Shared Governance Journey Essay

Shared Governance Journey Essay

Nurses are at the front line of offering health care services to patients and spend their time protecting patients’ lives and promoting improved health for everybody. The implication is that nurses need a working environment capable of supporting their needs and promoting the expected standards. The pathway to excellence program works towards such an environment by recognizing the importance of such an environment. The framework has six standards that are key in creating a positive practice environment for the nursing staff in patient care environments such as long-term and acute care (Nelson-Brantley et al., 2020). Therefore, the purpose of this assignment is to explore the key concepts in the path to excellence to be initiated at the Saint Louis Medical center.

The Pathway to Excellence Model

            The path to excellence model is associated with the American Nurses Credentialing Center. Through the pathway to excellence program, the body recognizes institutions that formulate practice environments for nursing. As such, these institutions have to display that they have the expected nursing practice environment criteria as defined under the pathway to excellence model standards: professional development, well-being, quality, safety, leadership, and shared decision-making (Bates et al., 2020). Shared decision-making offers nurses a voice in engaging in interprofessional decision-making in every area that affects nursing practice. Central to this is engaging in the interprofessional shared decision-making in selecting, planning, and implementing appropriate new technologies and lowering any stress connected to such technologies.

Leadership aspects enhance the environment of governance by making the organizational leaders accessible to help in the critical decision-making process. In addition, the leadership standards also support succession planning, accountability, orientation, and leadership development (Bates et al., 2020). The safety aspect entails nurse and patient safety. While it ensures that patients are safe in the care environment, it also emphasizes a workplace culture devoid of violence, bullying, and incivility. On the other hand, quality is centered on improving population health, progressive environment, evidence-based care, family-centered care, and person or individual-centered care. The professional development aspect involves ensuring that the nurses competently offer care and are offered support and mentorship (Bates et al., 2020). Lastly, the well-being aspect enhances a workplace culture where nurses’ efforts are recognized and offer resources and support for promoting their mental and physical health.

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The Application of the Concepts to Saint Louis Medical Center

The pathway to excellence concepts can be applied to the Saint Louis Medical Center due to the increasing nursing issues (Bates et al., 2020). Even though the center has excellently served Summerville and the surrounding communities for years and has largely contributed to the health maintenance of the whole community, there is a recent challenge. Recently, there has been a sharp increase in the number of hospital admission of elderly individuals with cardiovascular conditions and heart failure. The last three years have shown a worrying trend where there has been a 10% increase every year in such cases, and most of the cases are readmission cases within the same year. The increase in the population living in Summerville by ten percent since the year 2016 means that the Saint Louis Medical Center has had to deal with an upsurge in numbers by serving more patients. Specifically, the center has been serving more patients 65 years and older with heart failure.

The concepts in the pathway to excellence are important in solving the problem which is currently arising at the Saint Louise Medical Center. One of the concepts to be applied in the quality standard from the framework is readmissions. Readmissions mean that specific aspects of care are not right, maybe during discharge or patient education during discharge. Therefore, this standard will be used to establish the possible causes of the rising cases of readmission and use appropriate nursing strategies to solve the problem (Perry et al., 2020). Leadership will also be needed as the unit leaders will have to take center stage and ensure that the proposed interventions are applied for better outcomes. As such, the model is related to nursing in that the standards highlighted in it can be applied to ensure that patient services are improved to the acceptable standards and that the working conditions are favorable and enabling such that the nurses can offer their best in caring for the patient.

As a nurse executive, it is my responsibility to engage my nursing staff and the leadership to ensure that the rising problem is solved. One way of engaging them is by creating a need to change the current situation of increasing rates of readmissions. Readmissions are detrimental to the organization and the patients; therefore, by creating a sense of the need for change among the nursing staff and leadership, it will be possible to implement a proposed change (Park et al., 2019). I will also establish communication channels with the staff and the leadership to ensure that the plan and intentions are clearly communicated for more effective implementation. I will also welcome feedback from the staff and the leadership concerning their views on the current challenge facing the organization. This will help as important views from the nursing staff directly involved in caring for these patients can be used to effectively bring positive changes.

Conclusion

The pathway to excellence framework offers a base where organizations can build their efforts to ensure that patients get quality and safe care. In addition, it also ensures that the nursing staff has a conducive and enabling environment that appreciates their efforts and takes care of their mental and physical well-being. The framework can be applied at the Saint Louise Medical Center to enable the hospital to continue serving the purpose that it has served admirably.

References

Bates, M., Hargreaves, J., McCright, M., Pabico, C., & Hume, L. (2020). Introducing the 2020 Pathway to Excellence® manual. Nursing Management, 51(4), 7-10. Doi: 10.1097/01.NUMA.0000657296.39677.a6

Nelson-Brantley, H. V., Beckman, D., Parchment, J., Smith-Miller, C. A., & Weaver, S. H. (2020). Magnet® and Pathway to Excellence®: focusing on research and evidence-based practice. JONA: The Journal of Nursing Administration, 50(5), 245-247. Doi: 10.1097/NNA.0000000000000877.

Park, C., Otobo, E., Ullman, J., Rogers, J., Fasihuddin, F., Garg, S., … & Atreja, A. (2019). Impact on readmission reduction among heart failure patients using digital health monitoring: feasibility and adoptability study. JMIR medical informatics, 7(4), e13353. https://doi.org/10.2196/13353

Perry, A., Mallah, M. D., Cunningham, K. W., Christmas, A. B., Marrero, J. J., Gombar, M. A., … & Thomas, B. W. (2020). Pathway to success: implementation of a multiprofessional acute trauma health care team decreased length of stay and cost in patients with neurological injury requiring tracheostomy. Journal of Trauma and Acute Care Surgery, 88(1), 176-179. 10.1097/TA.0000000000002494

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NR531 Case Study Background Information
St. Louis Medical Center (SLMC)

St. Louis Medical Center (SLMC) has proudly served Summerville, Ironridge and the surrounding communities of Chamberlain County, South Carolina, for over 50 years. The organization has remained a key component in maintaining the health of the community at large. SLMC has over 500 physicians, approximately 450 nurses, and is one of the largest employers of the Chamberlain County area. SLMC takes pride in its ability to remain a leader in the healthcare industry statewide. The hospital has a continuous commitment to delivering the highest quality care by addressing crucial issues, such as patient safety, technology, and expanding services to meet community needs. SLMC has placed special emphasis on optimizing the quality of life of all those served by expanding beyond the traditional focus on medical needs to the needs of the whole person.
SLMC has seen a sharp increase in the number of hospital admissions of elderly patients with heart failure and cardiovascular disease. Specifically, in the last 3 years, SLMC has had a 10% increase each year in the number of heart failure hospital admissions, of which, most were readmissions in the same year. Even though there is an increasing trend in the number of patients 65 years and older with heart failure on a national level, Summerville, in particular, has had to treat explosive numbers of this vulnerable population.

Market Analysis
Summerville, SC History
Summerville is a city in South Carolina in the United States. It is bounded by Ironridge, SC, on the West, the Atlantic Ocean on the South and East, and Chamberlain 2 Island on the North. According to city records, the city has a total land area of 2.99 square miles. The city government consists of a Mayor, three township supervisors, and a solicitor. Summerville has its own police department.
By 1790, Summerville had become a thriving village with business houses dispersed among the huts and log cabins. In 1817, a stage coach stop was added to this growing town. Harvey Summer, a successful logger, purchased a large parcel of ground and began to sell off lots. This brought more people to the town that was subsequently named after him. Summerville added a steel mill, and Mr. Summer’s logging company was relocated there. By 1940, Mr. Summer’s descendants opened an auction house after closing the logging company. This was a huge commercial attraction for the area and Summerville continued to grow. Other businesses moved to Summerville. This commercial core was the beginning of the Summerville we know today.
Summerville has been thriving in this challenging economic time and has increased its population by 10% since 2016. This is an upscale community with modern, well-maintained homes. The SLMC is located within the Summerville city limits. There is also a city hall with a WIC office, movie theatre, shopping center, restaurants, grocery store, and several homes that line the Summerville streets. This is a suburban area with modern looking buildings and clean streets. There is a taxi service as well as a bus that transports people around Summerville and into Ironridge.
Summerville, SC Statistics
Population in August, 2018: 16,599 SC: 4,625,364 (2018, 24th largest state)
Females: 8,598 (51.8%) SC Females: 51.3%
Males: 8,001 (48.2%) SC Males: 48.7%

White: 60% SC White: 66.2% (2018, ranked 26th)
Black: 23% SC Black: 27.9% (2018, ranked 14th)
Hispanic: 9.5% SC Hispanic: 5.1% (2018, ranked 30th)
Asian: 7.5%

Age
Median age: 64.3 years SC median age: 37.9 years
Under 18: 18.7% Under 18: 23.7% (2018)
Between 18–64: 62.8% Between 18–64: 62.6% (2018)
65 and older: 18.5% 65 and older: 13.7% (2018)

Education
Residents 25–64 years old with high school diploma: 88.6%
SC residents 25–64 years old with high school diploma: 86.4% (2018)
Residents 25 years and older with associate degree or higher: 34.5%
Associate degrees: 10.3%
Baccalaureate degrees: 18.7%
Master’s degrees: 4%
Post Master’s: 1.5%

SC Residents 25 years and older with associate degree or higher: 30.7%

Income per capita: $74,900 SC income per capita: $33,884 (2018—ranked 45th in U.S.)
Median household income: $68,594
SC median household income: $42,580

Health Statistics
Births
Live births: 124 Teen moms: 14 out of the 124
White: 69 White: 4
Black: 41 Black: 4
Hispanic: 11 Hispanic: 5
Asian: 3 Asian: 1

Abortions: 12
White: 4
Black: 2
Hispanic: 5
Asian: 1
Infant mortality: 7
White: 2
Black: 2
Hispanic: 3
Deaths: 79
Death rate: 4.8 per 1,000
Causes of Death
White Black Hispanic Asian
Heart disease 12 6 2 1
Malignant neoplasms 10 4 3 1
Accidents 3 3 2 2
Cerebrovascular accident 3 2 1 0
Chronic lower respiratory disease 2 1 1 0
Alzheimer’s disease 2 2 1 0
Diabetes 2 1 1 0
Pneumonia 2 2 2 0
Influenza 1 1 1 0
Kidney disease 0 1 1 0

Ironridge, SC History
Ironridge is a city in South Carolina in the United States. It is bounded by Summerville, SC, on the East, the Atlantic Ocean on the South and West, and Chamberlain 1 Island on the North. According to city records, the city has a total land area of 2.95 square miles. The city government consists of a Mayor and City Council. The City Council has five members, including its president, secretary, solicitor, and treasurer. Ironridge has its own police department.
Ironridge was founded in 1887 as a company town by J.J. Newberry Company as the site for its foundry. The foundry employed as many as 6,000 workers in its prime. In 1900, 20,966 people lived in Ironridge. In 1992, the J.J. Newberry Company went out of business and the foundry was closed.
Ironridge has been hit hard by the economic decline of our time and is in a critical stage of urban decay or urban blight. It has lost more than 20% of its population from 2018 and continues to deal with a large number of homeless people, increased illegal drug use, and high crime rate. Ironridge has grungy and dilapidated buildings and homeless people clearly evident on the streets. The mental health clinic and in-patient facility located in Ironridge typically treats 40–60 patients every day. Ironridge is also home to an OB/GYN out-patient clinic. The industrial area near the bridge leading to Summerville has a disaster occurring. There is a taxi service as well as a bus that transports people around Ironridge and also into Summerville.
Ironridge, SC Statistics
Population in August, 2018: 12,682 SC: 4,625,364 (2018, 24th largest state)
Females: 6,899 (54.4%) SC Females: 51.3%
Males: 5,783 (45.6%) SC Males: 48.7%

Black: 48.7% SC Black: 27.9% (2018, ranked 14th)
Hispanic: 32.3% SC Hispanic: 5.1% (2018, ranked 30th)
White: 10.1% SC White: 66.2% (2018, ranked 26th)
Asian: 8.9%

Age
Median age: 42.2 years SC median age: 37.9 years
Under 18: 22.8% Under 18: 23.7% (2018)
Between 18–64: 73.7% Between 18–64: 62.6% (2018)
65 and older: 3.5% 65 and older: 13.7% (2018)

Education
Residents 25–64 years old with high school diploma: 44.5%
SC residents 25–64 years old with high school diploma: 86.4% (2018)
Residents 25 years and older with associate degree or higher: 19.3%
Associate degrees: 14.1%
Baccalaureate degrees: 4.2%
Master’s degrees: 1%
Post Master’s: 0

SC Residents 25 years and older with associate degree or higher: 30.7%

Income per capita: $21,679 SC income per capita: $33,884 (2018—ranked 45th in U.S.)
Median household income: $29,835
SC median household income: $42,580

Health Statistics
Births
Live births: 179 Teen moms: 42 out of the 179
Black: 86 Black: 22
Hispanic: 74 Hispanic: 16
White: 12 White: 3
Asian: 7 Asian: 1

Abortions: 19
Black: 10
Hispanic: 6
White: 2
Asian: 1
Infant mortality: 32
Black: 17
Hispanic: 12
White: 3
Deaths: 118
Death rate: 9.3 per 1,000
Causes of Death
Black Hispanic White Asian
Homicide 12 8 6 1
Heart disease 10 6 2 1
Malignant neoplasms 10 4 3 1
Accidents 9 8 4 3
Cerebrovascular accident 3 2 1 0
Chronic lower respiratory disease 2 1 1 0
Cancer 2 2 1 0
Diabetes 2 1 1 0
Pneumonia 2 2 2 0
Influenza 1 1 1 0
Kidney disease 0 1 1 0

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Note: the information above is not based upon factual data.

Shared Governance Journey

Guidelines with Scoring Rubric

Purpose

The purposes of this assignment are to: (a) identify and articulate key concepts of one of the following: either your future pathway to excellence or your shared-governance model you wish to initiate at one of the three areas: 1. Saint Louis Medical Center (SLMC)/community or critical access hospital, 2. Home health/community transition, or 3. Long term care/skilled nursing facility (SNF) or memory care (CO 5), (b) provide empirical, scholarly evidence to support your proposed project (CO 4), and (c) communicate your information in a clear, succinct, and scholarly manner (CO 5).

Note: You are completing this assignment as if you are the nurse executive. You are to decide whether you wish to focus on implementing your pathway to excellence or a shared governance model. You will choose one of the areas to implement either your pathway to excellence or your shared governance model. What elements would like to adopt and implement for your organization?

Course Outcomes

Through this assignment, the student will demonstrate the ability to:

 

• (CO4) Apply the use of research in the evaluation of healthcare outcomes, utilizing critical thinking skills, and interprofessional research strategies. (PO 4)
• (CO5) Examine effective verbal and written communication; utilizing communication skills of the professional role to promote and improve quality and safety in healthcare. (POs 1, 2, 5)

 

Due Date: Sunday 11:59 p.m. MT at the end of Week 3

Total Points Possible: 200

Requirements:

1. This paper will be graded on quality of paper information, use of citations, use of standard grammar, sentence structure, and organization based on the required components.
2. Create this assignment using Microsoft (MS) Word, which is the required format for all Chamberlain documents. You can tell that the document is saved as a MS Word document because it will end in .docx.
3. Submit to the appropriate assignment area by 11:59 p.m. MT on Sunday of the week due. Any questions about this paper may be discussed in the weekly Q & A discussion topic.
4. The length of the paper is to be no greater than three pages, excluding title page and reference page.
5. APA format, using most current edition, is required for this assignment, including a title and reference pages. Use APA level 1 headings for the organizational structure of this assignment. Remember that the introduction does not carry a heading that labels it as a level heading in APA format. The first part of your paper is assumed to be the introduction. See the APA manual sixth edition for details. Use the suggested format and headings to organize your assignment.
   1. Include introduction; include your which of the three areas of focus you have chosen (do not label as a heading in APA format)
   2. Key components of pathway to excellence or shared-governance model
   3. Supporting evidence
   4. Importance to nursing examples
   5. Conclusion

 Preparing the paper

Note: Use the documents related to SLMC to assist in the completion of this assignment, as needed.

1. Include a clear introduction of your focus area (choose one of the three above) in the introduction paragraph, including a sentence that states the purpose of your paper.
2. Clearly articulate key components (at least two) of either your pathway to excellence or your shared-governance model project to be implemented.
3. Include a minimum of three sources of scholarly, empirical evidence that supports your area of focus. See resources related to SLMC if you need to review the information for that area.
4. Provide specific examples (at least two) of the impact and importance of either your pathway to excellence or shared-governance model project related to nursing. Consider how you will engage your staff and leadership team in this project.
5. Provide concluding statements that should summarize your overall assignment content.
6. The paper will be three pages maximum, excluding title and reference pages.
7. Title and reference pages must be in APA format following the sixth edition manual.
8. Use 12 point, Times New Roman font and one-inch margins on all sides of the paper.

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Category	Points	%	Description
Introduction	30	15%	Introduction clearly introduces your focus area and purpose of the assignment.
Pathway to Excellence or Shared Governance Model Components	45	22.5%	The key components of either the pathway to excellence or shared-governance model for the project are clearly articulated.
Evidence	30	15%	There is a minimum of three scholarly, empirical evidence sources supporting your area of focus.
Examples	40	20%	Examples clearly demonstrate the impact or importance of either your pathway to excellence or your shared-governance model project related to nursing and how you will engage your staff and leadership.
Conclusion	30	15%	Concluding statements summarizing content are present.
Text, title page, and references are consistent with APA format.	10	5%	Text, title page, and references are consistent with APA format.
Ideas and information from other sources are cited correctly.	10	5%	Ideas and information from other sources are cited correctly.
Rules of grammar, word usage, and punctuation are followed.	5	2.5%	Rules of grammar, word usage, and punctuation are followed.
Total	200	100	A quality assignment will meet or exceed all of the above requirements.

Grading Rubric

Assignment Criteria	Exceptional (100%) Outstanding or highest level of performance	Exceeds (88%) Very good or high level of performance	Meets (80%) Competent or satisfactory level of performance	Needs Improvement (38%) Poor or failing level of performance		Developing (0) Unsatisfactory level of performance
Content Possible Points = 175 Points
Introduction (include focus area)	30 points	26 points	24 points	11 Points		0 points
	Introduction introduces your focus area and purpose of assignment clearly.	Introduction introduces your focus area with minor lack of clarity or elements.	Introduction of your focus area lacks occasional important element or specificity.	Introduction of focus area has multiple instances of inaccuracies		Introduction of focus area is not present.
Pathway to Excellence or Shared-Governance Model Components	45 points	40 points	36 points	17 Points		0 points
	Identification of key components of either the pathway to excellence or shared-governance model for the project are clearly articulated, with no inaccuracy.	Identification of key components of either the pathway to excellence or shared-governance model for the project is articulated with rare inaccuracy.	Identification of key components of either the pathway to excellence or shared-governance model for the project lacks occasional important elements or specificity.	Identification of the key components of either the pathway to excellence or shared-governance model for the project has multiple instances of inaccuracies.		Identification of the key components of either the pathway to excellence or shared-governance model for the project is not present.
Evidence	30 points	26 points	24 points	11 Points		0 points
	At least three empirical, scholarly evidence sources supporting your area of focus are included.	Empirical, scholarly evidence sources supporting your area of focus included with rare inaccuracy; or only two sources are included.	Empirical, scholarly evidence sources supporting your area of focus lack occasional important element or specificity; or less than two sources are included.	Empirical, scholarly evidence sources supporting your area of focus have multiple instances of inaccuracies.		Empirical, scholarly evidence sources supporting your area of focus are not present.
Examples	40 points	35 points	32 points	15 points		0 points
	Specific examples clearly demonstrate the impact or importance of either your pathway to excellence or your shared-governance model project related to nursing and how you will engage your staff and leadership.	Examples demonstrate the impact or importance of either your pathway to excellence or your shared-governance model project related to nursing and how you will engage your staff and leadership, with missing elements.	Examples clearly demonstrate moderate impact or importance of either your pathway to excellence or your shared-governance model project related to nursing and how you will engage your staff and leadership.	Examples clearly demonstrate little impact or importance of either your pathway to excellence or your shared-governance model project related to nursing and how you will engage your staff and leadership.		Examples are not present.
Conclusion	30 points	26 points	24 points	11 Points		0 points
	Concluding statements summarizing content are present and accurate.	Concluding statements summarizing content are present with rare inaccuracy or missing elements.	Concluding statements summarizing content lack occasional important elements or specificity.	Concluding statements summarizing content have multiple instances of inaccuracies.		Concluding statements are absent.
Content Subtotal						_____ of 175 points
Format Possible Points = 20 points
Text, title page, and references are consistent with APA format.	10 points	9 points	8 points	4 points		0 points
	Text, title page, and references are consistent with APA format.	Text, title page, and references are consistent with APA format, with two to four exceptions.	There are five to seven APA format errors in the text, title page, and reference pages.	There are eight to nine APA format errors in the text, title page, and reference pages		There are more than 10 APA format errors in the text, title page, and reference pages.
Ideas and information from other sources are cited correctly.	10 points	9 points	8 points	4 points		0 points
	Ideas and information from other sources are cited correctly.	Ideas and information from other sources are cited correctly, with two to four exceptions.	Ideas and information from other sources are cited with five to seven errors.	Ideas and information from other sources are cited with eight to nine errors.		Ideas and information from other sources are cited with more than 10 errors.
Grammar Possible Points = 5 points
Rules of grammar, word usage, and punctuation are followed.	5 points	4 points	3 points	2 Points		0 points
	Rules of grammar, word usage, and punctuation are followed.	Rules of grammar, word usage, and punctuation are followed, with two to four exceptions.	Rules of grammar, spelling, word usage, and punctuation are consistent with formal written work, with five to seven exceptions.	Rules of grammar, spelling, word usage, and punctuation are consistent with formal written work, with eight to nine exceptions.		Rules of grammar, spelling, word usage, and punctuation are followed with more than 10 exceptions.
Format Subtotal					_____ of 25 points
Total Points						_____ of 200 points