Ch. 13: Decentralization and Shared Governance

In Magnet organizations, shared governance needs to be manifested through what mechanisms for nurses' decision making? a. Unit practice councils b. Democratic leaders c. Authoritarian leaders d. System-wide practice councils

ANS: A In a national study of the nursing practice environment, Clavelle and colleagues (2013) found that in Magnet organizations, the primary governance structure was shared governance, which was significantly and positively related to an improved professional practice environment. To be real and make a difference for nurses, the shared governance needs to be manifested through point-of-care structures where direct-care nurses make decisions about patient care and unit operations. Unit practice councils (UPCs) are an example.

An employee satisfaction survey is conducted annually and shows that nurses in a particular unit are committed to their jobs and feel that they make positive contributions. These nurses are: a. engaged. b. disengaged. c. unproductive. d. at retirement age.

ANS: A An ongoing challenge among U.S. employers, including health care systems, is to keep employees engaged. A Gallup poll (2014) indicated that only 31.5% of employees in the United States report they are "engaged at work," meaning they are committed to their job and making positive contributions. Fifty-one percent reported they are "not engaged at work," meaning they are not likely to put effort into organizational goals. Seventeen and a half percent are "actively disengaged," described as unhappy, unproductive, and likely to spread negativity. Shared governance is the gold standard for engaging nurses in solving problems at the point of care.

Institutions organize and structure themselves by defining departmental function and authority to achieve a more coordinated effort. In institutions where the executive leader retains more decision-making authority, the operation takes on a more _____ philosophy. a. centralized b. decentralized c. autocratic d. democratic

ANS: A Centralization and decentralization are organizational philosophies about power distribution that pertain to the hierarchical level of decision-making authority in the institution. Centralization means that decisions are made at the top levels. Decentralization means that decision making is diffused throughout the organization.

In organizations that practice shared governance, the responsibility for unit outcomes rests with the: a. nursing team. b. nurse manager. c. individual nurse. d. chief nursing officer (CNO).

ANS: A In organizations that practice shared governance, staff as well as nurse managers and leaders are responsible for innovation. Innovation is considered crucial to safely and effectively solve complex care problems. The entire team is responsible for unit outcomes, not just the individual manager.

Participative leadership was first introduced in the late 1970s. It was adapted by health care organizations to form the basis of shared governance and has evolved to define the roles of nurses and resolve issues related to: a. patient care. b. nursing liability c. nursing salaries. d. nursing turnover

ANS: A Participative leadership—the notion of leaders turning to their team for input and ideas—was first introduced to the business world in the 1970s. It was adapted by health care organizations and nursing leaders in the early 1980s, and formed the basis of shared governance, which today has evolved to define the role of nurses as well as to resolve issues related to patient care (Gray, 2013).

The primary purpose of unit practice committees in a health care organization is to improve: (Select all that apply.) a. practice. b. processes. c. outcomes. d. reimbursement. e. urnover.

ANS: A, B, C The purpose of the unit practice council is described as being "part of the shared governance structure to promote shared decision making at the unit/clinic/program of care level. To make and implement recommendations to improve practice, processes, and outcomes"

Shared governance has far-reaching implications for today's health care environment. Patients benefit due to: (Select all that apply.) a. quicker responses at the point of service. b. more committed health care professionals. c. a more stringent model of health care service. d. better decisions being made by upper management. e. nurses being more assured, confident patient advocates.

ANS: A, B, E The focus of a health care environment that supports shared governance is to provide patient care safely, efficaciously, and efficiently. Patients benefit from a more efficient model of health care service; more committed health care professionals; quicker responses at the point of service; and a more assured, confident patient advocate

Organizational benefits of a culture of shared governance include: (Select all that apply.) a. improved financial outcomes. b. interdependence among staff nurses. c. increased commitment of staff to the organization. d. more senior leadership involvement at the point of service. e. a more efficient model for point-of-service decision making

ANS: A, C, E Organizational benefits include increased commitment of staff to the organization; accountability of the nurse; a new level of professional autonomy; a more efficient model for point-of-service decision making; more expert involvement at the point of service; a more assured, confident patient advocate; and improved financial outcomes.

At its start, shared governance requires the education and support of organizational executives, managers, and point-of-care staff. Organizational benefits include: (Select all that apply.) a. accountability of the nurse. b. reduction in liability claims. c. reduction in workers' compensation claims. d. improved financial outcomes. e. more expert involvement at the point of care.

ANS: A, D, E Shared governance has far-reaching implications for leaders in today's health care environment, in which the focus is to provide patient care safely, efficaciously, and efficiently. Organizational benefits include increased commitment of staff to the organization; accountability of the nurse; a new level of professional autonomy; a more efficient model for point-of-service decision making; more expert involvement at the point of service; a more assured, confident patient advocate; and improved financial outcomes. Patients benefit from a more efficient model of health care service, more committed health care professionals, quicker responses at the point of service, and a more assured, confident patient advocate

In an organization that has a decentralized organizational philosophy, decision-making authority rests in levels closer to the point of service rather than in the executive levels. Benefits of a decentralized organizational philosophy include: (Select all that apply.) a. encouraging more input. b. supporting greater innovation. c. facilitating faster response times. d. permitting a narrower span of control. e. allowing for more levels of management

ANS: A,B,C Decentralization encourages and facilitates greater innovation, more input, and faster response times. Centralized decision making results in a narrower span of control and more levels of management, while decentralized decision making generally means that the span of management is larger for each manager.

A nurse works in the critical care unit (CCU). She enjoys being on the unit charge nurse team, the recruitment and retention team, and the peer evaluation team. The recruitment and retention team is responsible for hiring new employees into the CCU. The five-member team, consisting of three registered nurses (RNs), a unit clerk, and a nurse's aide, conduct the interviewing process with key questions that were developed by the team. This is an example of: a. centralized power. b. shared governance. c. span of control. d. vertical authority.

ANS: B For shared governance to be effective, decision making must be shared by empowered staff at the point where patients receive care.

One obstacle in the implementation of a shared governance model is that nurses have: a. empowered participation in committee meetings. b. limited time to work on projects. c. the same basic educational foundation. d. traditionally worked in decentralized structures

ANS: B Implementing a shared governance structure can take years; it does not happen overnight. It takes commitment, ongoing education, transparency, time, and dedication. "Shared Governance is not easy to develop... It takes time to be effective. Neither staff nor leaders/managers should assume that the approach relieves leaders and managers of their responsibility to do their jobs" (Finkelman & Kenner, 2016, p. 457). "The biggest barrier to shared governance is having dedicated time for meetings and for work on projects

Nurses' involvement in shared governance is an important component of: a. practice models. b. Magnet recognition. c. increased reimbursement d. physician satisfaction.

ANS: B Nurses' involvement in governance is an important component of the American Nurses Credentialing Center's Magnet Recognition Program

Research about shared governance suggests that it is: a. enhancing the role of the nurse's aide within the organization. b. improving organizational and patient outcomes. c. not a cost-effective program when examining all areas of care. d. too much additional work for the already overwhelmed RN.

ANS: B Shared governance has far-reaching implications for leaders in today's health care environment, in which the focus is to provide patient care safely, efficaciously, and efficiently. Organizational benefits include increased commitment of staff to the organization; accountability of the nurse; a new level of professional autonomy; a more efficient model for point-of-service decision making; more expert involvement at the point of service; a more assured, confident patient advocate; and improved financial outcomes. Patients benefit from a more efficient model of health care service, more committed health care professionals, quicker responses at the point of service, and a more assured, confident patient advocate.

Shared governance is a model of organizational structure in which staff nurses are: a. employed to establish mutual goals with clients. b. empowered through autonomy and accountability. c. engaged in problem-solving strategies and techniques. d. equipped with evaluative thinking methodologies.

ANS: B Shared governance is a model of organizational structure in which staff nurses are empowered through autonomy and accountability.

The local hospital has a new specialty unit for women and children. The nursing staff has created a family advisory council to assist in reviewing educational materials used at discharge. This shared governance structure is an example of: a. interprofessional education. b. whole-system integration. c. engagement. d. collaboration

ANS: B Some see the benefits of decentralization and the shared governance model extending beyond nurses and all care providers to all employees. "As for the future of Shared Governance, Susan Allen PhD, RN (assistant vice president, Cincinnati Children's Hospital) says it would be ideal to see whole-system integration involving all hospital staff. Clearly, the next steps in this vision are to include patients and the community more deliberatively into the shared governance model. Allen says Cincinnati Children's Hospital has a family advisory council and a teen council that get involved in projects, including reviewing potential educational materials and designing a new learning center

The nurse manager should use which of the following behaviors when implementing a shared governance structure? a. Autocratic decision making of the manager b. Coaching the staff to be successful c. Harboring the vision within the team d. Reimbursing the staff for overtime

ANS: B To be successful, shared governance structures need leaders who are role models and mentors. Staff and management must be dedicated to coaching and continuous learning.

In organizations that practice shared governance, the nurse manager's role is to: (Select all that apply.) a. hire new employees. b. mentor the nursing staff. c. train new nurses in patient care. d. support the decisions of the nursing team. e. enable the staff to become effective leaders

ANS: B, D, E The nurse manager is primarily responsible for mentoring, facilitating, enabling, and supporting the staff personnel. Sustainable change can occur at the unit and organizational level if the nurse manager works within the framework of transformational leadership, shared governance, and action processes.

Decentralization occurs when: a. equipment is being purchased from approved vendors. b. hiring decisions are made at the executive level. c. power is distributed to those closest to the work of caregiving. d. supplies are distributed from one central supply area in the hospital

ANS: C Decision-making authority rests at lower levels in the organizational framework, closer to the point of care, rather than being passed up through the chain of command to an executive

Which of the following leadership styles is best suited for implementation of a shared governance structure? a. Authoritarian b. Autocratic c. Participative d. Laissez-faire

ANS: C Participative leadership—the notion of leaders turning to their team for input and ideas—was first introduced to the business world in the 1970s. It was adapted by health care organizations and nursing leaders in the early 1980s, and formed the basis of shared governance, which today has evolved to define the role of nurses as well as to resolve issues related to patient care.

Shared governance is a vehicle for engaging organizations and creating the necessary forums and intersections that assure the decisions and actions remain dynamic and as close to the point of service as possible. Shared governance promotes: a. dependence. b. non-punitive culture. c. collaboration d. executive decision making

ANS: C Shared governance is an accountability-based model through which nurses actively engage in making decisions regarding nursing practice, quality of patient care, education, nursing peer issues, and issues in the work environment. In a shared governance environment, staff take ownership of decision making. This is "a dynamic staff-leadership partnership that promotes collaboration, shared decision making, and accountability for improving quality of care, safety, and enhancing work life

The __________ of an organization is the formulation of ideas, plans, or dreams that help shape the future and ability to persuade colleagues and associates to share those dreams. a. mission b. core values c. vision d. organizational chart

ANS: C The mission, core values, and vision are the instruments that give voice to the organization's philosophy. "The mission is a simple and direct expression of a company's goals and objectives. It defines what a company stands for" (Kurian, 2013, p. 186). The vision is the formulation of ideas, plans, or dreams that "help shape the future and ability to persuade colleagues and associates to share those dreams

The instruments that give voice to the organization's philosophy include which of the following? (Select all that apply.) a. Goals b. Focus c. Vision d. Mission e. Core values

ANS: C, D, E The mission, core values, and vision are the instruments that give voice to the organization's philosophy. The mission is an aim to be accomplished. It influences the philosophy, goals, and objectives of an organization. The vision is a mental image or the power of imagination to see something that is not actually visible.

Traditionally, nurses have worked in strong, hierarchical institutions with centralized decision making and clear authority structures, rigid approval mechanisms, and extensive policies and procedures that have resulted in barriers to creating a shared governance system. One such barriers is: a. lack of role clarity. b. lack of time management. c. poor time management skills. d. that development takes a long time.

ANS: D Effective shared governance is an ongoing process. Both staff and unit managers need to become comfortable with how governance is shared. Development is gradual and time consuming. To be successful, shared governance structures need leaders who are role models and mentors. Staff and management must be dedicated to coaching and continuous learning.

The purpose of an organization's philosophy is to: a. influence the goals and objectives of an organization. b. display how the parts of an organization are connected. c. be an instrument that gives voice to the organization s mission. d. serve as the institutional framework that shapes the direction of knowledge and skill acquisition

ANS: D Hospitals are organized and their work is structured around a guiding philosophy. The philosophy serves as the institutional framework that shapes the direction of knowledge and skill acquisition. It is the pivotal factor in the long-term development of the institution.

In organizations that practice shared governance, staff, managers, and leaders are responsible for: a. technology. b. budgeting. c. education. d. innovation.

ANS: D In organizations that practice shared governance, staff as well as nurse managers and leaders are responsible for innovation. Innovation is considered crucial to safely and effectively solve complex care problems. The entire team is responsible for unit outcomes, not just the individual manager. The manager is primarily responsible for mentoring, facilitating, enabling, and supporting.

Which of the following statements best describes an organizational chart? a. All job positions are displayed clearly in a two-dimensional drawing. b. All outside organizations with relationships to the hospital are depicted. c. Informal and formal structures within the organization are outlined. d. It shows organizational positions and relationships in a visual representation.

ANS: D The organizational chart is a diagrammatic representation that displays "the flow of authority, chain of command, titles, and functions.