Nursing professional governance: Patient- and family-centered design.

Abstract

W hen the University of Vermont (UVM) Medical Center redesigned its CNO role in 2015, the new CNO’s top priority was establishing a governance system that engaged clinical nursing staff in organizational decisions relevant to professional practice. The UVM Medical Center is a 500-bed academic medical center in Burlington, Vt., with a staff of approximately 1,800 nurses across the care continuum. A limited shared governance structure was in place at the time, which consisted of nonstandardized departmental councils and a global nurse practice council. In a survey of nurses, only 35% felt included in organizational decision-making, with 66% attributing role satisfaction to their ability to effect change. Under this structure, clinical nurses were inconsistently involved in project proposals and implementation. Additionally, a review of council productivity and outcomes revealed opportunities for improvement and greater alignment with organizational strategic priorities. This article describes the organization’s journey to establishing professional governance with an innovative, patientand familycentered structure that leverages collaboration between the CNO, point-of-care staff, and organizational partners. A new approach The existing governance structure at the UVM Medical Center was a leader-driven, top-down approach, in which staff members were consulted on practice changes versus recommending and leading efforts. The new nursing professional governance (NPG) design requires active engagement of clinical nursing staff in shared decision-making. The structure evolved from leaderdriven to nurse-driven, with