Excellence Exchange FAQ

Our organization is trying to decide whether to pursue Pathway to Excellence® (PTE), Magnet®, or both. How do we determine which journey is best for our organization?

That’s a great question and an important strategic decision for the organization. There are many similarities between the two programs. Both programs are grounded in cultural transformation and provide a framework to create environments that support professional nursing practice and excellence in nursing. However, there are important distinctions between the two programs that will need to be taken into consideration such as different standards, eligibility, and data requirements.

PTE focuses on cultivating positive practice environments where nurses flourish whereas Magnet focuses on robust professional practice environments that foster nursing excellence and quality patient care with an emphasis on the impact of the professional nurse (i.e. what difference did it make?).

To better understand the similarities and differences between the two programs, check out this article by Gen Guanci on Which Journey to Take: Pathway to Excellence or Magnet.

Some organizations believe they should do PTE® first and then proceed on a Magnet® journey. This may or may not be in the best interest of the organization. If you would like a copy of our self-assessment tool, What Journey to Take, or would like more information on consultative support for your journey to excellence. please reach out to us at chcm@chcm.com.

Our organization is great about sending clinical staff to conferences. It is an expense the organization is supporting. How do you set expectations for staff to share information they learned at conferences?

This is a great question and one we often receive. A couple of things I would suggest for pre and post conference sharing are:

  • Make sure clinical staff understand the expectations before they go to the conference.
  • Be sure to address dress. If you expect business casual tell them, if jeans are ok, tell them, if athletic shoes are ok, tell them.
  • Include a list of expectations for the conference: daily debriefings, meal expectations, out of pocket expenses, session attendance, etc.
  • If you expect them to present when they get back, give a template of where and when: At UBC, at leadership council, lunch and learn, etc.

Contact us for more information regarding conference information and expectation templates.

Our organization is great about sending clinical staff to conferences. It is an expense the organization is supporting. How do you set expectations for staff to share information they learned at conferences?

This is a great question and one we often receive. A couple of things I would suggest for pre and post conference sharing are:

  • Make sure clinical staff understand the expectations before they go to the conference.
  • Be sure to address dress. If you expect business casual tell them, if jeans are ok, tell them, if athletic shoes are ok, tell them.
  • Include a list of expectations for the conference: daily debriefings, meal expectations, out of pocket expenses, session attendance, etc.
  • If you expect them to present when they get back, give a template of where and when: At UBC, at leadership council, lunch and learn, etc.

Contact us for more information regarding conference information and expectation templates.

A few weeks ago I heard someone say they had Level 3 authority. When I asked, they said it was 1 of 4 different levels of authority that CHCM teaches. Can you please explain?

A: The concept of levels of authority is an essential point we teach with all our shared governance work. difference between participatory management and shared decision-making.

  • Level 1: data/information/idea gathering
  • Level 2: data/information/idea gathering + recommendations
  • Level 3: data/information/idea gathering + recommendations then pausing together feedback, communicate, clarify or negotiate. Only after pausing is action (shared decision-making) done.
  • Level 4: Act and inform others after taking action. ‘Do as I would do’ .‘Act in my absence’

In shared governance organizations the majority of decisions that will be operationalized by clinical nurses should come from Level 3 authority.

What tips do you have to keep our document writing teams engaged and on track?

That’s a great question! Writing the document is a huge endeavor and it’s important to keep all team members engaged, on track, and accountable for getting the work done. This requires good coordination, communication, and project oversight.

First, you’ll want to take time to develop a comprehensive, realistic document creation plan that includes your desired milestones, timeline, and how the work will get done. As part of this plan, you’ll want to think about ways to ensure that those on the writing team have regularly scheduled protected time as well as the tools they need to be successful in their role. Writing buddies, off-site writing locations, and even writing retreats can be great strategies to carve out dedicated time to work on the document. Other things to consider include education for the writing teams and tools and templates that will need to be developed to help standardize and simplify the writing process.

To help keep the teams on track, consider scheduling a routine cadence of accountability, such as Team Accountability Sessions. These are routine, short, focused meetings to review the team’s progress and what assistance, or resources may be needed. These sessions may be held monthly, weekly, or even more frequently during “crunch time” and often have the option to join virtually. These routine sessions provide a valuable opportunity for the MPD or PPD to help clear the path forward and help remove any barriers that may be getting in the way.

Lastly, don’t forget about using a SOE scorecard or tracker to track your progress towards writing the document. This scorecard should be easily accessible to the writing team and updated regularly.

Is it true that Magnet® journey organizations are required to have their transition to practice program(s) accredited by ANCC in order to successfully meet SE11?

Having a nationally accredited transition to practice program is not a Magnet® requirement yet many believe it is beneficial since the document writing requirement is decreased. Currently there are two national accrediting bodies, the American Nurses Credentialing Center (ANCC) and the Commission on Collegiate Nursing Education (CCNE) with a third organization, Accreditation Commission for Education in Nursing (ACEN), currently developing standards for accreditation as well. If your organization has received accreditation in any of the 5 identified categories (new graduate, newly hired experienced nurse, internal transfer to new specialty, new nurse manager, new APN) you can submit your accreditation certificate as your SE11 documentation. If your organization does not have a nationally accredited program, you will be required to write to 3 of the 5 categories mentioned above. Your narratives must describe and demonstrate that your programs meet the 6 elements of transition to practice that facilitate effective transition. Regardless, if you have an accredited program, or write to 3 of the 5 categories, at site visit your appraiser team will validate that you have effective transition to practice programs in place for all 5 categories. 

Our shared governance team feels like we have an issue with timeliness in answering patient call lights, how can we know for sure?

The first step to verifying your concern on your unit is to find the data. Data should be the driver of the work for your shared governance team. All organizations are data rich, it just takes practice to navigate the departments within an organization that may be able to help you.

The following departments/individuals may be able to assist you:

  • Unit Manager

  • Unit Director

  • Patient Experience Officer

  • Quality Department

  • Shared Governance Director

  • Informational Technology Department

  • Environmental services or department that maintains your call light system

  • Call light system vendor

There could be several more individuals within your organization and we would recommend working with your immediate supervisor to begin your quest for data.

What education is needed for an organization implementing shared governance in the organization?

Great question! It is essential to know that there is education involved with implementing shared governance to make implementation successful. Education is needed at the beginning of implementation, further into implementation, and ongoing throughout the life of shared governance in the organization.

Before implementation, basic education on: what shared governance is, what it is not, why it is being implemented, and how it will benefit the organization, the individual, and the patients receiving care in the organization is imperative. Be sure to include leadership, clinical staff, interprofessional partners, especially since they will participate on councils and anyone interested in the process in the education.

Include education that addresses your organization’s specific structures and processes as well, as best practices in shared governance to council members. The best time to do this is before implementation and as changes are made to enhance the structure.

It is important to have an on-going orientation process for new council leaders and new members of councils as people join councils and assume new roles at various times throughout the year.

Ongoing education for all council leaders, (3-4 times a year) has been found to enhance council function and outcomes. Other education may be needed depending on the needs of the organization. It is important to plan what education is needed at the different phases of implementation and the ongoing support that is needed for your shared governance structure to thrive.

Do managers need to attend unit-based council meetings? What is considered the best practice?

To attend or not attend council meetings is a common question, and it really depends on the manager. In some instances, the formal unit leader can attend the meeting and allow the chair to lead the meeting, in other instances it is difficult for the manager to attend and not lead the meeting. In the latter case it may be more beneficial for the leader to attend only the last few minutes as a check in to see if they are needed as a resource, or if resources are needed for a project or initiative. This leader may choose to not attend the meetings at all. 

The key to leadership presence at council meetings is this: they need to know what is happening at the meeting, be available as a resource, coach, or mentor, and they need to provide information as needed. This information may be quality data, strategic priorities, and/or unit goals. All this can be accomplished in a few different ways: 

  • Routine meetings with the chair/co-chair before and/or after the council meeting 

  • Agenda planning collaboratively with the chair/co-chair 

  • Follow up after the meeting  

  • Sharing of quality data to drive the work of the council 

  • Attending the meeting and sitting outside the circle (in the background) 

  • The manager clearly articulating expectations and council members’ clear understanding of Responsibility/Authority/Accountability (RAA) 

These are a few ways the unit leader can be actively involved in the unit council with or without being physically present.

How does shared governance differ in an organization that is seeking Pathway to Excellence® designation versus Magnet® designation?

The short answer is there is no difference. Shared governance is an organizational structure that is put into place regardless of any designations an organization has or is in the process of obtaining. An organization chooses shared governance as a venue for clinical staff to have input into unit level and organizational decision making. It is an opportunity for leaders and staff to come together and make decisions in the best interest of the patient and the organization.  A robust, well-functioning shared governance system provides a setting for creative, collaborative, and thought-provoking solutions to improve practice and the practice setting.

I've heard you often mention the need to "build the business case" when talking about Magnet®, Pathway to Excellence®, and shared governance. What is a business case?

A business case is a data driven, strategic tool that provides justification for something. Wikipedia defines a business case as “a document that defines the core business benefit of a project in order to justify the expenditure of an initiative, project, event, or program”. It’s the “who, what, when, where, and why” of what you are proposing to do. A business case is not the same as a business plan. A business case is narrow in focus and used to convince decision makers to approve an action. It should include why something is needed, the expected results and benefits, the anticipated costs, and any potential risks. It should answer the question, “how does this address our issue?”. A business case is helpful when you need to demonstrate the value of a project or initiative, secure funding/other resources, prioritize competing projects, or obtain executive or board approval. Not all requests need a formal business case. However, if you are proposing something that will take considerable financial or human resources, a business case is a great tool to increase the likelihood that your request will be approved.

One of the questions we've been hearing over and over again recently is, how do we get our councils back on track again?

Many councils stopped meeting during the pandemic and while many clinical nurses are still having a difficult time getting away from patient care, most are beginning to explore ways to get their councils going again.

The first thing to reflect on when restarting your council meetings is to deeply think about the purpose of the council. The council is a venue to bring staff and leaders together to make decisions regarding practice, and the practice environment. With that in mind, begin to consider an agenda that focuses on relevant practice and begin the process of decision making to enhance practice.

1. What is going to work now? Our world and the way we operate in this world has changed drastically, so we should keep that in mind when we restart meetings. We have become very comfortable with virtual meetings and that could be a great way to get started or maybe even continue our council meetings in some cases. Virtual meetings allow people from home and people from the unit to come together despite not being geographically in the same space. You may even consider a hybrid meeting where some members are in person and others are virtual. If that is the case it is very important that people who have joined virtually are on camera and participating in the meeting. From the start, set mutual agreements for engagement in virtual meetings.

2. What time is appropriate for your council? Where once your meetings lasted 2 or 4 hours, now we might have a very specific agenda and the meeting may last an hour. Start small and build your councils back. Start with 2-3 agenda items, be clear on council goals and what decisions need to be made. Then put actions in place to get the work done. Many organizations have designated a shared governance day where many council meetings are held on the same day. Having meetings on the same day allows members to plan ahead of time and be able to attend the meetings. Having meetings on the same day may also allow for time, on that day, outside of meeting to get council work done.

What is the leader's role in supporting shared governance councils?

A well-enculturated shared governance model requires continuous evaluation, support, and improvement. Both leaders and staff serve distinct and important roles in this process to ensure the success of shared governance.  The leader’s role is to set and communicate clear guidelines around council decisions (Responsibility, Authority, and Accountability), coach and mentor council members, and foster a culture of accountability.  Leaders help councils function effectively without taking charge.  

Fundamental roles for leaders in shared governance include:

  • Serve as a resource for clinical staff  

  • Inspire and affirm council work 

  • Coach and mentor council members  

  • Ensure paid, protected time for council work 

  • Support chairs in agenda development  

  • Provide tools to complete projects  

  • Manage conflict 

  • Clearly articulate expectations 

If council decisions are not supported, pause to reflect on the following questions:  

  • Was the decision within the scope of the council? (practice, the practice environment, or professional practice) 

  • Were the guidelines of the decision clearly articulated? For example, if the council is asked to select a new bed alarm, budget and vendor parameters must be clearly articulated and understood.  

  • If not, did the council ask for this information before making a decision?  

It is important for leaders to clearly articulate the responsibility, authority, and accountability for decisions of the council. If the council does not receive clear information, it is the responsibility of the council to ask for it. If boundaries are not clearly defined it leads to confusion as to who makes what decisions, which discourages and derails shared decision-making. If decisions are made within the articulated boundaries, the leader’s role is then to support the decision. It is important to provide education for both leaders and staff regarding their role and expectations in shared governance.  

What is the difference between a charter and bylaws?

Bylaws serve as the “rules” or “blueprint” of shared governance in your organization. At a minimum, one set of bylaws oversee the shared governance model. The bylaws outline the purpose of shared governance, the purpose of each council and the function of the councils. Bylaws include membership (roles, not names), term limits, expectations, meeting times, ground rules, and the decision-making model.  

The charter is a set of guidelines based on the bylaws that states the individual council’s purpose, membership, guiding principles, responsibilities, and goals. Some organizations choose to combine these into one document; some may use different terminology. Keep in mind that shared governance is not a one-size-fits-all approach and should be tailored to meet the unique needs of the organization.  

Both bylaws and charters should be reviewed annually and amended, as necessary.

We currently collect a lot of data manually. What suggestions do you have for overcoming barriers to data collection?

This is a great question and a common challenge. Data should serve as the driver for decisions at all levels of the organization, so it is crucial that data collection structures and processes are accurate, user-friendly, efficient, and timely. To help overcome barriers, start with an assessment to better understand your current data collection structures and processes including existing data sources (where does the data come from), collection procedures (how do we get the data), internal and external databases (where is the data reported and what information does the database provide), reporting requirements (internal and external), definitions (what definitions are we using), and the end-users of the data (who receives the information, how do they receive it, what is the format, what do they do with the data, do they understand how to interpret the data etc.).

This assessment will help you better understand what is working well, the pain points, any overlaps or redundancies, available resources, and where to focus your efforts. Look for any opportunities to automate and integrate data collection into your existing systems such as automated collection from electronic health records, event reporting systems, HR databases, etc. Ensure that event reporting systems are user-friendly, non-punitive, capture the data you need, and align with the definitions used by your databases. If you find that additional resources are needed, develop a business case for why the resource is needed and the value to the organization, patients, and staff.

We are just getting started developing our shared governance structure and I wonder what suggestions do you have on what organization level councils we should consider?

The goal when just getting started is to be sure you set yourselves up for success. If you have too many councils, the organization could quickly become overwhelmed and not be able to support or manage all of them. Many organizations start out with 3-4 organization level councils. Initially, these council are nursing focused, with the goal of becoming interprofessional, and all report to a centralized coordinating type council.

These include: 

  • Nursing Practice Council which defines the practice of nursing at your organization. 

  • Nursing Quality Council which has the authority and accountability for continually improving the quality of the nursing care delivered and monitoring patient outcomes.   

  • Nursing Research and Evidence-Based Practice Council which is charged with advancing professional practice through scientific inquiry, use of evidence-based practice, and completion of nursing research studies. 

  • Nursing Professional Development Council which promotes life-long learning, supports the retention and recruitment of nursing staff, coordinates the nurse recognition annual celebration, and maintains the organization’s professional advancement program while promoting the professional image of nursing. 

As an organization matures in shared governance, councils could be enhanced through expansion such as becoming interprofessional in nature, merged such as combining Practice and Quality into one council, or added to such as an Informatics Council.

How do we get nurses involved in committees/councils?

The answer to this question is multifaceted. We’ll address several important factors: 

  1. Make committee/council work important, relevant, and worthwhile in your organization. Get feedback from staff as to what practice issues are important to them. What practices would they like to change? What new practices would they like to implement? 

  2. Provide protected time for meetings. Meetings should not be cancelled routinely, and staff should be allowed time off to attend or are relieved of duties (if working) to attend. 

  3. Make sure the work of the council is the venue for decision making regarding practice, and that decisions made in the councils (if guardrails are followed) get put into practice.  

  4. Make sure there is an understanding of Responsibility, Authority, and Accountability (RAA) from both leaders and staff. Council members need to understand and accept responsibility for making decisions. They need to have authority (what are they authorized to make decisions about?) And they need to have accountability (making sure there is proper follow through and evaluation of decisions for effectiveness.) 

  5. Incentives are a great way to get nurses involved in committees/councils. Many organizations give points/assign credit to their professional career advancement programs/career ladders for members of councils.