The concept of self-governance in nursing has been around for more than 30 years. Since then, the push to include direct care nurses and NNPs in hospital leadership and management decision-making has continued to grow.
Self-governance in neonatal care and all disciplines of nursing stems from the premise that nursing education and experience qualify nursing professionals for a leadership role in decisions that affect patient care.
According to a 2019 article published by Wolters and Kluwer, nursing self-governance is a valuable initiative not just for the success of nursing teams but also for the success of healthcare organizations as a whole.
What does nursing self-governance look like in the NICU?
Self-governance in the NICU means that neonatal nurses and neonatal nurse practitioners enjoy the same level of responsibility in making decisions for their units as they do in making decisions for their patients.
This self-governance reflects a level of autonomy that empowers nursing professionals to have a greater role in the management of healthcare delivery.
Why nursing self-governance matters
Nursing self-governance matters because it is a form of employee engagement. Nurses and NNPs get frustrated when their expertise is not included in hospital decision-making that affects them, their patients, and their units.
This frustration can lead to burnout and healthcare moral injury. It has also been found to result in worse outcomes for nursing professionals, patients, and healthcare organizations, including
- Decreased job satisfaction
- Decreased job performance
- Decreased hospital profits
- Increased nursing shortages
- Worse patient care outcomes
How to promote nursing self-governance in the NICU
Each healthcare organization has unique needs, goals, and challenges. For these reasons, hospitals will differ in how they promote nursing self-governance in the NICU. However, some common themes of nursing self-governance apply across nursing disciplines and hospitals:
GROUND RULES
Respect for direct care nursing expertise
The insights of direct care nurses and NNPs must be respected and incorporated into hospital leadership and management decision-making and not dismissed by nurse managers or upper management.
Consistent involvement of direct care nurses and NNPs
Direct care nurses and NNPs must decide what level of involvement they wish to have in their self-governance.
EFFECTIVE INITIATIVES
Hospital councils
Staff nurses and NNPs across disciplines and hospital units come together to discuss issues affecting patient care. At these meetings, nurse managers support direct care nurses and NNPs in collaborating with upper management.
Themed councils
Staff nurses and NNPs meet to discuss specific themes and broader nursing issues, such as fostering a healing environment, supporting professional development, and ensuring quality and safety.
Unit councils
Staff nurses and NNPs address issues that affect their specific units, propose process improvement initiatives, and review progress made.
TRANSFORMATIONAL LEADERSHIP
Caring
Nurse managers and upper management can support nursing self-governance by showing genuine concern for direct care nurses and NNPs and their initiatives. This simple but profound act of caring helps to build trust and empower nursing staff.
Challenging
Direct care nurses, NNPs, nurse managers, and upper management can challenge each other in going above and beyond the status quo to achieve superior outcomes.
Modeling
Nurse managers can role model the core values of nursing to direct care nurses and NNPs to promote excellent outcomes on a regular basis.
Motivating
Nurse managers and upper management can inspire direct care nurses and NNPs to effect process improvement.
The value of nursing self-governance cannot be overstated. Implementing effective nursing self-governance in your NICU can optimize nursing engagement, satisfaction, patient care outcomes, and cost-effectiveness.
