felt their voices were being heard, and that they had some control over the technologies, processes, and decisions that would affect their clinical practice.

In order to do that, we structured practice committees representing every nursing discipline across the hospital. For example, we had ICU, labor and delivery, NICU, medical/surgical, and surgical practice committees, usually called practice councils. Every nursing unit had the opportunity to develop their own council. Each council was made up of nurses who worked the unit, took care of the patients, and understood what a day in the life of a nurse was like in that unit.

The practice councils met once a month to discuss policy, practice, and product. If a vendor came into the hospital with a product (for example, a new IV tubing), the vendor would have to go before the practice council in every unit and make their case to the frontline nurses. And if those frontline nurses felt the product was of value and would enhance their practice, then they referred the vendor up to the house-wide practice council.

The house-wide practice council was made up of a single representative from each unit practice council. Once a product review went to the house-wide practice council, the vendor would be invited back, and nurses from all different disciplines would then have an opportunity to express their opinion about what they were seeing and what was being offered up. If the product passed through the house-wide practice council, then it was referred up to the executive level.

I was at the executive level, and I can tell you: if a product made it through all of those councils and reached my desk, I always approved it because I knew due diligence had been done (and I praised the councils for their diligent work). I might have a few budgetary questions or thoughts about timing or logistics. But I was always mindful that a veto would destroy the concept of decision-making by the frontline.

Helping Hospitals Meet Magnet Certification Requirements and Grow HCAHPS Scores

A particular Magnet credentialing criterion specifically addresses nurse involvement with technology decision making. It requires that hospitals describe how nurses were involved in designing the rollout or implementation of a technology to improve nursing practice in the organization.

Vocera® develops and sustains products that give nurses tools to support clinical workflow and provide useful data to demonstrate successful outcomes. More than 55 Vocera customers are Magnet Hospitals, and we have more than 40 nurses who work with our customers to ensure their nurses are fully involved with designing, implementing, and deploying our technology solutions in their hospitals. We partner with our customers to fully document the process, which enables them to provide summaries to their Magnet surveyors.

We are currently working with a hospital in the Mid-Atlantic region to support their “nurse-selected technology/sustaining technology adoption” requirement for Magnet certification. As required by the Magnet criteria, the hospital’s nurses were involved in selecting the technology, educating the staff, and developing a sustaining protocol. Working together, we are developing assessments and data collection tools to demonstrate the success of nurse-driven technologies.

One of our products provided data that helped a Magnet Hospital in the Northeast achieve HCAHPS scores in the top 1% in the nation in its maternity unit and medical-surgical units after integrating the Vocera platform with their nurse call system. And another Vocera solution helped a Magnet Hospital in Northern California increase HCAHPS scores by approximately 25 percentage points for nurse communication and staff responsiveness.

The beauty of shared governance is that front-line nurses share in making decisions about what will allow them to function well and thrive. Shared governance is focused on empowering the people who work every day making life better for patients and families.

At Vocera, we celebrate nurses and all that makes their days go better. To all nurses on the Magnet journey, we extend our wishes for a great week of celebrating accomplishments and showcasing best practices at the National Magnet Conference.