Date of Graduation

Fall 12-10-2020

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions




Executive Leader DNP

First Advisor

Dr. Elena Capella

Second Advisor

Dr. Mary Lynne Knighten



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