Improving the reach and results of Shared GoveRNance

In most professions, having a voice and knowing you’re contributing to the greater good is important and fulfilling. For nurses, being heard and sharing in decision-making for the betterment of patient care and nursing practice is especially meaningful and impactful. That’s why the focus on shared governance at UW Health has been sharpened to enhance access, two-way communication and overall reach.

“When I started at UW Health in August 2020, I quickly learned that the size of our nursing workforce presented many challenges from a communications standpoint,” said Rudy Jackson, DNP, MHA, RN, CENP, Senior Vice President, Chief Nurse Executive. “As I rounded through units and ambulatory areas and attended council meetings, I was amazed at the limited number of RNs who knew what was happening in our councils.”

In 2021, Rudy shared this finding with the Nursing Coordinating Council (NCC) that, in turn, devised a plan to collaborate with the UW Health Magnet and Nursing Excellence team to tackle the goal of reaching every UW Health nurse with important nursing-related council communications.

Developing a communications plan

In June 2021, the NCC held its second annual workshop to bring fiscal year 2022 members together—every chair and chair-elect on the nine core nursing councils—to provide background and guidance for the chairs as leaders of the councils and identify priorities for the coming fiscal year. One of these priorities was to develop a communication plan specific to shared governance, to reinforce the two-way communication and importance of RN voices depicted in the shared governance model (above).

“The workshop is the perfect time to kick off the new council year and let these council chairs know what a pivotal role they play in ensuring nurses have a voice,” said Foster Lake, BSN, RN, Chair, Nursing Coordinating Council. “I remind them that they are empowered as representatives to continue progressing the quality of care we deliver and nursing practice in general.” Alan Kaplan, MD, Chief Executive Officer, UW Health, also attended the NCC workshop to set expectations for nursing shared governance, show his support and fully endorse the work of the NCC.

Year in Review FY22

The NCC held its third annual workshop June 27–28, 2022, to welcome the incoming FY23 nursing council chairs. During the workshop a Year in Review document showing the most notable accomplishments for each council from FY22, was shared with all attendees: council chairs, Chief Nurse Executive Rudy Jackson, all four Chief Nursing Officers — Michele McClure (University Hospital), Anne Mork (Ambulatory), Kim Vander Ploeg (American Family Children’s Hospital) and Nicole Kalscheur (East Madison Hospital) — as well as Dr. Kaplan. The Year in Review showcases some of the impressive work of the councils and speaks volumes to the progress and results they produce throughout a given year that keeps RNs at the center of all they do.

Taking it to the streets

Following the workshop, a review of literature to better understand what is known about shared governance communications resulted in few findings. The next step was to round on nurses across UW Health to hear directly from nurses about what communications they care about and what communication vehicle(s) prove most effective. The Magnet team and NCC rounded on more than 100 nurses.

Feedback from nurses emphasized a distinction between tell me what “I need to know right now” and what is “nice to know” information.

Shared GoveRNance key messages

As part of the collaboration with the NCC, Haley Kovac, MSN, RN, Nursing Program Specialist, Magnet and Nursing Excellence, worked closely with Foster to create a monthly communication. To make sure nurses have the information they need to know each month, the nine core councils will identify a “key message” or “key decision” to share with all nurses. To meet the diverse ways in which nurses receive communication — identified during the rounding — this information is shared in many formats: via email, cascading in huddles, the Weekly Briefing email and through unit councils. The email comes directly from Foster, who shared his excitement about this new process. “This is the first time the Chair of the NCC has communicated directly to all UW Health nurses,” Foster said. “We’ve really taken empowerment to the next level to show our nursing colleagues that this is really happening. Shared governance is working for you — decisions are being made and actions are being taken.”

Tracking and communicating council actions

To ensure nurses have access to information about everything the councils are working on (“nice to know” information), Haley, Foster and the NCC are working to create a “stoplight report” that will serve as a tracking tool for each council. “The stoplight report will provide a simple and effective way for each council to log every project they’re working on,” said Haley. “It’s a great way for councils to regroup at the end of their monthly meetings and ask ‘What did we accomplish for nurses today?’” This phase of the shared governance communication plan is going live in early 2022.

Other efforts to engage with RNs

Knowing there’s not one solution to reach all nurses, the NCC also evaluated and improved two other feedback loops that provide direct care RNs with a way to access the NCC:

  • Submit improvement ideas to the NCC: Serves as a way for nurses to share suggestions by following an SBAR format (situation, background, assessment, recommendation)
  • Ask the NCC: Encourages nurses to email questions to the NCC (via about UW Health nursing practice, benefits or any work-related topic. The NCC researches the answer, emails the nurse directly and also shares the answers in video format via the monthly UW Health-wide Weekly Briefing email.

“It’s hopeful and positive to see these efforts in motion,” Rudy said. “At the end of the day, we want our nurses to know we see them, we hear them and we want to do what’s best for them and patient care.”

Forum for Shared Governance

In June 2021, UW Health was accredited as a Shared Governance Organization by the Forum for Shared Governance, based on the responses UW Health RNs submitted in an Index on Professional Nursing Governance survey. “Through rigorous survey of all nursing staff, managers and administrators, UW Health has demonstrated its nurses call the shots for their patients,” said Robert Hess, PhD, RN, FAAN, CEO and Founder, Forum for Shared Governance.