Implementing Shared Governance in Rural Hospitals

Abstract

Nurse disengagement and high turnover rates present significant challenges in healthcare, particularly in rural hospitals, where resource limitations and staffing shortages exacerbate the issue. Traditional top-down management structures have been identified as a contributing factor to diminished nurse morale, lack of autonomy, and decreased job satisfaction. This has strongly influenced the increase in turnover rates, further straining the healthcare system, making it imperative that hospitals implement interventions to improve job satisfaction and nurse engagement. A literature review has identified Shared Governance (SG) models as an evidence-based best practice intervention in acute care hospitals, and they correlate with increased job satisfaction, decreased turnover, and improved patient safety and satisfaction. This project provides a framework for creating and integrating SG into rural hospitals, demonstrating its potential to enhance nurse engagement and retention while ultimately improving patient care quality. The intervention involves establishing an SG Council, comprised of direct patient care nurses and other key stakeholders, ensuring that nurses are involved in policy decisions, resource management, and practice improvements. Following the Institute for Healthcare Improvement’s (IHI) Plan-Do-Study-Act (PDSA) cycle for iterative improvement, the project’s effectiveness will be measured using the Maslach Burnout Inventory (MBI), the Practice Environment Scale of the Nursing Work Index (PES-NWI), and hospital retention data. The proposed implementation of shared governance holds promise for improving nurse engagement, retention, and job satisfaction in rural hospitals. This QI project emphasizes the importance of nurse empowerment in fostering a positive work culture and improving healthcare outcomes. Continued data collection and evaluation are needed to assess the long-term impact of shared governance on nursing practice and patient care outcomes.