Digital Repository Masters Projects Spring 2023 Realigning Shared Governance to Improve Nurse Job Satisfaction Jamie Fontenot Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Fontenot, J. 2023. Realigning shared governance to improve nurse job satisfaction. Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. WSU REPOSITORY MSN/DNP Realigning Shared Governance to Improve Nurse Job Satisfaction Project Title by Jamie Fontenot Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY Ogden, UT April 1, 2023 Date Jamie Fontenot, BSN, RN April 1, 2023 Student Name, Credentials Date (electronic signature) 4/4/2023 MSN Project Faculty (electronic signature) Date Melissa NeVille Norton (electronic signature) Date DNP, APRN, CPNP-PC, CNE Graduate Programs Director Note: The program director must submit this form and paper. 1 Realigning Shared Governance to Improve Nurse Job Satisfaction Jamie Fontenot, BSN, RN, MSN Student Weber State University Annie Taylor Dee School of Nursing 2 Abstract Nursing job satisfaction is a significant concern in the current healthcare system. Establishing effective solutions and tools to improve nurse job satisfaction will be critical in maintaining a strong and effective nursing workforce. This project aims to improve nurse job satisfaction by implementing a strategy to improve nurse engagement, empowerment, shared decision-making, and a professional practice work environment (PPWE). Shared governance councils aligned with an evidence-based model produce improvement in all of these essential factors related to nurse job satisfaction. This project includes resources for nursing staff and nurse leaders to implement shared governance realignment and education on the impact of shared governance participation. Education and nurse and leader buy-in are critical for the success of shared governance and its potential to improve job satisfaction in the nursing field. The benefit of improving nurse job satisfaction impacts the nurses themselves, their teams, their organizations, and the patients they serve. Keywords: nurse job satisfaction, shared governance, empowerment, engagement, shared decision-making, professional practice work environment. 3 Realigning Shared Governance to Improve Nurse Job Satisfaction Nurses comprise the highest percentage of healthcare workers and interact most with patients at the bedside (Kelly et al., 2021). The nursing profession is constantly changing, and the environment can often be stressful, making the need for improved job satisfaction essential. Utilizing shared governance models to improve nursing empowerment and engagement has been established as a vital goal of the Magnet model (Moreno et al., 2018). Shared governance is a model which incorporates the bedside nursing staff into the decision-making process for a unit, a facility, and an organization (McKnight & Moore, 2022). The purpose of shared governance is to engage the nursing staff in making decisions that directly impact them, their peers, and their patients (McKnight & Moore, 2022). Shared governance often consists of a council or a committee where staff can bring their concerns, ideas, questions, and suggestions to a group that can make decisions from the bedside staff up rather than from executive leadership down (McKnight & Moore, 2022). Shared leadership is an element of the Magnet principles. Magnet designation was developed in 1990 by the American Nurses Credentialing Center to recognize hospitals that gave excellent nursing care (McMacken, 2021). Magnet has developed principles that define excellence in nursing for both the patient and the nursing staff (McMacken, 2021). Magnet designation is awarded to hospitals that apply and meet the defined standards of nursing excellence (McMacken, 2021). Magnet structure models consider multiple factors of shared governance, from how shared decision-making should function to the length and scheduling of meetings, ensuring bedside staff can adequately and consistently be involved in the councils (Moreno et al., 2018). Aligning shared governance models with these principles is vital to ensure 4 that nurses feel heard and that they are an essential part of the decision-making process, all critical factors that impact job satisfaction. Increasing nurse participation in shared governance is also essential because the more involved nurses become, the more impactful the shared governance structure will be (Kanninen et al., 2021a). Educating bedside staff on the benefits of participating in shared governance will be essential to their buy-in and the success of shared governance as a collaborative decisionmaking body. Improving participation and including more input from bedside staff in decisionmaking will work towards an environment that fosters improved job satisfaction. Statement of Problem Job satisfaction is essential in any career, and nursing is no different. Obtaining high levels of job satisfaction is also critical for organizations because employees with higher levels of job satisfaction tend to be more productive and are retained for longer periods (Kyytsonen et al., 2020). A current problem within healthcare organizations is a decrease in staff satisfaction. This is evident in a particular organization when reviewing caregiver Press Ganey survey results which survey staff satisfaction, engagement, and perception of their workplace. Press Ganey results from multiple inpatient units within an Intermountain Healthcare facility for the 2022 year revealed that specific units that had previously obtained tier one and tier two levels for overall job satisfaction had dropped to tier three, the lowest level possible for the survey (R. White, personal communication, May 12, 2022). Engagement and shared decision-making are key indicators of nurse job satisfaction (AlRuzzieh et al., 2022). The principles of shared governance aim to produce and enhance engagement and shared decision-making. However, the existence of shared governance alone is insufficient to deliver these outcomes if it is not well aligned with high-functioning, proven 5 models (Moreno et al., 2018). This project intends to determine what high functioning shared governance looks like and how implementing high functioning shared governance or restructuring existing models impacts nurse job satisfaction. Ways Project Contributes to Intended Recipients Improving job satisfaction for bedside nursing staff is essential as they make up the highest percentage of caregivers within a hospital setting (Kelly et al., 2021). Nurses who feel empowered to speak up about problems they see within their workflows, such as patient safety, procedures, protocols, or other organizational matters, tend to feel more dedicated to their organization and job (Al-Ruzzieh et al., 2022). Empowering and engaging nurses also impacts patient care and satisfaction (Moreno et al., 2018). According to McKnight & Moore (2022), one of shared governance's most significant clinical impacts is improved patient outcomes. Patient outcomes associated with nursing-sensitive indicators have been shown through studies to improve when a shared governance model is in place (McKnight & Moore, 2022). Management, leaders, and the organization also benefit from nurses participating in effective shared governance because these councils and shared decision-making can produce new and innovative ideas from frontline staff that can significantly impact workflows and patient outcomes (Medeiros, 2018). Developing satisfied nursing staff who are empowered and engaged in shared decision-making is also essential to the Magnet principles (Moreno et al., 2018). Obtaining Magnet status is a current goal of the facility discussed in this project; therefore, aligning shared governance with Magnet principles to produce more satisfied, engaged, and empowered staff will be essential. Improving shared governance structure and participation should lead to improved job satisfaction and higher staff retention, which are all critical to the continued success of an organization (Kyytsonen et al., 2020). 6 Rationale for Importance of Project A work environment that supports nursing staff and values their opinions, ideas, and concerns is essential to building and maintaining a satisfied workforce. Utilizing an efficient and high-functioning shared governance model provides a platform for the bedside staff to share their voice, be heard, and participate in decision-making. This is essential because those decisions impact them as individuals, their teams, and the patients they serve. Effective shared governance can help support a better work environment focused on improving engagement, empowerment, and overall job satisfaction. Establishing this type of work environment is essential because nurse burnout and turnover rates are at a record high, making it critical to focus on improving job satisfaction (Kelly et al., 2021). Literature Review and Framework Job satisfaction is essential for all career fields, and nursing is no exception. Shared governance was introduced as part of a nursing professional practice model in the United States in the late 1970s to help improve staff empowerment and engagement (Kyytsönen et al., 2020). Shared governance in a nurse-centered organization has been viewed as a model for improving job satisfaction by strengthening and enhancing empowerment, engagement, autonomy, and shared decision-making (Al-Ruzzieh et al., 2022). Recent Press Ganey employee surveys demonstrate that job satisfaction among nurses has been declining. Shared governance has increased nurse job satisfaction (Al-Ruzzieh et al., 2022). However, the presence of shared governance without an effective structure does not significantly contribute to improved job satisfaction (Moreno et al., 2018). The proposed changes will align established shared governance councils with Magnet models and principles to produce effective outcomes that enhance job satisfaction. This literature review aims to present evidence regarding the impact of 7 a shared governance model on nurse job satisfaction. An established framework model will also be described as a basis of the project research and development. Framework The Stetler Model will be used as a framework for the problem of job satisfaction and the impacts of effective shared governance on job satisfaction levels. The Stetler Model includes five phases: preparation, validation, comparative evaluation/decision-making, translation/application, and evaluation (Melnyk & Fineout-Overholt, 2019). The preparation phase involves identifying a problem and using evidence to validate the problem (Melnyk & Fineout-Overholt, 2019). Validation includes assembling an evidence table and reviewing and evaluating evidence (Melnyk & Fineout-Overholt, 2019). In the comparative evaluation/decision-making phase, the evidence is synthesized, and unrelated evidence is removed (Melnyk & Fineout-Overholt, 2019). This phase also provides an opportunity to conduct research (Melnyk & Fineout-Overholt, 2019). Translation/application is the phase where the application level is determined, meaning that it is specified if it is the organization, a unit, or a group of people who are the target for the project (Melnyk & Fineout-Overholt, 2019). The proposal for the practice change and the plan for disseminating the plan is also developed in this phase (Melnyk & Fineout-Overholt, 2019). The evaluation phase considers the outcomes, the changes that may need to be made, and the cost of implementation (Melnyk & Fineout-Overholt, 2019). The Stetler Model is a good fit for this problem because research and evaluation aim to provide probabilistic information, not absolutes (Stetler, 2001). This allows for experimentation, continuous improvement, and change to the shared governance model in response to feedback and outcomes. There is also importance put on considering internal and external factors (Stetler, 2001). Integrating internal and external factors will be necessary for the proposed plan to realign 8 existing shared governance models with established Magnet models to improve outcomes and job satisfaction. Maintaining flexibility will also be essential, as the outcomes will rely on the targeted nurse's responses to the implemented changes. The Stetler Model was developed to help nurses use research and tools to critique evidence and successfully apply their findings (White et al., 2019). Strengths and Limitations The Stetler Model has strengths and weaknesses related to the proposed changes to improve job satisfaction outcomes. The strengths of the Stetler Model include conducting individual research and using internal and external factors when evaluating pertinent evidence (Melnyk & Fineout-Overholt, 2019). This is a critical strength to consider as a feedback loop from staff will be essential to make successful changes. Another strength of this model is the ability to focus on smaller unit-level groups and larger organizational-level groups. This allows for greater dissemination and application (Melnyk & Fineout-Overholt, 2019). The weaknesses of the Stetler Model include that the model is an individual practitioneroriented model rather than an organizational-focused model (White et al., 2019). While other characteristics of this model fit well with the project, a model focused on an individual changing an organizational process seems contradictory to the project's purpose. Analysis of Literature The literature review on shared governance and its impact on nurse job satisfaction included a thorough search of evidence through quality search engines. The review of the evidence resulted in the development of three themes relating to shared governance and its impact on nurse job satisfaction. These themes will be further explored in this section. Search Strategies 9 The evidence search for this literature review was conducted using Weber State University's Stewart Library's OneSearch and CINAHL. Articles searches were limited to include only articles published within the last five years to maintain the most up-to-date and relevant information. The search included keywords of shared governance, nurse shared governance, shared governance impact, hospital shared governance, nurse job satisfaction, nurse retention, Magnet shared governance, shared decision-making, shared governance council, improving shared governance, and nursing leadership role shared governance. Various combinations were created with the above-mentioned keywords to conduct a thorough search. Effective shared governance enhances the work environment. Job satisfaction is essential to a professional practice work environment (PPWE) (AlRuzzieh et al., 2022). Three studies' results reflected a connection between shared governance and a higher incidence of a professional practice work environment. A cross-sectional study containing 580 nurses working in a Magnet hospital resulted in a statistically significant difference in the PPWE score between shared governance council members and nonmembers (t = 2.906, P = 0.004), reflecting higher PPWE scores in shared governance members (Al-Ruzzieh et at., 2022). A systematic review by Kyytsönen et al. (2020) also addresses the components of the professional practice work environment, which reviewed 13 original research articles to establish six core elements of shared governance, including professionalism, shared decisionmaking, evidence-based practice, continuous quality improvement, collaboration, and empowerment. A longitudinal, quantitative study conducted over four years in a 300-bed tertiary facility by Olender et al. (2020) also resulted in statistically significant correlations for staff involved in shared governance and PPWE components. The most substantial relationship was between work engagement and empowerment (r = 0.668, P < .001). The second most significant 10 relationship was between work engagement and caring (r = 0.295, P < .001) (Olender et al., 2020). The final substantial relationship was between empowerment and caring, which resulted in (r = 0.147, P = .006) (Olender et al., 2020). Di Fiore et al. (2021) conducted a prospective, two-group comparative design using the Index of Professional Nursing Governance, a validated, reliable tool to compare data between shared decision-making scores pre- and post-shared governance implementation. A multivariable linear regression model was used to evaluate the impact of nurse characteristics on shared decision-making responses which resulted in an overall adjusted score of (P = .017) and improvement in three of six domains: professional control of work, structures for decisions, and access to information (all P values between .005 and .031) (Di Fiore, 2021). A study done in a more rural setting found increased rates of new graduate nurse retention, specialty certifications, advanced degrees, and retention over a three to four year period after implementing shared governance (McClarigan et al., 2019). Shared governance alone does not guarantee improved staff satisfaction. A review of multiple articles revealed a gap in many shared governance councils that inhibited the intended outcomes of shared governance councils. These gaps, or areas for improvement, all revealed the necessity of aligning shared governance with a model that would help produce the designed and desired outcomes of the shared governance model. According to one article that performed a thematic analysis of a shared governance restructuring process, restructuring established shared governance councils to better align with Magnet Models improved the empowerment of the bedside staff's perspective in decision-making, which increased staff engagement and commitment (Moreno et al., 2018). 11 Kyytsönen et al. (2020) systematically reviewed 13 original research articles. Based on their review, they developed a shared governance framework to be utilized in hospital settings. This framework incorporates elements they determined were essential to shared governance. Their review concluded that hospitals considering implementing shared governance should expect the process to require significant time and support from leadership and council members of the crucial shared governance elements (Kyytsönen et al., 2020). Two clinical experts, Medeiros (2018) and Lal (2021), state that certain principles are essential for shared governance to be effective at all levels, including partnership, equity, empowerment, accountability, and ownership. Lal (2021) focuses on the 2019 Magnet® Application Manual and its focus on shared decision-making through shared governance, speaking to the importance of utilizing Magnet principles within shared governance models. After reviewing nurse satisfaction scores, Oss et al. (2021) developed a remodel of shared governance within a hospital setting based on Magnet principles. The remodel significantly increased nurse job satisfaction after purposeful intervention through shared governance councils and their realignment. Comparing results a year apart, 53% of nursing units reported increased job satisfaction following the implementation of shared decision-making (Oss et al., 2021). Hasselblad & Loan (2022) also address the realignment of shared governance councils with established models by utilizing O'Grady and Finnigan's model. Utilizing the PES-NWI survey and the seven categories defined by the ANCC Magnet Recognition Program® to benchmark staff satisfaction against other similar facilities, there was a noticeably lower staff satisfaction rate (Hasselblad & Loan, 2022). As with the Oss et al. study, there was a comparison of preimplemented shared governance change and post-implementation survey results (Hasselblad & Loan, 2022). Data were analyzed using SPSS version 26 and showed an improvement from 3.79 12 to 4.06 (on a 5-point scale) in Nurse Participation in Hospital Affairs Autonomy, which was statistically significant with a p= 0.028 and SD of 0.20 (Hasselblad & Loan, 2022). Also statistically significant was the area of "I am involved in decisions that affect my work," which increased from 3.41 to 3.91 (p= 0.036, SD 0.30) (Hasselblad & Loan, 2022). Leader and staff commitment are essential to shared governance. When reviewing the evidence, there were many references to leader support being essential to the success of a shared governance model. According to Kanninen et al. (2021a), sharing the power to make decisions could be mutually beneficial if nurse leaders are willing to let go of control over certain issues and allow shared governance councils more autonomy. Kanninen et al. (2021a) used a qualitative interview study including 16 nurses to determine nurses' experiences as members of shared governance councils. One of their research findings was that without consistent support from the unit and organizational leadership, the shared governance councils were unsuccessful in advancing shared-decision making or autonomy in their departments (Kanninen et al., 2021a). In a separate study, Kanninen et al. (2021b) completed an integrative literature review using Whittemore and Knafl's five-stage method and the PRISMA approach for reporting. One result of this review was nursing leadership's critical role in achieving successful outcomes from shared leadership (Kanninen et al., 2021b). Another article written by Medeiros (2018), a clinical expert and a nurse with a master's degree, states that support and skills offered by nurse leaders are essential in empowering their teams to make decisions that positively impact staff satisfaction, patient care, and clinical outcomes. Moreno et al. (2022) also describe how nurse leadership accessibility and visibility are essential to the success of shared governance models. The information included in this article was obtained through a thematic analysis of shared governance restructure implementation in an 13 organization (Moreno et al., 2022). A significant theme from this study attributes the success of shared leadership to the leadership in the organization maintaining accessibility and visibility in the councils (Moreno et al., 2022). This allows frontline staff to continue engaging and being actively involved in decisions impacting system issues, processes, and other important decisions for the staff and patient populations (Moreno et al., 2022). Nurmeksela et al. (2021) use inductive thematic content analysis for the results of 133 respondents to open-ended questions from the Nurse Manager Work Content Questionnaire (NMWCQ). The analysis resulted in four themes from managers, including a shift from hierarchical leadership to shared governance (Nurmeksela et al., 2021). Summary of Literature Review Findings and Application to the Project The review of the literature on shared governance revealed that when implemented correctly, it can significantly impact the job satisfaction of nurses. A review of the literature also revealed that the mere presence of shared governance councils does not produce improved nurse outcomes, suggesting that alignment with established models is necessary. Alignment with models such as the Magnet model is statistically more likely to improve a professional practice work environment, leading to improved staff satisfaction. According to the reviewed literature, continued support and investment in shared governance by managers and other leaders is a critical factor when developing the realignment of the shared governance project. The literature review encourages thoughtful development of the proposed project to ensure it aligns with the themes identified in the literature, increasing the likelihood of successful outcomes. The literature on shared governance in nursing has limitations. Many studies occurred in individual facilities, which may not apply to larger populations. Some of the studies were also 14 performed in facilities outside of the United States which may limit the pertinence of the study data to other nursing populations. Project Methodology This MSN project aims to determine the impact of a successful shared governance model on nurse job satisfaction. The goals include establishing an evidence-based model to improve the success of shared governance and educating staff on the benefits of participating in shared governance councils; this will be accomplished by providing education and support documents to nursing staff. Three deliverables have been created to promote this project's introduction and implementation within the Rapid Treatment Unit at Primary Children's Hospital. The deliverables include (a) a PowerPoint presentation, which includes the evidence-based benefits of shared governance, (b) a promotional flyer for staff that can be dispersed in person and through email, and (c) a checklist including characteristics of a successful shared governance model. Description and Development of Project Deliverables Three items were created to aid in the implementation of this project. In this section, the deliverables are described in detail. In addition, a brief explanation of the importance of each deliverable is also included. Effective Shared Governance Impact PowerPoint The first item is a PowerPoint presentation (see Appendix A). The purpose of the presentation is to educate nurses on the benefits of participating in shared governance councils. This presentation includes evidence-based research on the impacts of shared governance. Nurse job satisfaction is a priority outcome of effective shared governance models, as recent employee engagement survey results identify job satisfaction as an area for improvement. The presentation 15 will describe the current shared governance councils and what those councils address. The presentation will also explore what characteristics of shared governance models promote the success of shared governance and how aligning with Magnet principles can increase the effectiveness of the currently established councils. Promotional Flyer The second deliverable is a promotional flyer for staff (see Appendix B). The flyer will summarize the unit's shared governance councils and provide simplified information on the positive impacts of shared governance participation. The flyer will aim to recruit nurses to participate in shared governance councils. Shared Governance Checklist The final item created for this project is a checklist for shared governance councils. The checklist aims to align current shared governance councils with evidence-based models that reflect Magnet principles (see Appendix C). The checklist can be utilized for individual shared governance councils to make necessary changes to ensure they are maximizing the success of their councils. The checklist also allows consistency throughout shared governance councils and guides shared governance chairs. Plan and Implementation Process This MSN project will be implemented after presenting the proposal to the unit manager. Setting up a meeting time with the Rapid Treatment Unit manager to present the deliverables and the proposed plan will be necessary. It will then be necessary to involve the shared governance chairs and elicit their support in utilizing the checklist to realign their councils with evidencebased models. Meeting with all shared governance chairs at once will be ideal. This will ensure that all questions and concerns can be addressed and that the checklist is well understood and 16 something the chairs feel can be implemented and integrated into their current shared governance council model. Once the manager and the shared governance chairs are on board with the proposal, delivering the information to the staff will be necessary. Presenting to the team in a large setting, such as at an already scheduled staff meeting, will be the best option to have a large audience. The shared governance chairs will be present to show support and answer council-specific questions. This setting will also provide a platform for questions and answers regarding the shared governance councils and the desired impacts. The handout will then be dispersed to all staff in person or through email to help reinforce and educate them about the effects of shared governance participation. The final step would be enlisting current council members to promote council participation to additional staff. Utilizing personal stories and experiences from current participants can help show the individual outcomes of joining a council. The goal will be to enlist more staff to participate in the unit councils. Interdisciplinary Teamwork Utilizing all stakeholders in the unit to incorporate and advocate for the proposal will help ensure the project's success. Support and promotion of the project will be more successful if unit leadership, council chairs, and council members work together toward a common goal. This team will be essential to implementing the needed changes within shared governance to help improve job satisfaction. Unit Manager. The success of any shared governance council relies on the support of the unit leadership (Medeiros, 2018; Moreno et al., 2022). Unit managers should work with unit councils to ensure shared decision-making (Medeiros, 2018; Moreno et al., 2022). Establishing a 17 recurring monthly meeting with management and council chairs will ensure both parties continue to work towards the same goals. The unit manager is also highly invested in the engagement of the staff and increasing staff satisfaction. To make this project successful, the unit manager will need to support the proposed plan to educate staff and realign the council models. The unit manager should support the changes and allow the councils to implement and enforce them. Council members need to accept responsibility and be accountable for the changes made within the council (Medeiros, 2018). Shared Governance Chairs. The shared governance council chairs will be involved in the initial stages of the project implementation. They will be presented with the information before presenting the project to the staff. Shared governance chairs can share opinions and concerns and ask questions regarding the project rollout. They will also be essential to the implementation by promoting the changes and encouraging other nurses to join the councils. Chairs will also be able to share perceptions on how the changes impact the councils and provide feedback on areas needing additional focus or clarification. Shared Governance Council Members. Shared governance council members are also a critical piece of the project rollout. Their continued support and feedback will be instrumental in determining if the changes are productive and impactful. They will also be essential in recruiting other staff members to participate in councils by sharing their personal experiences and thoughts on how participating in a council has affected their job satisfaction and their engagement on the unit. Timeline The project will begin by setting up a meeting with the unit manager to propose the project information, deliverables, and suggested timeline. This meeting will take approximately 18 one hour. Once that meeting has occurred, and the project has the manager's buy-in, there will be a meeting with all council chairs. This will consist of a small group of six chairs. This meeting will be blocked out for two hours to allow for questions. A two-week response time will be allowed to ensure all participants are able to attend. This meeting will include sharing the checklist and allowing feedback on a feasible timeline for implementing the changes. The PowerPoint would also be presented to the group to ask for input on delivering the proposal information. At the conclusion of this meeting, the presentation to the remaining staff will be scheduled for the next staff meeting. As staff meetings occur quarterly, this will allow two months to implement any feedback and create a solid presentation plan. During this time, a method for receiving feedback will also be determined. Feedback will be requested from the council chairs and the council participants monthly for six months after the implementation to determine if the changes have made a positive impact. The results from the 2023 employee survey will also be helpful feedback to determine if this change improved employee engagement and job satisfaction scores. This survey does not come out until the fall, making the monthly feedback results timelier and more accurate to the impact of this project. This timeline suggests an allotment spanning approximately six months to plan, implement, and evaluate this project (see Appendix D). Plan for Evaluation of Project The success of this project will be determined by developing and utilizing a feedback questionnaire for both council chairs and participants. A baseline questionnaire will be used to compare to monthly follow-up results. The questionnaire will include questions regarding current levels of engagement, their perception of the council's effectiveness, and levels of job 19 satisfaction. The questionnaire will be given to staff members after the monthly council meeting. Following monthly results for six months should provide the chairs, the manager, and the project leader with an idea of how effective the changes have been. Comparing the 2022 employee survey to the 2023 survey will also provide feedback on the effectiveness of the project. Still, it will be more challenging to determine a direct correlation as other factors will impact this score. Ethical Considerations Ethical considerations of this project include the principle of justice. As it refers to nursing, justice typically represents fair and equitable care for all patients (Gaines, 2022). When considering nursing as a profession, justice means doing what is right for everyone and the greater good of nursing. Shared governance provides shared decision-making and increased autonomy needed to make changes and decisions essential to the development and success of the nursing profession. Autonomy is another ethical principle addressed by this project. Autonomy includes shared decision-making and advocacy, both essential to establishing an environment that supports nursing and adds to nurse job satisfaction (Gaines, 2022). Discussion Nurses play an integral and significant role in the healthcare system and comprise the highest percentage of healthcare employees (Kelly et al., 2021). Nurses often work in high-stress positions and experience change and the need for adaptation in their workplace. A lack of empowerment and engagement in this work environment can hinder job satisfaction within the nursing profession (Di Fiore, 2021). This project aims to improve nurse job satisfaction. It proposes that utilizing an effective shared governance model can improve empowerment, engagement, shared decision-making, and a professional practice work environment (PPWE), all shown in the literature to improve nurse job satisfaction. This discussion will include 20 dissemination planning, the significance of implementing a process to align shared governance with evidence-based models, and the potential impact on nursing practice. Implications of the project will be discussed, including limitations and recommendations associated with aligning shared governance with proposed models. Evidence-based Solutions for Dissemination Dissemination of the project starts on a unit level, as described in the methodology section of this paper. As stated, after shared governance council realignment, there will be a sixmonth time frame where feedback will be collected to determine if there are any gaps in the existing model or additional considerations of the group. Feedback will be collected from shared governance chairs, shared governance council members, non-council staff members, and unit management. The use of survey questions pre and post-realignment will be used to determine the effectiveness and to collect information on other needs. The use of staff satisfaction surveys will also be essential to compare results pre and post-implementation. Once the project has been implemented and effectiveness determined, the project can be distributed throughout other units in the hospital through hospital-wide shared governance councils. Depending on the success of implementation throughout the hospital, wider dissemination may be presented on an organizational level. The information collected and represented in this project paper will also be presented to fellow students and faculty at Weber State University. Significance to Advance Nursing Practice The impact of an improved shared governance model on nursing practice can be as significant as giving nurses a voice and a reason to continue their growth and development within their current workplace. Empowerment and engagement can help nurses see their worth and value within their roles and organization (Kanninen et al., 2021a). The benefits of 21 establishing an environment composed of professionals who collaborate and can provide relevant input and solutions can be outstanding and enhance the individual nurse and the team they work with (Kanninen et al., 2021a; Olender et al., 2020). This empowerment and engagement impact all individuals interacting with this team, including the patients (Olender et al., 2020). Implementing a shared governance model aligned with evidence-based principles and guidelines will help promote a professional practice environment that supports nurses, their professional needs, and their overall satisfaction within their workplace (Kanninen et al., 2021b; Moreno et al., 2022). Implications Establishing nurse job satisfaction as a priority within the nursing realm requires the utilization of evidence-based practices to improve job satisfaction, empowerment, and a PPWE. This project directs nursing leaders, shared governance leaders, and staff members to strengthen shared governance models to support nurse job satisfaction. Research from the literature review guided the creation of deliverables to assist nurse leaders in implementing and aligning a successful shared governance model. The deliverables are also valuable tools to educate staff on the impact of shared governance participation. Continual review of the implementation process and needs must be prioritized as the realignment with evidence-based models offers guidelines but may not address or support all needs specific to a particular area. The limitations of this project include the challenge of obtaining the participation of bedside staff in the shared governance council. Staff involvement is critical to the outcomes they perceive and receive from the council (Di Fiore, 2021). Other limitations include eliciting buy-in from all leaders and maintaining a streamlined and structured implementation process. The guidelines in the literature review may be interpreted differently depending on the leader 22 implementing them and their beliefs on how a shared governance council should function. These limitations should be considered and addressed with the leadership, council, and staff. Recommendations The literature review reveals that shared governance within a hospital setting produces higher levels of engagement, empowerment, shared decision-making, and a professional practice work environment (PPWE) (Al-Ruzzieh et al., 2022; Kyytsönen et al., 2020). The literature also shows that more than the mere presence of a shared governance council structure is required to produce the desired outcomes related to the nursing staff and the elements contributing to job satisfaction (Moreno et al., 2018). Aligning shared governance councils, new or existing, with evidence-based models improves outcomes and increases nurse job satisfaction (Kyytsönen et al., 2020; Las, 2021; Oss et al., 2021). The recommendation determined from the literature review is to ensure the alignment of shared governance with models shown to show improved outcomes. A continual evaluation process will also be essential to determine specific unit or organization needs. Review and assessment of the nurse job satisfaction results will be critical to assess the effectiveness of the realignment. Leaders must be open to feedback and make changes as needed to maximize the desired outcomes and goals of the shared governance model. Another area of consideration is the generational differences impacting the future of the nursing workforce, which may alter the process needed to engage shared governance and ensure its success. Continued research into what impacts nurses and their job satisfaction will also be necessary, as shared governance should not be the only consideration for nurse job satisfaction. Conclusion Nurse job satisfaction is an essential consideration in the current workforce climate. Enhancement of job satisfaction through engagement, empowerment, and shared decision- 23 making provides an environment that supports nursing staff and their priorities. Utilizing a wellfunctioning and well-aligned shared governance model improves the previously mentioned strengths within a workplace. Buy-in and support for a shared governance realignment should come from all team members, including the bedside staff, shared governance chairs, unit management, and executive leadership. Nurses are at the heart of healthcare. Prioritizing nurses and their job satisfaction is critical to producing a thriving healthcare system. 24 References Al-Ruzzieh, M. A., Ayaad, O., & Hess, R. G. (2022). The role of participation in and effectiveness of shared governance councils in the nurses' perception of a professional practice work environment. JONA: The Journal of Nursing Administration, 52(1), 51–56. https://doi.org/10.1097/nna.0000000000001102 Di Fiore, T., Zito, A., Berardinelli, A., Bena, J. F., Morrison, S. L., Keck, D. E., Kennedy, K., Stibich, A., & Albert, N. M. (2018). Staff perceptions of decision-making in a shared governance culture. 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