Christi Welter (Host 1): Welcome to Nurses Connect, a podcast from Children's Health dedicated to exploring critical issues and dynamic topics that shape the nursing profession today. I'm Christi Welter, Program Manager of Nursing Communications.

Brennan Lewis (Host 2): And I'm Brennan Lewis, Vice President of Nursing Excellence. We are your co-hosts for Nurses Connect, and we're so happy you have decided to spend some time with us today. On this episode, we're discussing how nurses can make a difference in decisions that shape their practice through nursing professional governance.

Host 1: Last year, our nursing program made the shift from shared governance to professional governance. Today, our Chief Nurse Executive Tammy Webb, is joining us to discuss some of the key components of nursing professional governance or NPG and why we transitioned to this new model. Together, Tammy and Brennan laid the groundwork and spearheaded the strategy for NPG at Children's Health. Welcome, Tammy, and thank you for joining us today.

Dr. Tammy Webb: Thank you. I'm so glad to be here today.

Host 1: To get us started, can you both help us understand what is nursing professional Governance and how is it different from shared governance?

Dr. Tammy Webb: Sure. So with nursing professional governance, we look at nursing as a profession. So, nursing is one of the oldest most noble and trusted professions. And we are a discipline, much like our colleagues in healthcare, like physicians and pharmacists or therapists. And so, we truly have an identity. It's recognizing that nurses are professionals that have ownership and decisions that affect their practice. And this starts by empowering nurses with accountability, autonomy, and authority. So, this is different from shared governance, because it focuses on nurses as professionals.

Shared governance evolved over many decades, much promoted by the ANCC Magnet recognition, and it was really important work to advance nursing to be recognized as a profession. And so, moving from shared governance to nursing professional governance is really an evolution of ensuring that nurses are making the decisions, not just providing shared input to leadership or hospital administration. So, that's really the culture shift that we're making at Children's Health to ensure that nurses truly are making decisions that impact their practice and the work environment that they serve in.

Host 2: One of the things that was really important to us is really shaping the nursing culture at Children's Health. And as a profession, we're accountable to quality practice, competence, and knowledge, and this is how we really demonstrate nursing as a profession. We knew that we really needed to focus on the mindset around the profession and involvement in professional governance. So, we've talked a lot with our nurses, nurse leaders around instead of, "This is my job," really shifting the mindset to "This is my profession." Instead of saying things like, "This is extra work," it really is, "This is the work," instead of saying things like, "No one cares about my voice." It's really empowering our nurses to take ownership in saying, "I care about my voice." And instead of believing nothing will ever change, it's believing that change will happen and how might we do it?

Dr. Tammy Webb: Exactly. So with shared governance, we didn't engage nurses until year two. And with NPG, we're engaging our new nurses immediately. They bring a new perspective, they modernize the profession, they're the future workforce, and they help us to challenge the status quo. So, nurses not only share decision-making, but they make the decisions and they're empowered to ask questions like, "How can we make this work and why do we do it this way?"

Host 1: That's great. And Tammy, can you talk about how Nursing Professional Governance aligns with the nursing strategic priorities at Children's Health?

Dr. Tammy Webb: Sure. So first of all, nursing professional governance really is the core or the framework for us to execute a nursing strategy in a organization. So, we developed the nursing strategy to advance our future nursing workforce, aiming to fulfill the growing demand of healthcare systems by attracting and retaining the top best talent in Nursing. We also aim to transform practice with empowering our nurses with knowledge and skills and resources that they need to provide the best, highest quality, patient-centered care that promotes optimum quality of health for all, and advancing professional nursing excellence, aiming to elevate the role of nurses as leaders, innovators and advocates to advance professional nursing excellence.

So, this is all through their development, mentoring them and collaborating with other interprofessionals to meet the healthcare needs of our evolving patients, individuals, children certainly, and communities. But a critical underpinning of this strategic plan was to launch and establish and evolve to nursing professional governance to really cultivate that professional accountability and ownership of their practice. To do this, we needed a first design and build a structure and processes to support that engagement at the right levels and at all levels for all nurses to help own nursing professional governance.

Host 1: And Brennan, I know that you worked really closely with Tammy on all of this. How did you determine that this was the right direction?

Host 2: When we were considering a shift to nursing professional governance, we started with a SWOT analysis to really identify our strengths, weaknesses, opportunities, and threats. At the time, we were a three-time Magnet-designated organization and we had a 10-year history, really a great foundation with shared governance. We have about a 96% of our direct care nurses having a BSN. We had a very high engagement score of a 4.2. And we really did have nurses participating in shared governance and starting to use evidence-based practice. What we really needed to work on was increasing decision-making that was truly happening in the councils, reviving our unit practice council structure. And really, our overall structure to support that decision-making from the unit level, the department level, all the way up to the system. We wanted to focus really teaching nurses how to evaluate data and work to improve patient outcomes.

Host 1: So once the analysis was done, what were the next steps in building out the strategy? And maybe Tammy, could you elaborate on that a little bit?

Dr. Tammy Webb: Absolutely. So yeah, the first thing that we did, when I first came as a CNE, is really to look at what decisions are nurses making, and they could talk about their participation in shared governance at the time. It was really pretty strong. But they weren't telling me the impact that that was having on their practice. So, that's when we decided to measure it. We did a couple of different levels of measurement over time where we were asking for the nurse's perspective. And what we found out early on was it really leaned mostly to administrative leadership decision-making, not so much in the area of where nurses were actually being autonomous in that decision-making. We also saw a bit of that in nurse engagement scores, which have now greatly improved. So, we really wanted to move that into a formal process and a structure for nurses to be able to be empowered to make decisions and move decisions from administrative nurse leaders into the nursing professional governance.

So, I'll give you a great example. So if your chief informatics officer calls your chief nursing officer and asks them to make a decision about nursing practice or a change that they're going to make in your health record, i'm not the expert anymore. So. I help them, Brennan helps them to connect to the appropriate councils for the nurses to inform. And then, they're actually formally making decisions, not just providing input.

Host 2: One of the things that I'll add is knowing that we wanted to shift to professional governance, we really looked to see what resources we needed internally to support a robust governance structure. At the time, we had one program manager and what we evolved to was a program director with two program managers, and it really is to support our large health system with two hospitals in varying locations, large clinics, et cetera. And so, we really wanted to make sure that we invested in the resources to really develop the infrastructure that would support decision-making at all levels.

Dr. Tammy Webb: And I'll also just share, you know, some of the successes as we're talking about, also some of the challenges that ended up being really positive outcome is, if you remember, kind of pre-pandemic, we really made nurses come to meetings on their own time or outside of their schedule. And then, we learned how to do virtual and remote meetings actually quite effectively. So when the pandemic hit, our participation went up exponentially and nurses had the availability and the flexibility to engage through the remote platform. So, I kind of gave up on forcing nurses to try to come into a meeting and sign in. We found different ways to engage them. We coach them on how to be engaged in a virtual platform. They're required to be on camera. They're required to participate. We see people's dogs and children and whatever's going on in their home life, and that's okay.

The other thing, I think, that's a huge success from what our nurses tell us is the value of their time. So before, they had to figure out how to get to council meetings, Brennan's team really helped us guide to a one-day all-day council meeting. It's protected. We adjust staffing for those nurses to have time paid away from their bedside job to participate. And then, the advanced leaders in governance that are chairs and higher level contributors have administrative time. And I think that's brought great recognition of the nurses' participation. Our membership is full right now. It's very competitive to kind of be nominated to be on councils, and we've seen exponential growth also in the outcomes of nursing councils in evidence-based practice, policy oversight and approval, nursing science and research, even leadership development.

And one of the things I'm most proud of is what I call really bedside to the boardroom, is I can better do my job as a CNE, because I represent nurses on the board, and they sanctioned our bylaws and approved all of our infrastructure that we put in place and have a new understanding of how nurse decisions are made.

Host 1: Well, next episode, we'll be diving in deeper into the specific ways the strategy was operationalized and how it has contributed to our culture of nursing excellence at Children's Health. Until then, Brennan and Tammy, what is one thing each of you want our listeners to know about nursing professional governance?

Host 2: I think one of the things that stands out, looking back and how we really transition, and it's been a journey, it's certainly not a sprint. It's more like a marathon. And we continue to work at transitioning and leveraging our governance structure to its full capacity. But what we did that was really successful, we started planting seeds and that started with sending myself and my program manager at the time to the Nursing Professional Governance Conference that American Organization for Nursing Leadership hosts. And it was one of the most impactful conferences that really helped us to start visualizing what our journey needed to look like. We brought that information back into our organization and began planting seeds starting at the highest level of nursing to our nurses that lead from the bedside. And that was really foundational to help us really transition from shared governance to professional governance.

Dr. Tammy Webb: Yeah. And I would just add, especially as you know, leading a nurse executive team and workforce, it's not just a nursing strategy or a strategy to do MPG or do it because it's promoted to receive Magnet recognition, but it really is the foundation for all nurses to own and lead their practice. And we honestly can't do what we do without it. And to also comment on what Brennan said, when our magnet site visit was here, just to share a quick story, they went into one of our inpatient units and asked a nurse if they were a team leader. And the nurse said, "No, I lead from the bedside."

And I knew then something was happening positive in our culture, because nurses do lead from the bedside and we need to continue to foster that. All nurses should somehow be engaged in nursing professional governance. And this is really and truly how we demonstrate our values for practice, quality, competency, and knowledge.

So, we also want to thank Dr. Tim Porter-O'Grady. A lot of our work is based on the work that he's published over the years with his colleagues, and he's always been very supportive to us in our times with him in conference. So much of this work, if you want references, certainly, you could find much more information

Host 2: Just one thing to add is really looking back and as we resurveyed our nurses to find out where we've been and where we've come and nurses really saying they're definitely more involved in decision-making than they ever have been. And we're seeing that reflection in the amount of EBP projects, evidence-based practice projects, quality improvement projects, going out and presenting at national conferences, publishing for the first time, as well as within our nurse engagement scores.

It's really exciting now as our colleagues in other professions like pharmacy and respiratory are really reaching out and saying, "We want to start a governance structure similar to yours." If you had some advice to give to another organization that was looking to implement nursing professional governance, where would you tell them to start?"

Brennan Lewis (Host 2): I think it goes back to something I said is it is a heavy lift, especially depending on how large your health system or your organization is, and investing in the right resources upfront to support the infrastructure, because lots of meetings talking about what professional governance is and really shaping the culture and shifting mindset isn't just taking place in one conversation. It takes place with many conversations, lots of training, and lots of reinforcement. And so, I think investing in the resources to really support the infrastructure of the council is one of the most important.

Dr. Tammy Webb: And then, just fundamentally ask your nurses. You've got to have their perspective about how it's working, what decisions they're making, how they want to engage, and don't assume they've ever done it. Because I mean, in school, they're not really an independent practice. Many of them have never had an environment that fostered it. So, you do have to learn where they are and their understanding and awareness and what their perspective is.

Host 2: One of the things that I think is a real highlight is, you know, ensuring that our chief nursing officer, Tammy as our chief nurse executive, are really visible to all of our nurses and accessible. And one of the things that is really a success was starting a general session and inviting every nurse in our whole health system to join and hear what's going on in nursing, how are our nurses contributing to excellence every single day? And then, hearing from Tammy, our chief nurse executive, to really showcase and highlight various different work that our nurses are doing across the system.

Host 1: And for the average nurse that's, you know, listening, maybe it's a clinical nurse or a nurse manager, why should they be involved in nursing professional governance?

Host 2: We get this question often, is how do I get my nurses inspired to engage in professional governance? And it goes back to really setting that mindset and formal nurse leaders, really empowering their nurses and letting them know their voice does matter, and they are the clinical expert over their practice at the bedside, and we need them at the table to help guide decision-making so that we get it right on the first time. And I think it goes back to making sure your leaders are equipped to have those conversations, and why that work is important. And again, it's not extra work. It is the work that we do as a nursing profession.

Host 1: All right. Well, with that, we will wrap up this episode of Nurses Connect. Thank you, Tammy, for joining us today.

Dr. Tammy Webb: Thank you for having me. I'm truly thrilled about our nurses empowerment and through this process. So, the contributions they're making to nursing excellence is really the outcome.

Host 1: And thank you to my co-host, Brennan, for sharing your knowledge about NPG.

Host 2: If you want to know more about nursing at Children's Health, we encourage you to visit childrens.com/nursingannualreport. Here, you'll find a variety of information that summarizes some of our initiatives, including nursing professional governance.

Host 1: And don't forget to tune in next month for part two of our discussion about nursing professional governance. Thank you to our listeners for joining us today, and we'll talk to you next time on Nurses Connect.