Bill Klaproth (Host): This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. And with me is Cy Amoin, President of Nursing Staff at Advocate Health in North Carolina and Georgia. And we have Judi Hahn, most recently the Executive Director at Nursing Professional Practice at Yale New Haven Health, as we talk about professional governance in nursing today. And Cy and Judi are also the co-chairs of the Professional Governance Leadership Conference happening this year. So, Cy and Judi, welcome and thank you so much for being here. Cy, let me start with you. So, what is professional governance and why does it matter today?

Cyril Amoin: Thanks, Bill. I'm glad to be here and love to talk about this topic. And that particular question resonates a whole lot to me as a professional governance leader myself in our organization. Professional governance is an organizational structure that supports and enhances clinical professionals' ownership of decisions central to their roles and accountabilities.

You know professional governance is working, first, if nurses feel a strong sense of accountability and ownership of their professional obligations. Second, when nurses develop and strengthen collateral relationships across the healthcare ecosystem. Third, if nurses exhibit effective decision-making through informed evidence-based framework. And finally, and ultimately, when all the aforementioned behaviors demonstrate an impact on healthcare outcomes and the societies we serve as a profession.

Now, why does it matter, right? This is cliché, but nursing is the backbone of healthcare. And healthcare is becoming more complex, more challenging these days. Technology is advancing rapidly, and the work of nursing is becoming more demanding. This is ultimately a great opportunity for nurses to step up, but we face issues of disempowerment and lack of control. The very backbone of healthcare is facing these issues. And can you imagine how vicious that cycle is?

Professional governance matters now more than ever because it provides the permission and respect for the power and expertise of the nurses at the frontline and gives them control over their practice.

Host: Yeah, that makes a lot of sense. I love when you say nursing is the backbone of healthcare. That is so true. So, that's why professional governance is so important. So Judi, what is the relationship then between clinical nurse leaders and executive nursing leaders in making successful nursing governance?

Judi Hahn: Yeah. Thanks, Bill. We've really shifted from what we used to call shared governance to professional governance, which really is a model for clinical nurses and executive nurse leaders to collaborate as peers, as professional peers to make decisions about nursing practice. And that really includes the competence of nurses, the quality of nursing care, and that advancement of nursing knowledge through evidence-based practice and research.

So in this newer contemporary mindset, every voice really has value regardless of role, and the professional accountability belongs to all members of the nursing profession. So, clinical nurses and executive leaders really focus on their partnership and mutual accountability versus that old-fashioned traditional top-down hierarchy. And together, as peers, these professionals define the standards of practice and advance professional nursing to ultimately achieve patient outcomes.

Host: Yeah. To strengthen professional governance, where should they start?

Cyril Amoin: Oh, that's a loaded question, Bill. It's a heavy one. But let me just start with the fact that there is no magic wand for professional governance. There's no spell and you snap your fingers and professional governance just happens. It is a lot of work, but it is great work.

But for any administrative leaders or any leader, professional governance starts ultimately with intent. That intentionality should be at the forefront. Ask yourself, why do you want professional governance in your organization? It must not be because professional governance is the recent current buzzword in nursing. Professional governance has a purpose that goes beyond the establishment of the structure, and organizations must truly believe in the power of professional nurses and—bold this—invest in it. Understand your administrative leader's role as an administrative leader. How do you plan on supporting the work? Ask yourself, how do you bridge the divide and strengthen the connections? And what is your role in this power gradient?

Another thing that you need to do is also assess your current state as an organization. Are the nurses owning their practice? Are they involved in the decisions that affect their practice and their accountabilities? Are the structures in place to position the nurses to take action? So, those are sort of reflective things that you need to have in mind as an administrative leader trying to roll out professional governance and have it in your organization.

And there are other things that we can do. And then, these are not steps. You don't have to do them step by step. But other elements that you need to consider is to establish definition and the vision of professional governance within your organization and understanding that, ultimately, as what Judi alluded to, it is a product of collaboration. It's not just one side and the other side, and one reports to the other. It is really a work of collaboration.

And there is also a need for securing executive and manager commitment. It is truly a commitment from the leaders for professional governance to work. It is crucial for you to clarify the decision-making authority and practice changes, and you build and redesign these foundational structures as leader as well. Position the nurses to understand professional governance, their role in the work, and the impact it demonstrates. And I know that's a lot, right?

But finally, I think one of the most important things is eyes on the prize. In addition to behaviors that reflect ownership, professional governance delivers positive outcomes. A collaborative approach in identifying which outcomes to tackle and develop processes to take is crucial in demonstrating that governance impact. So impact, impact, impact.

Host: Impact. Impact, impact. Now, Cy, you bolded invest in it in that. So, obviously, when you invest in something, you get more returns, better outcomes, et cetera, right?

Cyril Amoin: Exactly. And that's what the power of professional governance is. It's more than just the building of the structure. It's setting in motion the structure that works. And you know if it works if you're seeing things change for the better.

Host: Yeah, that makes sense. I love how you did that. Wait for it, here it comes. Invest in it. You really punched that out there. So, you got that point across. So, thank you for doing that. So Judi, what is the future then of nursing professional governance? If you could look into your crystal ball, where are we going with this?

Judi Hahn: Well, I think like I highlighted before, we are starting to see the old language of shared governance going away. We have embarked into this concept of really embracing our profession, which includes all nurses as peers, to work together through these accountabilities of the profession of nursing.

And like Cy's organization and Yale New Haven Health, we're starting to see more organizations use the power of systemness and really harness the system to standardize best practices, to harness the power of networking and integrating across inpatient settings into ambulatory settings. And we're starting to see professional governance in what we would say nontraditional settings everywhere that nurses practice.

I also think that our data and metrics are changing, and they're central really to the outcomes that we measure. So, think about the big data that we have now through the electronic health record and we really have lots of opportunity to measure the impact that we're making, which is very different than it used to be. So, I think that's the future.

I also think that in order to be nimble and move more quickly, we'll have to focus on communication and connecting our system along the way and all of our systems and partners that we practice with, with strong relationships to really drive those outcomes. And then, of course, shine out those outcomes to the people doing the work and celebrate them.

We do now know, and we've done a lot of research to study nurses engaged in nursing professional governance over the years, and we know that nurses are really fulfilled when they're engaged in this work and making change. And I think that we'll see that in the future the power of this structure to really make change. So, I think that's really a bonus and the icing on the cake.

Host: Well, as you say, nurses are certainly more fulfilled when they are engaged, and certainly professional governance can give them a structure for that. Cy and Judi, I want to thank you so much for your time today. This has really been wonderful. Thank you so much.

Judi Hahn: Thanks, Bill.

Cyril Amoin: Thanks for having us, Bill.

Host: Betcha. And once again, that was Cy Amoin and Judi Hahn. 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 at aonl.org/nursing-leadership-podcast. This is Today in Nursing Leadership. Thanks for listening.