Date of Graduation

Fall 12-10-2020

Document Type

Project

Degree Name

Doctor of Nursing Practice (DNP)

College/School

School of Nursing and Health Professions

Department/Program

Nursing

Program

Executive Leader DNP

First Advisor

Dr. Elena Capella

Second Advisor

Dr. Mary Lynne Knighten

Abstract

Abstract

Problem: According to the Advisory Board (2014), nurses are the least engaged group of healthcare employees. Healthcare organizations with a high percentage of disengaged nurses have increased nurse turnover rates and decreased patient satisfaction and safety scores (Kutney-Lee et al., 2016). Shared governance, in the form of unit practice councils (UPCs), is an underutilized model healthcare organizations can implement to increase nurse engagement.

Context: The UPC is an example of shared governance to engage and empower nurses to affect changes that impact their practice. This a multi-site health system with 21 medical centers in Northern California. This system would like to obtain the American Nurses Credentialing Center (ANCC) Magnet® recognition designation, which is based on nursing shared governance. Implementation of a shared governance model, such as a UPC, fulfills the requirement of exemplary professional practice under the Magnet® designation. Unit practice council is a structure that improves nurse engagement.

Intervention: The purpose of this project was to increase nurse engagement through the standardized implementation and evaluation of UPCs at two hospitals and seven nursing units within the macro-system of 21 Northern California hospitals. The intervention was a standardized toolkit that assists the staff nurse and nurse manager in co-leading the implementation of a UPC.

Measures: The primary outcome of interest was the improvement of nurse engagement on the Practice Environment Scale (PES) of the Nursing Work Index (NWI) pre- and post-implementation of the UPC. Data were analyzed for improvements in nurse participation in hospital affairs. The nurse and nurse manager, as co-leads of the UPC, were surveyed using the PES pre- and post-intervention of the UPC.

Results: Using a 4-point Likert scale, the manager and nurse participants reported greater than 10% improvement in engagement in the three areas of the PES of the NWI after implementing a UPC. Staff nurses’ opportunities to participate in policy decisions increased 57%, opportunities to serve on hospital and nursing committees increased 29%, and nursing administrator consultations with staff on daily problems increased 29%. The nurse managers surveyed, reported an increase in opportunities for staff nurses to participate in policy decisions by 40%, staff nurses having the opportunity to serve on hospital and committees by 120%, and nursing administrators consulting with staff on daily problems by 20%.

Conclusions: Implementation of UPCs is a deliberate strategy taken by hospitals to improve nurse engagement, nursing practice, and patient outcomes.

Keywords: unit practice council, unit-based council, shared governance, engagement

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