Bill Klaproth (Host): So, why is leadership so important to a successful professional governance? Who are the leaders in professional governance? And what is the role administrative leaders have in contributing to the success of professional governance? Well, let's find out with Beverly Hancock, Senior Director Leadership Development at the American Organization for Nursing leadership; and Kevin McEwan, Chief Nursing Officer at Madison Memorial hospital.

Host: This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. Beverly and Kevin, thank you for your time. So Beverly, let me start with you. When we talk about professional governance, why is it important that we're talking about this? Why do we need to raise awareness about this?

Beverly Hancock: Professional governance is a newer term for what has been around for over 40 years, which we've known as shared governance. And in the 40 year period, we have just not gotten to where we need to be in governing our profession. So, professional governance is nurses having control and ownership over the decisions and actions that relate to nursing practice. So, the quality, knowledge management, competence, those are all things that we need to own as nurses. And we are shifting our terminology to professional governance, which emphasizes more of that ownership. And in order to get where we need to be in governing our nursing practice, we need to have a strong emphasis on this, and particularly coming out of the pandemic. During the pandemic, people were saying that they were pausing shared governance, and you can't really pause control over your practice. And so, we realized that the concept was just not being well understood or well implemented.

Host: Yeah, really good thoughts. So, thank you for sharing that with us. So when it comes to professional governance, then, Beverly, why is leadership so important to a successful professional governance?

Beverly Hancock: One of the things that happened with shared governance was there was a strong emphasis on the structures. And the structures are very important. In order to govern our practice, we have to have means of looking at the quality of what we're doing and having research and other things, having connections between the work that is the nurses who are delivering care directly to the patient, all the way up to executive leadership. So, you need structures, but structures alone aren't going to get you where you need to be. And so, we need to have people who are able to lead within those structures. So, there really needs to be equal emphasis on the structures and the leaders. The structures are the vehicle, but the leaders are the drivers within professional governance.

Host: So Kevin, Beverly was just saying how important leaders are. So, who are the leaders then in professional governance?

Kevin McEwan: Well, ultimately, every nurse is a leader. Every nurse has ownership for their own practice. They're individually licensed. We're not licensed collectively or licensed as an organization within an organization. Every nurse leads. And those in the professional governance structures, there are formal leaders, positional leaders, we call them. And in some cases, the administrative formal leaders who have titles such as director or manager, participate in that structure, but they participate in more of a consulting and peer role when they're a part of the broader nursing professional governance. And then, there's positional leaders that chair that council or committee or structure. And so, they actually have positional leadership as well. So, leadership happens at all levels. It happens regardless of title or position. But within the structures of professional governance, nurses lead and they lead each other and they hold each other accountable and they make decisions about the practice of nursing.

Host: Yeah. You said every nurse leads. So, you also mentioned administrative leaders. So what is the role then of administrative leaders? What is their contribution when it comes to the success of professional governance? Can you expound on that a little bit more?

Kevin McEwan: Yeah. So oftentimes, those formal administrative leaders have a responsibility to make sure those structures are functioning. They also have a responsibility of kind of setting the vision. But the work of professional governance belongs to the nurses, so they have ownership of that and they lead these teams. They lead teams of patients, they lead teams of colleagues, they lead teams of a council. It can be a bit of a challenge. You know, that shift from a formal leadership title to all of a sudden being a member of a council, but being a peer and a consultant. And so, that happens a lot of times. And there can be a little bit of a power gradient and a struggle there as to who's really the chair or lead for this council, and it is the council chair. It's the positional leader that is oftentimes a staff nurse, a clinical nurse. But in professional governance, they become the leader and the formal leader becomes the peer and consultant.

Host: So, it's not necessarily a top-down leadership model. That's what we're trying to get away from, right? We're trying to get into a more collaborative, open, safe environment where everybody can share and participate. Is that right, Kevin?

Kevin McEwan: Exactly. Yes.

Host: Yeah, that's really important. So Beverly, let me ask you then, how are leaders developed? How do we take people that are just great workers and turn them into great leaders?

Beverly Hancock: Kevin's response to who are the leaders here gets at the complexity of leadership within professional governance because you have a hierarchical model for the administrative leaders, manager, director, executive. But as you said, professional governance is a collaborative leadership. When you have nurses whose primary role is to provide direct care, they are not, you know, in nursing school, we're not necessarily equipped to have strong leadership skills in things like leading a committee meeting or a council meeting or helping peers come to a decision or those types of things. And for the manager or the executive, it's not a natural thing when you're used to being in the positional leadership of an administrator to then be a peer. And so, there's a lot of skills that need to be focused on and it really starts with when somebody is in nursing school. That's really where we think the foundations need to be laid of talking about professional governance, ownership for practice, what does it mean to own your practice as an individual nurse. And that is a part of learning how to lead, is how do I manage my practice and work with the team around me and lead the team frequently that's there.

So, it starts there. It continues when somebody comes to an organization, it should be foundational. I think a part of the leadership development is understanding the expectations of each nurse. So when that is conveyed in orientation when someone is new to an organization and not just the direct care nurse, this is also for any person who is new to a leadership role where the expectation is we use professional governance here, and this is how each of us functions within that, here's the roles we have. But it's an ongoing thing. So when somebody is new to a council chair role, that is a really important role that takes good mentoring and coaching. And so, the manager is the best person to do that. The manager is sitting in the council meetings. They can meet with them ahead of time, go over the agenda, help them develop some of these leading meeting skills. But managers themselves need that development. They don't always come equipped with that.

So, it's really paying attention within the organization to say these are ongoing competencies that need to be developed. And how do we do that? We have roles of people being over like the president of professional governance or that the clinical council chair, which are our organization-wide roles, and those really need the nurse executive to be coming alongside them and mentoring, learning systems thinking, learning how the whole organization functions, understanding strategic goals. There's a lot of leadership development that occurs because of this coming alongside by people who are already strong in their leadership, whether it's an administrative role or a nurse that's in professional development or a past president or whatever it might be. So, it needs to be from multiple ways.

Host: Kevin, as our CNO on this podcast, I'd love to get your thoughts on how leaders are developed.

Kevin McEwan: Well, I think Beverly just did a great summary of how nursing leadership develops and the competencies that are established and it's actually advantage that nursing has over some of our other colleagues, even medical colleagues, that we have these structures in place to build and grow and develop leaders, and professional governance does that. It's a safe spot to run a unit-based council and to be the chair of your peers and to figure out how to compromise and delegate and followup and all of those kinds of things.

And so, we really do develop leaders along the continuum of opportunities within professional governance, that's a common succession planning tool that I don't think that most organizations always realize that that's what these unit-based councils and clinical councils and practice councils are doing, is they're helping emerging leaders to really find their self and to find their voice in nursing. So, we develop leaders in a lot of ways.

AONL has great training competencies that we use to evaluate leadership skills and development. And we have all kinds of opportunities to grow those leaders in areas where they need to strengthen. But professional governance helps us with that because it gives us the safe space in nursing to hold ourselves accountable to nursing practice and to improve practice through evidence-based research, and to implement safe good practice. And we sit back and go, "Wow, we really made some great decisions in this council," working together and owning nursing and not, you know, allowing our colleagues or medical community to say, "This is how you should treat patients in a certain way." So, there's a lot of development that goes on in lots of facets of healthcare. But shared governance is that platform and structure to really elevate our voice.

Host: Absolutely. Very well said. So, let me ask you each of this same question. What is your key takeaway when it comes to talking about nursing leadership, behaviors and professional governance? Beverly, let me start with you.

Beverly Hancock: A key takeaway is that it is this marriage of structure and leadership to be effective, that it is important to establish those structures well, whether it's committee structures or bylaws or all of the things that go into it. But without good leadership development, it is difficult for those structures to be effective on their own.

Host: I like how you said, the marriage of structure and leadership. What a great way to put it. And then Kevin, how about you? What is your key takeaway to remember when we're talking about nursing leadership behaviors and professional governance?

Kevin McEwan: I think it's that leaders at all levels need to be present. And oftentimes, we see professional governance as a way to delegate the practice of nursing to those closest to the bedside. And that's great. They should be absolutely at the table and front and center and at the bedside. But positional leaders, emergent leaders, our nurse leaders at the bedside all need to be present and work together to make sure that we have the outcomes, which are, you know, patient outcomes and patient satisfaction and staff satisfaction and good clinical, presentations. So, those are all things that that have to happen. It's that structure, process, outcome, focusing on the outcomes we want and make sure that that structure, but the process is us. It's nurses coordinating, collaborating with each other and our peers and colleagues to make sure that the outcomes for our patients are exactly what they deserve.

Host: Good advice for anybody. Leaders need to be present. So true. And then, I love how you said the process is us. Well, I want to thank you both for your time today, Beverly and Kevin. As we wrap up, I would just like to ask each of you if there are any additional thoughts you'd like to share. Beverly, let me start with you.

Beverly Hancock: You know, Kevin touched on this. But one of the exciting things that I've seen in professional governance is how it contributes to leadership development of staff, not just for the role that they're in in professional governance as a leader. But for clinical staff, it launches them into leadership. They see what it means to effect change, to have ownership of practice. And so many go on for formal leadership roles. Many of the leaders I've met got their start because of being formal leaders within professional governance as clinical staff.

Host: Great thoughts. Thank you for that, Beverly. And let's wrap up with you, Kevin, any additional thoughts?

Kevin McEwan: Well, I don't want to sound like a book salesman, but this new publication that's coming out really is a comprehensive book about text, about shared governance at all levels. And I don't think we've had anything like that. That has been a roadmap for system nurse leaders all the way to our bedside position leaders. And I'm just really, really excited for people to use this as a tool. Because in most cases, nurses have either adopted a structure or been gifted one from a previous leadership structure, or do not have shared governance within their organization. Dr. Tim Porter, Grady and Dr. Start and Dr. Hancock have put together this very, very comprehensive book with chapter writers who are in the know. I just think it's going to be exciting to watch people use this as a platform for restructuring or building professional governance in their organizations, and we really need it.

Host: Yeah. Well, Kevin and Beverly, thank you so much for your time. We appreciate it.

Kevin McEwan: Thank you, Bill. Thank so much for what you do.

Host: And once again, that's Beverly Hancock and Kevin McEwan. For more information, please visit aonl.com. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Today in Nursing Leadership. Thanks for listening.