JMC Model for Shared Governance/Shared Decision Making

Shared Decision Structure of the Professional Nursing Staff

The Jupiter Medical Center shared decision structure recognizes participation from all professional nursing staff members and demonstrates shared decision making within the formal structure of nursing. All decisions of each council are made through consensus of the membership.

 

Shared Decision Making Councils-Organizational Level

There are six organization-wide shared decision making councils within the Professional Nursing Service.

They include:

  • Nursing Leadership Council
  • Quality Practice Council
  • Clinical Practice Council
  • Informatics and Innovation Council
  • Nursing Research Council
  • Coordinating Council
  • Professional Development and Recruitment  Council
  • SAGE Nursing Committee
  • Magnet Champions

Membership in these Nursing Councils is comprised of one (1) Representative from each service area. Nursing Services areas include:  Emergency Services, Oncology/Medical Services, Surgical Services, Telemetry, Surgical Unit, Critical Care, Obstetrics, Ambulatory /Clinical Services.
(Ambulatory- Radiation Oncology, Occupational  Health, Cardiac  Rehab, Women’s Services, Oncology Research, Foshay Cancer Center, Bariatrics, and Wound Care) Clinical Services PICC GI, Interventional Radiology, Nursing Administration, Pain and Case Managers).  

Consensus membership shall not exceed nine members including Chairpersons except in the situation where a staff nurse member who is chairperson of a committee transfers to another department. In this case the chairperson may serve out the elected term and a new representative from the unit no longer represented will be chosen.  A Nursing Director and/or Clinical Nurse Educator, as appropriate, may act as council advisor.

 

Shared Decision Making Councils-Unit Level

All clinical units that provide nursing care will have a Unit Based Council. Membership on these councils will include at least five-seven members of the unit staff.

 

Components of Shared Decision Making Councils/ Governance Functions of the Professional Nursing Service.

(These functions provide clinically safe quality nursing care to the patient based on the Nursing Process (Assessment, Planning, Intervention, and Evaluation).

Shared Decision Making Function I:  Nursing Practice
Components:
  • Assessment: An individual nurse-patient-physician relationship is entered into upon admission assessment with a specific understanding of the plan of care. Nursing reassessment and reprioritization of the plan is ongoing.
  • Planning: A multidisciplinary plan of care is developed and organized in the problem oriented format with measurable outcomes identified. The professional nurse is accountable to the patient for the plan of nursing care.
  • Intervention: Specifics of care are identified and implemented in collaboration with other health professionals.
  • Evaluation: The nursing performance improvement process evaluates that nursing care provided has met the goals identified in the nursing plan of care.


  © Jupiter Medical Center

Shared Decision Making Function II:  Planning

To maintain an ongoing planning system that ensures effective use of resources in meeting short and long term objectives and is supportive and consistent with the strategic plan of Jupiter Medical Center and its professional nursing service.

Components:
  • All planning includes clearly identified objectives and standards utilizing available information.
  • Long term plans reflect the long term objectives of the hospital and professional nursing service identified through forecasting mechanisms, outlining advances in nursing practice and technology, and changing social conditions.
  • Planning is based on accurate projections of personnel, materials, and financial resources prior to each fiscal year.  Plans are reviewed quarterly and revised as necessary, with consideration toward achieving objectives.  Outcomes and evidence based nursing practice is considered in the planning process.
  • Operating and Capital budgets are planned for each fiscal year a collaborative approach with nursing, executive and physician leadership prior to approval by senior management and the Board of Trustees.
Shared Decision Making Function III:  Leading

The goal of this function is to maintain a working environment that encourages professional growth through nursing research, education, and practice, resulting in clinically safe, quality nursing care and personal satisfaction for nurses.

Components:
  • Decisions are made at each level of accountability in the organization utilizing the shared decision making model.
  • The Director/Manager of the individual department as a member of the Nursing Leadership Council is ultimately responsible for the nursing management activities and personnel in her/his department and is accountable to the Chief Nursing Officer.
  • Individual nurses are directly accountable to the patient for the nursing care they render in accordance with the objectives of the professional nursing organization, Clinical Practice Council, the individual department, and the mission of the medical center.
  • Each nursing department maintains an ongoing in-service education program, in conjunction with Professional Development Council, designed to meet the educational needs of the nursing staff.
  • All nursing research conducted in the professional nursing organization is coordinated through the Nursing Research Council.  Such research is designed and conducted without adversely affecting individual nursing care.
  • Information management is an important part of quality care. All aspects of documentation are coordinated through the Informatics Council to ensure compliance with regulatory agencies
  • All positions in the professional nursing organization are filled by the most qualified candidates available who meet the criteria and objectives for the position, regardless of any other factor.
  • Performance appraisal is an ongoing process with individuals evaluated with identified position criteria and departmental objectives. The professional nurse is appraised with input from their peers for her/his clinical practice, utilizing developed standards of nursing performance.
Shared Decision Making Function IV:  Organizing

The goal of this function is to organize work in order to promote effectiveness in delivering nursing care and assure personal satisfaction.

Components:
  • The organizational chart reflects professional relationships as well as the communicating mechanisms. 
  • Decisions are made by those most directly involved utilizing the appropriate resources.
  • Position descriptions and objectives are maintained for all nursing positions in order to facilitate services in the most efficient manner.
  • Patterns of organizational structure are reviewed and updated at least annually to accurately reflect actual organization and communication mechanisms.
  • The structure of  professional nursing within Jupiter Medical Center  represents a commitment to shared decision making and the tenets of the ANCC Magnet Recognition program

Shared Decision Making Function V:  Evaluating

The goal of this function is to evaluate the performance and delivery of professional nursing care at any site in the organization where nursing care is provided.

Components:
  • A performance assessment and improvement program is undertaken at all levels of the professional nursing organization. This program will be individualized for each unit based on the priorities that are identified in the unit’s Framework for the Delivery of Patient Care.
  • Specific elements to be incorporated in the performance assessment and improvement program include, but are not limited to: nursing sensitive quality indicator data from the NDNQI database, The Joint Commission standards, the National Patient Safety Goals, CMS Core Measures and each nursing unit’s “Performance Measures” as well as results of tracer activity
  • When possible, performance measures that are interdisciplinary in focus should be considered and/or included.