University of Virginia Health System

All RNs employed by the UVA Medical Center, School of Nursing and School of Medicine are automatically members of the Professional Nursing Staff Organization, and have the opportunity to actively engage in the shared governance of the practice of nursing at UVAHS.

The Professional Nursing Staff Organization has been evolving since the mid-1980's. In the early '80's, UVAHS Nursing followed a traditional administrative structure in which decisionmaking cascaded down through layers of nursing directors. Nurse leaders at UVAHS began to explore alternative models that would facilitate grass-roots participation in decisionmaking and nursing autonomy. A peer-driven Clinical Career Ladder, founded on Patricia Benner's "from novice to expert" principles, was launched in 1987, and between 1988 and 1991, the first phases of a shared governance model for nursing were implemented.

The first President of the PNSO was elected in 1991. The roles of the President and President-elect became even more important to the shared governance of nursing, in collaboration with the Chief Nursing Officer, as UVAHS reorganized into a "service-center" model which decentralized the previous division of nursing.

To facilitate the decisionmaking representation of so many diverse nursing practice areas, the first Nursing Cabinet was convened in 1996.

Additional opportunities for direct-care nurses and nursing leaders to engage in professional development, networking and shared decisionmaking were offered with the initiation of two semi-annual events in 1999, Leadership Forums and Nursing Assemblies.  

The PNSO Bylaws, core guiding principles for the operation of the PNSO, were first adopted by the membership in 2000, with annual opportunities for members to consider amendments. The Bylaws define the four core missions of the PNSO -- shared governance, clinical practice, professional development, and nursing research -- and provide direct guidance for the key structures and programs through which the PNSO pursues these missions on behalf of UVA nurses.

To further broaden the representative aspects of our shared governance model, the first Nursing Congress was convened in 2001; fifty-six peer-elected representatives engaged in a day of continuing education and planning, with the intent of defining the agenda for the 2002 Nursing Cabinet.

A re-evaluation and restructuring of the Clinical Career Ladder took place in 2002 to address changes in both the Health System and the state of nursing nationwide, particularly regarding advanced practice roles. Now, in 2006, another re-evaluation is underway, again addressing the evolving needs of UVAHS nurses and practice settings, based on feedback from direct care nurses.

In 2003, the Office of Nursing Governance Programs was formed to provide coordination and infrastructure support for nursing-related initiatives, both in the PNSO and in the larger Health System community. A Director and a Manager of Nursing Governance Programs are dedicated to facilitating these infrastructure improvements for nurses across UVAHS.

In 2004, the PNSO prioritized the goal to develop and evaluate new models of professional development and continuing education to advance nursing knowledge. One strategy was to design and operationalize a Nursing Research Program to enrich nursing knowledge and streamline the research process. The goal of the Research Program is to create an institutional milieu that encourages and supports clinical inquiry and evidence-based nursing practice.

Our shared governance model is not limited to nursing autonomy. The PNSO also advocates on behalf of Nursing and sharing the nursing perspective in broader interdisciplinary and institutional decisionmaking venues. Dr. Cipriano, 2006 President Lisa Forsyth, 2006 President-elect Sharon Bragg, and many nurses at all levels of the organization participate in strategic planning and interdisciplinary governance groups. Such groups as the Clinical Staff Executive Committee (CSEC), Patient Care Committee, Decade Plan Committees, Quality Council, Computer Services Oversight Committee, Parking & Transportation Committee, and numerous others; nurses' involvement has a direct impact on our collective work environment and the excellence of care provided at UVAHS. 

The PNSO continues to be a vital, growing entity at UVAHS, always pursuing better ways to address the needs of our members and our patients. Direct care nurses provide improvement suggestions anytime by contacting the PNSO Office or Dr. Cipriano, their Nursing Cabinet member or Nursing Congress Delegate, or their network of representatives on our various committees. Nurses also provide essential feedback via the annual Nursing Worklife Survey; trends from this data are closely analyzed and shared with all nurses, and both Congress and Cabinet use this data to guide and prioritize their activities.

Reference: For more information on the history and evolution of UVA's Professional Nursing Staff Organization, please see "Sharing Governance" by Pamela F. Cipriano, PhD, RN, FAAN, and Terry Lucas, MSN, RN, Advance For Nurses (Maryland/DC/Virginia edition), May 26, 2003.