Enhancing Nursing Shared Governance Council Health Through Development, Implementation, and Evaluation of an Onboarding Toolkit

Abstract

Healthy Shared Governance (SG) councils within healthcare organizations support exceptional quality outcomes, are associated with enhanced nurse satisfaction, and elevate patient care. Shared Governance structures and processes require support to maintain efficacy and may need revitalization over time to keep pace with changes within the organization. In organizations with existing SG structures, monitoring council health is one strategy for ensuring that council engagement remains effective (Hess et al., 2020). Declining council engagement, paired with a decrease in nurse satisfaction scores at one southern California medical center, compelled the organization’s Magnet® Program Director (MPD) to assess the existing nursing SG structure. A dearth of onboarding preparation for new council members was discovered. To address this gap, the project lead developed a Toolkit to support the onboarding of new council members and to assist council leaders in facilitating organized council activities. The Toolkit comprised two components: a new-member educational module which detailed key topics and a council leadership handbook with supporting templates for successful meeting facilitation. The Toolkit was implemented in three large councils within the medical center. Pre-implementation and post-implementation Council Health Survey scores revealed statistically significant improvement in two of the three domains of structures, activities, and membership. Four additional questions evaluated perceptions of autonomy and revealed improvement, with three demonstrating statistical significance. A change in leadership of one participating council may have affected the implementation of the Toolkit in that group and impacted the subsequent lack of follow-up survey responses. Additional variability in staff assignments in the first quarter of the year resulted in membership changes during the implementation phase and impacted follow-up response rates. Despite these limitations, the successful implementation of the Toolkit demonstrated a strategic initiative that can be replicated by other organizations seeking to strengthen existing SG structures and enhance nurse empowerment.