Formal Unit-Based Shared Governance to Improve Nurse Engagement

Practice Problem: Nurse engagement is a key driver of nurse satisfaction and nursing retention. Shared governance is an evidence-based practice proven to increase nurse engagement through shared decision-making and results in higher work satisfaction. PICOT: The PICOT question that guided this project was (P) in an ambulatory nursing clinic (I) what is the effect of a shared governance unit-based committee (C) compared to current practice (O) on nurse engagement (T) over 10 weeks? Evidence: An exhaustive literature search resulted in 61 peer-reviewed articles. Eleven studies were included after filtering for duplicates and keywords and evaluating for strength and quality of the evidence. Intervention: The project’s intervention was to implement a unit-based shared governance committee in an ambulatory nursing clinic. The Johns Hopkins Evidence-Based Practice Model for Nursing guided each step, and the ADKAR change model and the three key themes identified in the literature were included in the implementation. Outcome: Two of three measures demonstrated clinical significance including statistically significant results between the pre-and post-intervention Council Health Survey results and a 40% increase in staff engagement on projects implemented. The patient experience survey question “Likelihood of Recommending” score showed improvement at weeks four and eight, however, was not sustained at week twelve and continues to be monitored. Conclusion: This project successfully implemented the evidence-based practice of shared governance by developing a unit-based committee, educating, providing a toolkit of resources, then coaching key stakeholders. As a result, the clinic realized an increase in nurse engagement, patient experience, and ownership of the departments’ process improvement