Appreciative Inquiry and Shared Governance -A Strategic Formula to Enhance Nurse Satisfaction and Decisional Involvement

Purpose:
Positively influence year over year NDNQI RN Satisfaction Survey results using appreciative inquiry and shared governance.

Significance:
Job satisfaction predicts the level of inpatient satisfaction with nursing care (Tzeng, et al, 2001). Shared governance enhances nursing communication and builds positive trusting relationships, empowering the direct caregiver to actively participate in changes to his or her environment.

Strategy and Implementation:
Direct care nurse members of the hospital-wide shared governance council supported by the chief nursing officer created six focus groups based on sub groupings of the NDNQI RN Satisfaction Survey. Each focus group was led by a direct care nurse and facilitated by a clinical nurse specialist. Appreciative inquiry was used to discern current state, future state and a gap analysis to identify areas for improvement and action planning. Each focus group met for six weeks with the intention of developing action plans based on identified gaps. Two to three nurse managers joined each subgroup on week four to assist with strategic action planning. The direct care nurse leaders from each group shared the process and action items with the shared governance council and nurse leadership forum. This shared governance model created a loop of accountable staff from the direct care nurse to the chief nursing officer with the commitment to increase nurse satisfaction.

Evaluation:
Evaluation includes results from the Decisional Involvement Scale survey and the NDNQI RN Satisfaction Survey demonstrating results of this process and its effect on the nursing work environment.

Implications for Practice:
Shared governance and appreciative inquiry are effective evidence- based strategies to increase direct care nurse involvement and nurse satisfaction in complex adaptive systems such as large university hospitals.